New diagnosis??? Grace, and/or anyone, please help.

[Say_it_aint_so]

After ending a 3 year, monogomous relationship in Sept 2007, I had a thorough STD screening which showed that I was HSV Type 1 positive.  An HSV 1/2 IgG, Herpeselect Type Specific test was done.  The results were positive for HSV Type 1:    3.82  and negative for HSV Type 2:   0.23.  After speaking with my ex, he stated he had also been recently tested and was also HSV Type 1 positive and HSV Type 2 negative.

In late November, I unfortunately had unprotected sex with someone whom I had actually known for several years.  This person assured me that they tested often for STD's and that the results were always negative.  We decided to be monogamous and were together until recently when it came to light that he may have been sexually intimate with more than one other person besides me.  This relationship is over now.

I was re-tested on Feb 25, 2008 using the same method.  This time my doctor did not test for HSV Type 1, but the HSV Type 2 came back at 1.30 High.  This particular lab's range for high is anything over 1.09.

My doctor stated that I could be sure that I contracted HSV Type 2 from my most recent partner since I was negative when I tested back in November.  After speaking with my former partner of 3 years, he recommended I connect with you here on this site.  He is still HSV Type 2 negative having had recent testing also.

Can you please tell me if there is anything else that I can do at this point to know with certainty that this is an accurate diagnosis?  Should I wait and re-test after some time?  How can I get a Western Blot test or any other more specific testing that can be done?

As far as symptoms or outbreaks, I have had none, not even a cold sore, ever.  Besides my recent stupid behavior, I am generally very happy to have been an extremely healthy person and needless to say am devastated by the prospect of having genital herpes.

My doctor is very helpful and willing to do whatever is needed.  Please help.  Thankyou!

[H. Hunter Handsfield, M.D.]

There is at least a 50:50 chance that you do NOT have HSV-2.  Among people who have antibody to HSV-1 by HerpeSelect, and whose HSV-2 result gives an ELISA ratio between 1.1 and 3.5, about half the time the HSV-2 result is false positive. Your doctor probably doesn't know this, so it isn't his fault; this is a research result from only a single study and has not been widely publicized.  But most experts consider the research valid.

The fact that you had no symptoms of genital herpes during or following your more recent partnership is further evidence.  Although it is true that completely asymptomatic infection with HSV-2 is possible, most people who are concerned and on the lookout would in fact notice at least some symptoms.  So considering all the facts, I'm pretty certain you don't have it.

What to do?  First, repeat the HerpeSelect yet again.  If the HSV-2 result is again below 1.1, as I'm betting it will be, you're home free.  Second, have another HSV-2 blood test with a different method, such as the Captia HSV-2 test, produced by Trinity Biotech; or a BiokitUSA test, which your doctor can do in the office while you wait.  (A little research could find a lab that does the Trinity test, or your doc's office can order a single BiokitUSA test from his/her office lab supply company.)  (You could do both the repeat HerpeSelect and the other test at the same time, if you wish.)  Herpes expert diagnosticians know that a second test, by a different manufacturer, usually is an effective tie-breaker.

Finally, if all that fails to sort things out, ask your doc to send blood to the University of Washington clinical lab in Seattle for an HSV Western blot test.  WB is the gold standard for sorting out confusing HSV-2 test results.

You might consider printing this out for your doc.  If s/he wants to search the medical literature about all this, a good starting point is work by Drs. Rhoda Morrow and Anna Wald, University of Washington.

I hope this helps. In the meantime, don't be too worried.  I'm betting you don't have it.  Best wishes.

HHH, MD

[Say_it_aint_so]

Thank you so much.  Actually, my HSV2 result was 1.3, not 1.1.  Not much of a difference I know, yet I have no idea whether it makes a difference here.  This is what I needed to get a definitive answer.  Again, thank you.  I could cry from the relief!

[H. Hunter Handsfield, M.D.]

Doesn't make any difference.  I wouldn't call my answer "definitive", but relief is appropriate while you pursue the additional testing.

[Say_it_aint_so]

Getting worked up over a "what if" can only increase stress and make things worse, so I am keeping calm.  Follow-up testing is scheduled for June, which I think will be enough time(about 4.5 months) from the last sexual encounter with my partner.  I will be having the Western Blot and the Biokit HSV 2 Rapid test at that time.  May be going a little overboard, but that's ok with me to be sure ;-)  Also, I have had a very tiny, round cyst-like structure grow on the lower inside(teeth level) of my lower lip which, when squeezed oozes a clear, somewhat sticky substance.  It has occurred in the same spot and once squeezed, goes away without any marks.  There is no pain or ulceration associated with it.  So far, it has come up twice in the last 3 weeks.  I've never had anything like this before or any HSV 1 symptoms like cold sores and am wondering if this could be it.  Any ideas?

[H. Hunter Handsfield, M.D.]

Definitely not herpes.  Otherwise I have no opinion.  See a provider.

Time to end this thread.

[Say_it_aint_so]

Thank you for all of your help and responses.