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false positive
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false positive

n 2006 I had an HSV 1 and 2 IgG test which came up 0.3 and 0.6 respectively and negative for IgM.

About a couple of month ago I start getting like two or three small pimp-like dots on the outer area of my penis and the shaft.  Keep in mind that I completely shave with a razor in my pubic area, but I’ve been doing it for years without any ingrown hairs (look alike).  So being freaked out I went to the emergency room and the doctor (MD not a resident or PA) told me it was nothing.  I never felt them coming, there was no aura of any sort, and no pain they came and mostly I would scratch them off and they just bleed no puss or crust formation.  Still freaking out I went to my regular doctor for a follow up and got tested for everything.  My new results were different this time the numbers had increase:
HSV 1 AB, IgG 1.4
HSV 2 AB IgG 1.3    anything greater than 1 is a positive

Recap: no signs or symptoms except of possible new ingrown hairs now developing and i've never had a cold sore on my mouth ever.
What’s the chance that this can be a false positive?
Are low numbers correlated to a decrease change of outbreaks and spreading?

Sorry I know it’s a lot but I’m freaking out
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239123_tn?1267651214
Welcome to the STD forum.

Your test results are giving mixed messages, but most likely you do not have genital herpes.  You don't say exactly which HSV blood test was done.  But HerpeSelect (by Focus Technologies) is the most commonly used in the US.  With that test, technically any EIA ratio over 1.1 is positive, but only values of 3.5 and higher are definitive.  At the low numbers you report, probably only about 20-30% actually are infected -- and with the weakly positive HSV-1 result, it is even more likely your HSV-2 result is false.  The penile lesions you describe don't sound much like herpes either.

You can sort out the blood test result in a various ways.  You could just be re-tested; if you have a definitively negative HSV-2 result (EIA ratio under 0.9) you can rely on it.  Or you could ask your provider to request an ELISA inhibition assay on the current specimen, if the lab still has it in hand.  However, not all labs do that test.  Or you could have another test by a different manufacturer.  For example, if HerpeSelect/Focus was done first time, you could have a repeat by the BiokitUSA test (done in a few minutes in the provider's office), or find a lab to do the Captia test (provided by Trinity Biotech company).  Finally, you could have a blood specimen sent to the University of Washington clinical lab in Seattle for an HSV Western blot test, which is the ultimate gold standard for HSV blood tests.  However, WB is the most expensive and least likely to be covered by your medical insurance.

So the specific answers are that most likely your test is false positive, i.e. you don't have HSV-2.  It's harder to judge about HSV-1, since less research has been done about low-positive results.  But my guess is you don't have that virus either.  

If your HSV-2 result is truly positive -- i.e. confirmed by one of the other tests I recommended -- the numerical level says nothing about how active the infection is, whether or not you will have outbreaks, etc.  Regardless of the exact number, all positive results mean exactly the same thing:  the person is infected with HSV-2 and may or may not have symptomatic outbreaks.

By the way, don't have another IgM test.  Those results are always misleading.  Only the IgG results matter.  This has been discussed many times on this forum; use the search link to see lots of threads about it.  

Feel free to post the results of confirmatory testing if you decide to have it done. In the meantime, don't worry too much about this.  Most likely you don't have it.

Good luck--  HHH, MD
8 Comments
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Avatar_m_tn
thanks for all the help.  I called the lab and they told me it was a ELISA test. If I had this test done is there still a small change that its a false positive; or because of this specific testing should just accept the results?

thanks again
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Avatar_m_tn
thanks again i'm going tomorrow to get a western blot test, I'll let you know the result if you're still reading the thread.....how you're right Doc
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239123_tn?1267651214
ELISA is the standard method for IgG HSV antibody testing.  A Western blot won't help and will be a waste of money.  WB takes longer to turn positive than ELISA and never should be done until at least 3-4 months after the last possible exposure.  Since your IgG ELISA is negative for HSV-2, for sure your WB will be negative as well.  Just wait a while and have another IgG ELISA test.
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Avatar_m_tn
Thanks for the response you've been a great help! but I already took it this  morning.  My hsv igg elisa was 1.3 which was reported positive. I've read a lot of your forums and you said you think its a false positive adding my low hsv 1 result but I thought I was to re check..its still ok thou because last possible exposure was about a year ago....sorry I got confused..so if a do get a negitive result back o can trust that?  Confused
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239123_tn?1267651214
A negative WB will confirm that your current HSV-2 ELISA result is false positive.  However, a negative HSV-2 test of any time cannot be considered definitive until at least 3-4 months after the last possible exposure or onset of symptoms.  From your description, I doubt very much that the penile lesions you describe above are due to herpes -- and I would have recommended against any testing at all in this circumstance.  But if you want 100% assurance, you have no choice but to have another blood test (preferably an IgG ELISA, not WB) 3 months or more after you noticed the penile lesions.

If your current WB in fact is positive -- which as I said is doubtful -- please add a comment to let me know.  Otherwise, that should end this thread.
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Avatar_m_tn
sorry to bother you but I just got my results back and its positive for hsv 1 and negitive for hsv 2. Then it say seroconvertion can take up to 8-12 weeks which you said but last possible exposure was over a year ago.  So I can safely say negitive to hsv2? Ps my penile lesion when I pop them they bleed blood. And I can take a pic if need.....thanks again and I'm sorry to bother yiu
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239123_tn?1267651214
The test results prove you don't have HSV-2 or genital herpes; and herpes lesions do not behave the way you describe.  It sounds like folliculitis or acne.  We don't look at posted photos on this forum; you'll need to see a provider in person if you want a more definitive diagnosis.  But as for herpes, just let it go.  Time to move on.

That's all for this thread.  No more comments, please.
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