positive, negative, and equivocal results in pregnancy

[beck422]

First off, some background: I'm 37 wks pregnant, married to the same man for 3.5 years and we've been together for 8.  I've had sex (protected) one other time when I was 16.  Husband has had no other partners, and there is absolutely no question of infidelity.  I have never had any symptoms of herpes.  I work in the health care profession with children.  Around 24 wks I had a Torch-Titre done b/c there was a chance that I was exposed to Coxsackie.  The results came back negative for Coxsackie, positive for CMV (Dr. said it was a previous exposure), and positive for herpes (I understand now that the CMV is a type of herpes, and there could have been some cross-reactivity).  We did an IGm/IGg test twice to type the herpes.  According to the dr., it was typed as HSV-II and was a recent exposure.  However, after doing some research we have learned that this type of test is not great for determining type or time-frame.  We asked our doctor to have the HerpesSelect test done at 32 wks.  Those results came back negative for both types.  To be safe, we performed another Select test at 36 wks and those results were equivocal for type II and negative for type I (we don't know the actual numbers).

All of this came as a big surprise, b/c I don't have any risk factors and have never had any symptoms.  We only found this b/c of the Coxsackie issue.  

1)I've read that the original antibody tests can be discounted for a number of reasons, but what could explain going from negative to equivocal on the Select test?  

2)Is it likely that it is an old exposure from that first encounter, even thought I've gone 10 years with NO symptoms? (my husband has never been tested, but he's never had symptoms either)

3)Could it be a new non-sexual exposure since I've become pregnant? (HSV II in oral cavity from patient saliva, kissing, drooling, etc.)

4)Could I have contracted it in the last month, causing an equivocal result to show up now? (again, but how?)  

I'm looking for some sound, experienced advice b/c my doctor doesn't have much experience with this and is just as baffled as we are.  I'm concerned for the health of my baby, but we don't have enough time to do another Select test before she's born. Dr. started me on antiviral therapy to be safe, but will that make a vaginal delivery any safer, if I don't even have symptoms (asymptomatic shedding?????)

Thank you for any help you can provide...

[H. Hunter Handsfield, M.D.]

Given your and your husband's sexual histories, and the test results, you can rest assured you are not infected with HSV-2.  I cannot explain the difference between a negative and equivocal HerpeSelect result, but most equivocals in fact are negative.  (I could interpret it better if you could provide the missiing optical density numbers.)  It seems almost certain the initial tests were falsely positive; as you already learned, the older, non-type-specific tests are simply unreliable.

That already touches on most of your specific questions.  1) No clear explanation, but you're probalby in fact negative.  If you wish, still another repeat HerpeSelect test might sort it out furter.  2) Certainly genital HSV-2 infections can go 10 years without symptoms.  But that seems an unlikely explanation in your case.  3) HSV-2 simply is not acquired through non-sexual routes, except by transmission to newborns from their infected mothers.  4) Conceivably the equivocal HSV-2 result reflects recent infection, but this is not possible if your and your husband's sexual histories are accurate.  But if you have any doubt about that, you could be retested; if your test becomes definitely positive, you and your husband would have to address the source.

I hope that helps.  Sorry the answers cannot be more clear.  Best wishes--  HHH, MD