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Avatar universal

Concerned and Confused HSV2 Results


Naturally, after receiving results that I was positive for Herpes Simplex Virus Type 2, I'm throughly freaked out. Yet at the same time I'm having some doubts and just wondering if anyone can help with confirming or denying my suspicions. Or really any advice as to what I should do next.

So Here's my situation: The Physician's Assistant told me that I tested positive, but it was so low (1.19 Is what I believe she said)  that I'm "barely positive" and it means I was "exposed" but not necessarily ever going to show symptoms. Now I've been doing some research and from what I understand 1.1 is the level in which medical professionals are required to tell you your positive. However, through some of these forums I've read that " the lower the levels, the more likely the result is false" and at such low levels there's only a 30-40% chance I actually have HSV2. Also, on another website I was researching, someone asked "Of those of you who tested low positive for HSV2 and sought out confirmatory tests, what were your results?"

Now only %14 turned out to be positive and %42 of those who sought a second opinion, turned out to be negative i.e. not infected. I took statistics, but I'm still unsure of whether that is a good enough percentage to feel assured I don't have it.

Moreover, I read that there are studies which state that those who also tested positive for HSV1, had more of a likelihood of the HSV2 test being false. So I don't know if this is irrational speculation, but I tested negative for HSV1, so does that mean I have MORE of a chance of my HSV2 results being true?

And the fact that I even tested with a 1.19 inclines me to conclude I have it definitely, correct? As in even though it's really low and maybe not active, I can still spread it? Because I DO have it??

Obviously I'm very lost on the subject and not very knowledgeable as to the how the virus functions, so PLEASE any and all feedback is welcomed!! What does this alllllll MEANNN?!
42 Responses
3149845 tn?1506627771
Hi, if you did your test 2 or 3 months post exposure bottom line is you need retesting for confirmation as falls into the false positive range. If you tested eariler it is a sign of a recent infection and testing at the 3 months mark would be required to confirm.
Avatar universal
Well I've had a couple random partners, since I broke up with my ex.So.....I don't really know when or who it was when it comes to exposure. Therefore, I don't really have a point to work from. The PA did state that it was something that seemed to have happened  a while ago, because the test they use is for past exposure not recent. Apparently....it's what she said. I'm not sure how it works.

I took the test a week ago though, so are you saying I should wait and do a confirmatory test three months from now?

Even though it's a expensive, I was thinking about going ahead and shelling out the 200+ to get the Western Blot Test that everyone on here seems to recommend as "the gold standard" of herpes tests. I think it be worth it for the peace of mind.
Avatar universal
p.s. I hit "best answer" on accident, is there anyway to undo that action? I don't know this site at all......
Avatar universal
I disagree with the advice you have been given regarding your testing from the PA. This is a low positive that is most likely either false or building toward a higher positive. Yes you do have to wait 16 weeks post the last possible exposure you are concerned about for a retest to be sure of your status or next steps. I'd do this before considering WB.

You also do not describe any symptoms? Why did you test?
Avatar universal
Are you saying to disagree with her conclusion to say I'm positive for HSV2?

I wasn't concerned or necessarily even felt I had exposure, I just figured since I've had  multiple partners since my last monogamous relationship  and all of it was without protection, I thought I should get my yearly STD testing out the way and I always ask for a full range i.e. I wanted to be tested for EVERYTHING. Though I'm still waiting to do a "Well Woman Exam" to see if I have HPV.

Also, after my very last partner I started getting some redness down there accompanied by a tingly/ burning sensation. And in general, irritation.I've never had such a thing happen, so I went the the OB/GYN to see what the case was and the PA took a sample that she analyzed within mins under a telescope and said I had a bacterial infection that may have been caused by many things, such as switching partners, or even using a certain body wash or new laundry detergent. She went further on to say that it doesn't mean it was sexually transmitted though that could be the case.

So I think I was just wanting to make sure everything was ok and had myself tested for any possible infection. But I almost threw up when I heard "Your positive for herpes."

Now I'm paranoid. I still  have some redness and irritation down there and I don't know if that means I do have herpes and maybe I'm about to have an outbreak or it's the bacterial infection from before and it just didn't clear? Idk...

I'm still trying to process it all and preparing myself for the possibility that my suspicions are wrong and I DO have genital herpes.

No bumps or sores or anything like that, but they said since it's so low I may not even ever break out, but I DO INFACT HAVE HERPES and can pass it on.

So confused what to think.
Avatar universal
Additionally, what do you mean by"or building toward a higher positive"?
1998092 tn?1391242845
I agree with Fleetwood. Wait until you're 16 weeks past exposure and get another IgG. If you really want to spend the money, however, you could certainly go for the Western Blot in 16 weeks and save the copay for an IgG that may come back inconclusive. The Western Blot will be conclusive.

"Building toward a positive" concerns the fact that the antibodies take between 12-16 weeks to generate enough to trigger a positive result on the blood test. You have tested positive for antibodies, but false positives have been reported with the IgG ELISA when the ab count falls under the 3.5 mark. Test again in 16 weeks.
Avatar universal
Thank you for your feedback!

I'm still trying to understand herpes.....so the fact that I tested positive means I DO INDEED have it in my body? So I can't test any lower than my original 1.19?

That's what I'm not understanding, I get that 3.5 and higher indicates a "without a doubt", but if you fall in the low range and test negative the second time around is that like your not AS infected with herpes?

I am going to wait though and take another Igg and if that comes back again with a positive, I'm gonna do a WB. Or is that too much?
Avatar universal
With herpes, there are only two states, infected or not infected.

Blood testing for the vast majority is conclusive, for an established infection the IgG outcome will be >3.5 and for a negative person 3.5.

You need to test again and need to balance cost, convenience etc. The WB is costly but the results can be taken as definitive.
Avatar universal
Ok, if less than 3.5 means you aren't infected, than why do these doctors or physician's assistant's tell you, you are if your results are above 1.1?

I know that's the level that was given by HerpeSelect, but if it's isn't accurate than how are they allowed to ruin peoples lives by being able to tell you you have herpes. I mean I almost swallowed by tongue when I found out. So If I get another positive Igg, but a negative WB what am I to believe?

Avatar universal
The reality is that testing for a lot of ailments in life is just not fully accurate. I'm sure the tests are not designed out of malice for people. People are are individuals and unique bodies and immune systems. It isn't possible to design a 100% accurate test.

If the test designers had their time again, maybe they would have defined the cut off 1.0 as some other higher level. Regardless, there will always be an ambiguous range. It is the nature of using antibodies an proteins that stick to the glycoproteins in the testing wells.

I agree with you that a level from 1.1 to 3.5 should be discussed in the context of a low positive meaning that whilst not conclusive proof, there is something worthy of further investigation. The chances of infection are around 50/50 in this range.

I don't agree that a test ruins lives, although I agree doctors should be better at interpretation in some instances. It is your body and your choice as to who you sleep with after all. Medical science can only help you understand yourself and your ailments better than you can on your own.

The WB is a far, far more comprehensive test for antibodies than other commercially available tests and the results from this trump all others.
Avatar universal
Thank you for your valuable feed back, since I have to wait three months to get tested again, I think I'll save up for the WB in that time and go ahead and get it. I rather know 100% in my heart whether I have it or not.

I just wish it wasn't such an arduous process.

& boy am I terrified to find the answer out.....
1998092 tn?1391242845
That's a wise decision.

By the way, it's not true that under 3.5 means your negative. You could be positive. In fact there's an "equivocal" range that's neither negative nor positive. The key usually reads something like:

Less than 0.9 = negative
0.9 - 1.09 = equivocal (inconclusive)
Greater than 1.09 = positive

For many of the blood tests, this key holds true. Dr. Wald at the University of Washington and Terri Warren told me recently that the HerpeSelect ELISA, which is the IgG test most used by the medical community, has recently been shown to be problematic in the "low positive" range. So really, the medical community ought to always order the Western Blot. They don't because it's expensive and takes a bit longer to return results.
Avatar universal
Of course, I know there is the chance that I am positive, but if the test is problamatic in the "low positive" range and I have a "barely positive" result, then wouldn't you agree there is the good chance It's a false positive?

See this is where I'm confused. Let's say I have taken the western blot and my results have come back negative. Now being that this is the most reliable test, I can feel secure that I am not infected. However, If I'm not at all infected, than why did I test positive on the IgG in the first place?

That is what I don't get. All these testimonies of testing positive on IgG and then negative on western blot......Either you're infected or you're not and if you're not, then why would ANY test say you're postive?

Avatar universal
The virus generates a lot of proteins that are attacked by our immune system. One of these proteins is a glycoprotein that is attacked by our body's immunoglobulin (IgG for short).

Glycoprotein is made from rabbits' livers and other from other animals and harvested and coated into testing wells. Your blood is exposed to the wells and stuff in your blood sticks to the glycoprotein. Most often that stuff is IgG type specific antibodies, however sometimes other stuff sticks and colors the testing well. This produces the false positive. It is not known what this other stuff is, but one day they might and will create a cleansing agent for it first. Maybe testing will evolve to one of the 70+ other proteins associated with herpes, who knows.
Avatar universal
Thank you Fleetwood, this is the type of explanation I was looking for. So this "other stuff"  because it sticks to the testing well like the Glycoprotein does, results can be misinterpreted as positive and you may in fact NOT have herpes, AT ALL?

Is that what you're saying?

Also, Idk if you can answer this or not, but the PA stated that it couldn't be a recent infection, so It had to be from someone I had sex with a while ago. Does that mean it's pointless to wait 3 months because I probably have it?

I mean if she said it was from a while ago, I don't see what waiting will change. I feel like I may be doomed :(
1998092 tn?1391242845
How soon after the sexual event did you test?

The antibodies take time to generate fully. So if you test at 1.19 in, say, 6 weeks, and you do in fact have the virus, you will probably test at 3.5 at some point later, because the antibody load is continually increasing. However, you might not get to 3.5 until up to 6 months or more after the sexual event.

I think the reason your PA told you this was not a new infection is that it usually takes 3-4 months for the antibodies to generate enough to trigger an accurate positive result. A new infection will often generate a negative until the 3-4 month mark. This is not cross the board, however. It's possible to test positive after only a handful of weeks.

This is why I ask how soon after the sexual event you tested at 1.19. If it was less than a week after, I would also suspect, as did your PA, that you contracted the virus more than a week before, prior to the sexual event in question. However, if you tested at 1.19 after 3 weeks, I'd be more inclined to consider that this was a recent infection.

I hope that's not too muddy.
Avatar universal
Idk, I've had four partners in the past year, so no clue when I could have been exposed. That's why I got tested, It's been a while since I got tested and since I've been with four people I figured It was about time.

& Your talking like we know for sure I have it.....are you implying that you feel I may, based off of what you know from this post?

Also, say I don't have it and my WB comes back negative. What does that mean for future testing........ That I'll always show up positive on a IgG and will have to take a WB instead? Would my partner have to take the same test for the same reason?
Avatar universal
So I found out that Planned Parenthood, a non-profit that provides OB/Gyn and Womens Care Services in Florida does use the IgG Elisa for HSV 2, but if it comes back positive they confirm it with the Western Blot.

Now the nurse I spoke to said I only have to wait two weeks to retest, do you all think this is a good route to take?

I feel like it be easier than me trying to do the western blot process myself.
Avatar universal
It is up to you, sometimes the element in your blood can dissipate, other times, yes you may pretty much always test false positive. Hence if it falls negative, then that is what you will be.

How long is it exactly since your last encounter or are you still with a partner?

The WB needs to be taken 16 or more weeks after the last sexual episode to be conclusive about not having an infection.
Avatar universal
Ok, beforehand let me apologize for any idiotic or seemingly irritating  questions I may ask, just trying to sort this all out in my head.

So what do you mean "the element in my blood can dissipate?"
As in, if the WB comes back negative, than that initial 1.19 was my body creating antibodies, even though there wasn't a full on infection?
And if still comes back negative on WB, but positive on IgG's I'm not infected but they're elements of the virus that will always be in my body?

It's been on an off with this las partner, but we did have sex Sunday the 15th. However, I think from now on I'm going to insist we abstain. I haven't mentioned I might be infected, I know that may seem wrong, but I rather avoid the sex and not say anything until I know for sure. It's not an easy thing to tell someone.

So if it should be taken 4 months after, why would that nurse tell me 2 weeks is ok?

1998092 tn?1391242845
No apologies needed - all your questions are valid - that's what the forum is for!

What causes a false positive on the IgG hasn't been clearly elucidated in any of the reading I've done so far. If there are any medical personnel on this board, perhaps they can chime in. However, I do not think the IgG is detecting HSV antibodies when they return a false positive. It's likely something else that's falsely triggering the positive result.

By some chance, were you taking antivirals when you had the first test done? Terri Warren mentioned at a support meeting in Portland last year that if a patient is taking antivirals in the first few weeks following the primary infection, it can impact test results. No, I wouldn't predict for sure that whatever it was that caused a false positive will stay in your body forever.

And no, I really urge you to wait until 4 months has passed from exposure to get the Western Blot. Dr. Wald confirmed to me last August that this is the amount of time it usually takes to return an accurate result.
Avatar universal
Thank you for the reassurance!
I will speak freely.....

Ok, now it's making sense! See that is the part I wasn't wrapping my head around. IT CAN be detecting something else that may make it a false positive......in my head I'm thinking, ok well if it's positive on a IgG, but not on a WB then what made the IgG positive in the first place for all these people and possibly me?

I wasn't taking any anti-virals. I took an antibiotic called Flagyll for the Bacterial Vaginosis I had gotten.

I had a feeling that you'd say that :/
Four months of anxiety! But I rather be accurate than unsure! I'll wait, it's just killing me to know. I'm trying not to stress, but on the one side my partner keeps wanting to have sex and asking me why I won't and I don't want to tell him what I'm going through because I don't think he'd be understanding. But explain me this if you can.....

So me and him have had unprotected sex before and after I've received these test results, so essentially if I do have it, either way he's been exposed and if I don't have it then we're safe.  So why must you wait for months from the last time you had sex and not four months from when you got tested?

I guess what I'm asking is, would it be unwise to continue to have sex with him? even though he might have been exposed either way?

Avatar universal
Yes you are right, it is more than just IgG antibodies that can stick to the antigen in the testing wells to produce the false positive. It is possible not to be producing IgG and test positive, this happens in a small number of cases.

You are in a complex situation. I have only a straight answer, which I'll give later. In order of highest to lowest chance your situation is as follows:
(a) you have a false positive reading and are not producing IgG antibodies
(b) you have been recently infected by your current partner and you are commencing to produce IgG antibodies such that a subsequent test will record a higher antibody level
(c) you are a rare person who has the infection, possibly for a long time, but blood tests only detect a low level of antibodies for you.

You can use this information to help you decide upon your next steps. The pivotal uncertainty here is the status of your current partner if he is the only one in the 16 weeks leading into your test. Is this the case? If it is then you will need to make an assumption as to whether he has HSV2 or not. If you want to assume he doesn't and it has been 16 weeks or more since the preceding partner, then a negative WB will eliminate HSV2 infection from all preceding partners. If it comes back positive, you won't know the source and your current partner may well be the source or you may have given it to him if he tests positive.

My own view, it is too complex to continue with a sexual relationship in the absence of disclosure and further information. I'd say to the partner that there is no more sex until mutual testing is undertaken for all STDs. Both of you then have full STD testing including IgG antibodies for HSV1 and HSV2. Full printouts of the tests are obtained and placed next to each other for discussion. Now maybe your will be negative by then and all good, if not then you have the discussion about the WB further testing. If he doesn't have HSV2 then the 16 weeks is from the preceding partner. If he does, then 16 weeks from last sexual contact with him.

It is complex to work through even with full disclosure and testing let alone trying to continue without disclosure, testing and discussion. If this partner isn't willing to understand and work through this with you, then he isn't longer term material!
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