2 negative, one positive igG results...what gives?

[treegirl57]

Hi Terri,

Nine years ago, I was tested and got a negative HSV 2 result (igG was 0.51) four months after I'd been sexual with someone I knew to be positive.  Five months later, I tested positive for HSV 2 (igG was 1.84).  I asked my doctor how I could be positive, and she said that it was because I had been exposed to the virus, and that if I had truly been positive the first time around, my igG would have been 0.0.  What do you think about this?

Secondly, why do the numbers fluctuate?

Third, if you've been "exposed" but test negative, does this mean you can infect someone?

Finally, I've never had symptoms and have not been sexually active in the nine years since the positive result.  I decided to get tested again, and this time, the results were negative.  I'm going to get the Western Blot to confirm.  Do you think I should get the Western Blot?

Thanks!

[Terri Warren, RN, Adult Nurse Practitioner]

So it didn't help clarify your situation.  My guess is that there is a typo in these results. the atypical reactivity is probably against HSV 2, likely the same thing that might be tripped the ELISA test.  I'm so sorry this didn't help clarify things for you.  The standard interpretation about indeterminate western blots is that if it stays indeterminate for 6 months or longer, then it is very unlikely to be HSV 2 infection.  

I suppose it is possible that the hep c is somehow interfering with these test results.

Perhaps the best thing to do is to retest in 6 months again with western blot and see what happens.  I sure wish it had been clearer for you!

Terri

[Terri Warren, RN, Adult Nurse Practitioner]

If you are truly positive, and we can't know that from the test results that you currently have, and you have no symptoms, you could still infect someone else, yes.  But you can't go there without a western blot, in my opinion.

I have only extremely rarely seen anyone with a 0,0 result.  They almost always have some value, for certain..  Your doctor is truly mistaken about this.  I've seen thousands and thousands of these test results, and I'll bet I can count on one hand the negatives that read 0.0.

Terri

[DiDiva]

Just wondering if you ever got anywhere with getting definitely results?  Hope you're well.

[Terri Warren, RN, Adult Nurse Practitioner]

Exactly.  If the antibody test is truly positive, it means that you are infected AND infectious to others.

Terri

[treegirl57]

Yes, I thought that was a typo, too.  I'll get retested again by October.  That will be a full six months since the hep C treatment ended.  

Just one more question, in the meantime?  I understand that while many people are "exposed" to HSV, that this does not always lead to infection.  Does this mean that exposure mean that you're negative, and that an infection means that you're positive?  Also, if you've only been exposed, can you still infect someone with HSV?

[treegirl57]

I just got my Western Blot results back, and they're confusing.  First, there was nothing about my HSV2 results.  The lab requisition form from my doctor's office clearly said that I wanted the WB for HSV 1 & 2, and we used the correct Quest test order number.  Do you know why I might not have been given the results for HSV 2?  Should I follow up with Quest about this?

Next to "HSV WB Specimen," the word serum appeared under the "In range" column.  What does this mean?

Under "HSV WB Result," it states the following: "Low level antibody detected by WB assay.  Indeterminate for HSV."  

In addition, they included a WB interpretation, which says: "No antibody to herpes simplex virus type 1 detected by WB assay.  Atypical reactivity was noted against proteins on the HSV WB.  This reactivity may or may not be due to HSV-specific antibody.  Full antibody profiles to HSV may take 12-16 weeks to develop especially if antiviral therapy was given.  We suggest a convalescent specimen be sent.  For best results, the two specimens should be tested together.  Please indicate that the second specimen is a "convalescent" specimen so the two specimens can be tested together."  Can you clarify what this might mean?

I have never been on antiviral therapy for HSV, but I did just complete a 72-week treatment for hepatitis C.  Could that be what is effecting my results?  

[treegirl57]

So, based on this literature, is there any indication whether someone who is sometimes positive and sometimes negative on the ELISA, is able to infect another person with herpes?

Also, are there peope who's ELISA tests come back with a 0.0 igG?  I ask because when I tested positive, my doctor told me that if I had really been negative the first time I'd been tested, my igG would have been 0.0.   I hate to be a pain, but this has been a 9 year nightmare for me, and I want to have a better understanding of all of this.  

[Terri Warren, RN, Adult Nurse Practitioner]

My guess is that you have some other protein in your blood that is artificially tripping the test and who knows why that might fluctuate.  Also, if it is herpes, there is some evidence in the literature that some people will vary in their antibody production enough to be sometimes positive and sometimes negative on the ELISA, but the western blot remains consistently positive if they are infected.

Terri

[treegirl57]

I do plan to get the Western Blot, but my question about fluctuations has to do with the fact that I had a negative result that became a positive result 4 months later, followed by a negative result nine years after that.  That's three test results: one positive and two negative.  Why that sort of fluctuation?

[Terri Warren, RN, Adult Nurse Practitioner]

Your numbers did more than fluctuate, they moved from negative to positive.  You may be tested too early for YOU, though in general four months is enough time to wait.  It is also possible that your low positive result is a false positive.  You need a herpes western blot from UW to sort out these discrepant results.  You already knew that, huh?  My guess is that you aren't infected with HSV 2.

Terri