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Confirmatory Testing
Hi Grace. So I have been reading these posts for a little over a week now and never thought I'd be asking a question, but I'm pretty lost and scared at this point and am not getting much guidance from my primary physician who seems to know even less than me, and you guys seem to be great at providing advice and emotional support (even if it may wind up just giving me false hope in the end).
A week ago I went in for routine blood work and, in addition to letting me know that my cholesterol had improved (giddyup), my doctor was also nice enough to include in his 9:00pm email with no call back number that I also tested positive for genital herpes! Very sensitive right? As I can remember I've never had any symptoms of a genital herpes outbreak (other than an itchy, mildly irritated penis for a couple of days after a beach wknd about two months back, although it never even crossed my mind at the time that HSV could be the cause). No obvious sores, rashes, clusters, etc. like the pictures I've seen online. That said, I also admit that I did have some unprotected encounters in my day back when I was young and dumb so who knows if I was exposed years ago and just never had symptoms.
I know its a bit egocentric, but I felt like my world just imploded. To make matters worse I just started dating an amazing girl about a month ago and we recently became sexually active before my test (just oral sex performed on me the wknd before the test. No vaginal intercourse). Prior to that I hadn't had sex in about six months (once, protected). Prior to that it had been another six months, also always protected with a monogamous long term partner for several years).
Anyway, immediately I went online and began researching and called him for my specific test brand and results. My results read as follows: HSV 1 and 2 - Specific Ab, IgG (164905)....HSV-1: negative and HSV-2: 1.14. I believe this is the infamous Herpeselect test that nobody seems to trust, yet everybody seems to get. So having read your posts I immediately asked for a confirmatory WB to confirm what seemed to be a "low positive" based on everything I read. So I went back two days later and drew more blood. The following morning my doctor called me to tell me that the labs they use in NYC don't offer the WB anymore and that I would need to go out of state or something to get that test done. But since the lab already had the blood sample he suggested doing the confirmatory test that they do offer at Focus Diagnostics (CPT-86696). The results were as follows: HSV-2 Inhibition Study, ELISA: HSV-2 IGG Screening Index- 1.90, Inhibition 62% (= or > 60% is positive).
So that's where things stand as of this morning. I feel like I'm just in denial since these tests are pretty accurate in general at identifying HSV antibodies and have aced two of them in a row. But I have also read some pretty uplifting stories on your message board so figured I would reach out and hopefully get some thoughts on where I should go from here. Should I bother seeking further confirmatory testing? There is a free clinic in the Bronx that offers a "biokit" test I believe (although appointments take several weeks). Otherwise I'm not even sure how I'd go about getting a WB (e.g. in NJ somewhere at a new doctor's office). I called the lab in NJ and they told me they wouldn't even draw the blood and forward to University of Washington for WB testing.
Any advice/guidance you could provide would be incredibly appreciated.
God bless
A week ago I went in for routine blood work and, in addition to letting me know that my cholesterol had improved (giddyup), my doctor was also nice enough to include in his 9:00pm email with no call back number that I also tested positive for genital herpes! Very sensitive right? As I can remember I've never had any symptoms of a genital herpes outbreak (other than an itchy, mildly irritated penis for a couple of days after a beach wknd about two months back, although it never even crossed my mind at the time that HSV could be the cause). No obvious sores, rashes, clusters, etc. like the pictures I've seen online. That said, I also admit that I did have some unprotected encounters in my day back when I was young and dumb so who knows if I was exposed years ago and just never had symptoms.
I know its a bit egocentric, but I felt like my world just imploded. To make matters worse I just started dating an amazing girl about a month ago and we recently became sexually active before my test (just oral sex performed on me the wknd before the test. No vaginal intercourse). Prior to that I hadn't had sex in about six months (once, protected). Prior to that it had been another six months, also always protected with a monogamous long term partner for several years).
Anyway, immediately I went online and began researching and called him for my specific test brand and results. My results read as follows: HSV 1 and 2 - Specific Ab, IgG (164905)....HSV-1: negative and HSV-2: 1.14. I believe this is the infamous Herpeselect test that nobody seems to trust, yet everybody seems to get. So having read your posts I immediately asked for a confirmatory WB to confirm what seemed to be a "low positive" based on everything I read. So I went back two days later and drew more blood. The following morning my doctor called me to tell me that the labs they use in NYC don't offer the WB anymore and that I would need to go out of state or something to get that test done. But since the lab already had the blood sample he suggested doing the confirmatory test that they do offer at Focus Diagnostics (CPT-86696). The results were as follows: HSV-2 Inhibition Study, ELISA: HSV-2 IGG Screening Index- 1.90, Inhibition 62% (= or > 60% is positive).
So that's where things stand as of this morning. I feel like I'm just in denial since these tests are pretty accurate in general at identifying HSV antibodies and have aced two of them in a row. But I have also read some pretty uplifting stories on your message board so figured I would reach out and hopefully get some thoughts on where I should go from here. Should I bother seeking further confirmatory testing? There is a free clinic in the Bronx that offers a "biokit" test I believe (although appointments take several weeks). Otherwise I'm not even sure how I'd go about getting a WB (e.g. in NJ somewhere at a new doctor's office). I called the lab in NJ and they told me they wouldn't even draw the blood and forward to University of Washington for WB testing.
Any advice/guidance you could provide would be incredibly appreciated.
God bless
I agree to an extent. Each of these tests has a certain rate of error so you can never "be sure". So I wonder whether the marginal reassurance I might get from a negative WB is worth the stress. According to the CDC it was a mistake to test me in the first place! But I suppose if the medical community were only testing symptomatic patients, an over-sensitive test like the Herpeselect ELISA would be bareable.
The fact is that the herpeselect test is incredibly inaccurate in the low positive range (especially below 2.0) and its a wonder it hasn't been pulled from the market as a result or at the very least been required to re-evaluate its positive index threshold.
Facts: I got a negative biokit, and the chances of a false negative biokit coupled with the overwhelming likelihood of false positives on the herpeselect tests based on my results and my lifelong lack of symptoms compel me to leave it at that and move on with my life.
It's unfortunate the medical experts don't weigh in. I agree with you that this is an interesting case.
The fact is that the herpeselect test is incredibly inaccurate in the low positive range (especially below 2.0) and its a wonder it hasn't been pulled from the market as a result or at the very least been required to re-evaluate its positive index threshold.
Facts: I got a negative biokit, and the chances of a false negative biokit coupled with the overwhelming likelihood of false positives on the herpeselect tests based on my results and my lifelong lack of symptoms compel me to leave it at that and move on with my life.
It's unfortunate the medical experts don't weigh in. I agree with you that this is an interesting case.
You are in an unusual situation that clinicians dont want to test talk about.
Numeric values are index values; the number is arrived at by comparing positive and negative controls that are run on the machine at the same time as your sample. Yours are very close and most likely you are negative. You are still testing in the false positive range on 2 different tests. The only way to know for sure is the Western Blot. If you test negative with this test 4 months after exposure you can certain your not infected.
Numeric values are index values; the number is arrived at by comparing positive and negative controls that are run on the machine at the same time as your sample. Yours are very close and most likely you are negative. You are still testing in the false positive range on 2 different tests. The only way to know for sure is the Western Blot. If you test negative with this test 4 months after exposure you can certain your not infected.
ehbeedub- thanks for your response and I pray that you are right about the likelihood that I've cleared HPV. Since my last occurrence I have gotten gardasil, so hopefully that will protect against future transmission against previously unencountered strains.
With respect to WB, it's very difficult to get from New York State due to recent regulatory changes. And most local labs aren't very helpful. Given the fact that (1) I am asymptomatic to date, (2) had very low positive scores on the herpeselect tests that were within ranges that are most likely falsely positive based on all the studies I've read and (3) tested negative on the biokit which is pretty darn accurate with 95% negative predictive value, is it really necessary to undergo further confirmatory testing via WB in my case (e.g haven't I been through enough!!)?
With respect to WB, it's very difficult to get from New York State due to recent regulatory changes. And most local labs aren't very helpful. Given the fact that (1) I am asymptomatic to date, (2) had very low positive scores on the herpeselect tests that were within ranges that are most likely falsely positive based on all the studies I've read and (3) tested negative on the biokit which is pretty darn accurate with 95% negative predictive value, is it really necessary to undergo further confirmatory testing via WB in my case (e.g haven't I been through enough!!)?
troubledadult- First, thank you for taking the time to respond. All thoughts are enlightening, even those I may not totally agree with. With respect to HSV, I received oral prior to the test. Once I became aware of a potential virus, I ceased all sexual contact. Hopefully, my biokit results confirmed my hsv negative status. With respect to HPV (so much fun being a sexually active adult these days! Why couldn't I be born in the 50s!), while it is true I had a few warts about 15 months ago, I have been clear ever since and based on the studies I've seen, there is a very strong likelihood my immune system has cleared the virus. And in any case (1) my partner has received a gardasil vaccination, (2) I have no visible warts obviously, (3) we use condoms 100% of the time, and (4) I'm not aware of any risk of transmission via oral sex. That all said, I appreciate your sentiment. But, at some point I need to be able to pursue a happy life, and given where things currently stand in terms of symptoms and testing re: HPV and HSV I'm not sure this needs to be raised with my partner. Thoughts of course are very welcome.
Had a second Herpeselect test two days later, that time with a reflex to inhibition assay, which I understand is sometimes done to confirm a low positive like the 1.14 that I initially had. That test came back with an index value of 1.90 and a score of 62% (which is also quite low. I saw a study that showed similar chances of false positive in the low 60's as those seen with an index value of 1.1-1.5). I then went in for a biokit a week later, which was negative. All this well beyond 6 months since last relevant sexual encounter.
Hi, you kind of lost me here. You first tested and received a 1.14 which is in the false positive range and requires another test to reconfim. Did you have the second test and if yes what were the results.
Since a lot of the posts I read this past week don't include follow ups I thought I'd check back in with where things stand and get people's thoughts. I went to Montefiore in the Bronx this week and had a biokit test, which the nurse practitioner interpreted as "clearly negative." I looked with my own eyes and the test area was completely void of any pink or red spot. As I previously mentioned, I am asymptomatic and it had been close to six months since my last sexual encounter when I received a 1.14 on the herpeselect igg-2 (followed by a 1.90 and 62% on the inhibition assay, which is also barely above the 60% threshold for positivity).
Based on everything I read, 1.14 and 62% on the inhibition assay are more than 80% likely to result in a false positive, and the biokit is an approved confirmatory test with over 95% specificity and negative predictive value. At this point, do I need further confirmatory testing, or can I move on with my life until actual symptoms appear (since according to most experts I never should have gotten serological screening to begin with!)
Based on everything I read, 1.14 and 62% on the inhibition assay are more than 80% likely to result in a false positive, and the biokit is an approved confirmatory test with over 95% specificity and negative predictive value. At this point, do I need further confirmatory testing, or can I move on with my life until actual symptoms appear (since according to most experts I never should have gotten serological screening to begin with!)
HPV is not a lifelong infection. The majority of cases clear within a year, and more than 80% of adults will acquire the infection at some point in their lives. As long as women are having yearly pap smears and following up on any abnormalities, HPV is not something that should be a concern, especially since there is no test for men.
Nervouswreck, the variability in the test numbers has to do with the control sample that they use, which varies from test to test. You'll never get the same number twice. A jump from 1.14 to 1.9 could be significant if you had a recent exposure (but it sounds like oral was your only recent sex act?), but it's more likely just a normal variation in the test numbers.
You need to get a Western Blot to be sure. The easiest way is to become a phone patient of Terri Warren at Westover Heights clinic and have her order the test for you.
Nervouswreck, the variability in the test numbers has to do with the control sample that they use, which varies from test to test. You'll never get the same number twice. A jump from 1.14 to 1.9 could be significant if you had a recent exposure (but it sounds like oral was your only recent sex act?), but it's more likely just a normal variation in the test numbers.
You need to get a Western Blot to be sure. The easiest way is to become a phone patient of Terri Warren at Westover Heights clinic and have her order the test for you.
With a low positive a second test is advised but there needs to be a wait period like a few months. The second test is of no value confirming absolute and as troubleadult advises to treat this as positive till the correct testing times results are in.
you have hpv and still let someone perform oral on you? I don't know exactly how hpv works but i'm sure its a life time disease. two test results came back positive and you're still in denial? i hope your a good enough person to immediately stop all sexually activity and disclose that you have HPV and HSV 2. yes you are confirmed positive for herpes until proven otherwise.
Im a volunteer and the dr's dont reply here only in the paid expert forum.
I just noticed that a second blood was drawn. These numbers vary depending of the tests as some are more sensitive, but still falls into the low positive and would require a second testing.
I just noticed that a second blood was drawn. These numbers vary depending of the tests as some are more sensitive, but still falls into the low positive and would require a second testing.
That's too bad, I enjoyed reading her posts. Are you a medical professional and do other medical professionals (e.g. Dr. Handsfield) post replies to this board? With my results, I'd really like to hear what people think about my chances of still coming back with a negative, even with the 1.90 on the second test. How could two blood samples drawn 2 days apart yield such different results? I'm really freaking out here and it seems like its harder to get a WB than a concealed carry permit in NYC!
Hi, Grace retired and we all will miss her excellent guidance.
Testing the same blood is useless for second confirmation. New blood needs to be drawn. You can have your doctor draw your blood and send it to a lab that will foward it to washington for the WB. Might take a bid of reasearch on your part but it can be done and WB will send the results to you.
Both the testing of the previous blood falls into the low positive and surely needs to be confirmed and the WB is the best avenue.
Testing the same blood is useless for second confirmation. New blood needs to be drawn. You can have your doctor draw your blood and send it to a lab that will foward it to washington for the WB. Might take a bid of reasearch on your part but it can be done and WB will send the results to you.
Both the testing of the previous blood falls into the low positive and surely needs to be confirmed and the WB is the best avenue.
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Herpes spreads by oral, vaginal and anal sex.
Herpes sores blister, then burst, scab and heal.
STIs are the most common cause of genital sores.
Millions of people are diagnosed with STDs in the U.S. each year.
STDs can't be transmitted by casual contact, like hugging or touching.
Syphilis is an STD that is transmitted by oral, genital and anal sex.
