I am on the verge of a nervous breakdown, PLEASE HELP!

[DepressedGirl]

Hello Doctor,
I'd like to thank you for providing so much help to all of us who can't go on with our lives just thinking of HSV 2.  My situation is the following:  I had unprotected sex 3 TIMES with an ex boyfriend of mine (his HSV 2 status is unknown until this day) and I know that he has slept around with many women w/o a condom FOR A FACT.  I did wait for my 12 week mark to get tested for HSV 2 so my dillema is the following:

1) February 7th of '08- my last UNPROTECTED encounter w/ ex boyfriend (ugh I can't believe I was so stupid)
2) May 6th of '08 (3 month mark- HSV 2 IGG, Type Specific Results:  <0.9 NEGATIVE)- **these tests were both done through LabCorp and Quest Diagnosis - both showed negative results
3) Since I'm a PSYCHO and always need reassurance I decided to test again on 7/09 and this is where I am driving myself nuts because of the nature of the results (This second HSV 2 test was done only through LabCorp):

HSV Type 2-Specific Ab, IgG
HSV 2 IgG, Type Spec    1.74  High   Inded 0.00-0.90

Does this mean that I'm HSV II Positive? My general doctor suggested that these results were not CLEAR CUT and that it was INCONCLUSIVE and more so that If I have not developed any visible symptoms that I am COMPLETELY FINE (he also mentioned that he's not content with LabCorps interpretations).  At this point, I have made another appointment with my gynecologist to have a second test done to CONFIRM whether I'm positive or negative for genital herpes. Do you have any suggestions/opinions? Should I have been content with my initial HSV Type 2 specific NEGATIVE results at the 3 month mark?  NOTE:  I am HSV 1 Positive which drives me to believe that it can be a false positive after reading your many posts regarding the HERPESSELECT tests.

Your help will be greatly appreciated Doctor! I JUST NEED SOME PEACE OF MIND SINCE I HAVE NOT ATE IN ALMOST 3 DAYS JUST THINKING ABOUT THIS.

[Edward W Hook, MD]

You seem to be in a cycle in which you allow your concerns feed on themselves to make yourself worry more and more.  This is likely to be the cause of your problems, not herpes.  You already know what I am about to tell you.  I will say it once- not more:

1.  You are low risk
2.  You do not know that your ex-BF has herpes.  Half of persons who have had over 50 sex partners DO NOT have herpes.
3.  You have had NO clinical events to sugest that you have acquired herpes.  Most people who miss the diagnosis do so because they attribute their outbreak to other causes, not becase there is not an outbreak.  I doubt that you would miss an outbreak.
4.  Most exposures to infected persons with herpes do do result in herpes transmission.
5.  Your repeat test remains a "low positive"
6.  Your risk of a false positive in increased because you already have HSV-1
7.  The more you test, the more likely you are to have a false positive test result.  Your anxiety over herpes will increase your risk of a FALSE POSITVE test through UNWARRANTED testing.

Is there a chance you are in the process of developing herpes- yes.  Is it likely that that is what is happening -no.

Please try to get your anxiety under control.  It is hurting  you.  Even if you do have herpes (again, VERY  unlikely) that is not the end of the world.  One out of five Americans has herpes and the disease has very good therapy.  EWH

[DepressedGirl]

Doctor,
The reason why I was so freaked out initially when I first tested for HSV II is because I had a minor CUT on my vagina near my anus once (I hear that herpes can manifest as cuts as well- is this true?).  But after I rec'd the negative results I was confident that I was fine but THEN I see another cut (now on my inner labia and this is when I had my herpes nightmare back).  Can you please explain further what you mean by this:

4.  Most exposures to infected persons with herpes do result in herpes transmission

7.  The more you test, the more likely you are to have a false positive test result.  Your anxiety over herpes wil increase your risk of a FALSE POSITIVE test trhough UNWARRANTED testing.

Doc, would you suggest that I get tested once again (even after my initial HSV 2 negative results?)

Also what does this mean:
HSV 1 IgM, IFA <1:20
HSV 2 IgM, IFA <1:20

Antibodies not detected.

I SWEAR I WILL LEAVE YOU ALONE AFTER THESE QUESTIONS.

THANKS AND GOD BLESS YOU FOR HAVING MERCY OVER THIS POOR SOUL.

[Edward W Hook, MD]

4.  Just what I said.  On average, people with herpes have the virus present in the area of their infection a little over 10% of the time.  This is called asymptomatic shedding and is the cause of most herpes transmission.  At the same time, numerous studies indicate that even with virus present the partners do not get infected following exposure.  By way of example, think of how often you have been in contact with people who have the flu or colds but do not get them.

7.  False posiive tests can occur for a lot of inidvidual reasons and day-to-day variation in test performance.  The more you test, the more likely you are to get a false positive test.     Think of it this way - if you have a test that gives false positive results 1% of the time  (this is an example,only, most tests have far lower rates of false positves) and you test 1000 people who are unlikely to have the disease of interest, simple math tells you that you are more likely to have false positive tests in 10 who do not have infection than a real infection in any person who does not.  Similarly, if you test 1 person without infection 1000 times, 10 times that uninfected person will have falsely positive tests.  Unnecessary testing is asking for trouble.

Both of those results are negative, inidcating that the tests used on you(which also have relatively high false positve result rates) did not detect antibodies to HSV-1 or HSV-2.  Thus these tests did not suggest you have herpes.  EWH

[DepressedGirl]

Doctor
Thank you so much.  LAST QUESTION, I PROMISE:
I've just noticed on my lab results that there was a combined IGG test with the following results (I find them RIDICULOUSLY high and I want your input as if this can suggest HSV 2 infection):

HSV I/II IgG        50.2    High     index 0.0-0.8

This is extremely confusing since my HSV I IgG results read 4.09, What is going on here??!?!?!?!

LAST POST OF MINE I SWEAR. ;(

Your immediately response is great appreciated.  You're my savior.

[DepressedGirl]

Dear doc- I promise my above post is THE LAST QUESTION.
Ugh, I need a psychiatrist at this point. lol

[Edward W Hook, MD]

You do need the help of a mental health professional - you are over processing your risk and your concerns.

As for that test result.  This is a useless meaningless test (actually, it is not even a test, it is a calculation using your other tet resultss).  It means that you have more than 10 times as much antibody to HSV-1 (which you know that you have) as HSV-2 (which is what you are getting so bent out of shape about).  I would just ignore it but if anything it is further evidence that you do not have HSV-2 and that your anxiety is mis-directed.

I am concerned that this exchange is fueling your anxieties rather than helping.  there will be no further answers.  I hope you can put this aside.  EWH