hsv confusing results

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Thank you for taking the time to answer my question. After learning my girlfriend cheated on me throughout our 2yr relationship, I decided to get a full std work up. The assistant suggested an hsv test though I mentioned I have never seen any symptoms.The doctor informed me that i had exposure to both hsv 1 & 2. The lab report says as follows: Hsv 1 igm non reactive, hsv 2 igm non reactive, hsv 1 igg reactive, hsv 2 igg reactive. Upon calling the lab, I was informed that my #s were 1.53 for type1 & .71 for type 2. I asked for the O/D or elisa ratio & was informed that the " cutoffs" were .45 for type 1 & .44 for type 2. Supposedly I had the head clinician who could not name the test used other than to say it was called" diagnosis of hsv infection & diffrention of 1 from 2. And it was a clinical utilities differention." What is your opionion? Thank you for your wonderfull work & time.

[H. Hunter Handsfield, M.D.]

Your doc probably was thinking about lymphogranuloma venereum (LGV), but that kind of chlamydial infection is vanishingly rare in the US.  It has recently made something of a reappearance, but so far only in a few gay men with rectal infections.  In 30+ years in a busy STD clinic, I have seen exactly one case of classical LGV.  In any case, I cannot solve the problem with that misdiagnosis or the costs associated with it.  If there was a component of lymph node enlargement/inflammation in addition to the hernia, herpes is a more likely cause than chlamydia/LGV.  But I cannot say whether that episode has anything to do with your confusing HSV blood test results.

I'm very familiar with Focus Technologies but  haven't a clue what "Packard" means.  The best I can do is repeat my advice above about retesting; or to seek another opinion, perhaps from an infectious diseases specialist, to interpret the current lab test results and perhaps to recommend additional testing.

Sorry, but that's the best I can do.

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I had my blood drawn at an std clinic in South Florida. The lab that did it is in Miami. After numerous conversations with the lab, they refered me to a place that uses the Focus/Packard kit. The lab will have no further communication with me. I should mention that my Dr. initially diagnosed me with chlamydia due to swollen lymph nodes. My  report came back negative for this and my swollen nodes turned out to be a hernia. Additionally, my Dr. said I was not infected, just exposed & that I need not discuss the hsv results with any partners as I was not contagious.I have learned that this is false. Obviouslly I am dealing with people who are not well informed or are running a medication mill as I have invested over $800.00 in tests & antibiotics for non-existant chlamydia. Does this update change your opinion on my hsv results/test?  ps I have not tested with the lab I was referred to at this time  Thank you!

[H. Hunter Handsfield, M.D.]

It seems you have had an HSV blood test that I'm not familiar with.  With the most commonly used test (Focus), the OD ratio cutoff would be around 1.0 and your results would be positive for HSV-1 and negative for HSV-2.  But if the cut-offs were really as you describe, apparently the results are positive for both viruses.  Perhaps you had the Trinity Biotech test or, if you're in a commonwealth country, the Kalon company's test, and I don't have direct experience with them.  For Focus, low-positive HSV-2 results sometimes are falsely positive.  But to my knowledge that issue has never been studied for other commercial tests.

The way to sort this out is to either get further clarification from your provider or the laboratory; or to have repeat testing, perhaps this time with the Focus HerpeSelect test.  (If you're in the US and a specimen goes to one of the two major national labs, Quest or LabCorp, the Focus test will be done.)  Or go straight to the official tie-breaker test, an HSV Western blot; your local lab would have to send a specimen to the University of Washington lab in Seattle.  It's expensive, though.

Good luck--  HHH, MD