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Confused by Test Results

Last September, during a routine visit with my GYN, she noticed a sore on my outer labia.  I had noticed it as well and thought it might be a pimple or ingrown hair.  She announced that it looked like herpes and proceeded to swab it for testing.  One week later she called to tell me that the test was positive.  I was shocked and convinced that the test had to be wrong so I asked to have a type specific blood test done.  The swab was taken on 9/11/08 and the blood test was done on 9/22/08.  The results of the HSV Type 2 Specific AB, IgG was <0.91.  She also ordered the HSV, IgM I/II combination which I now know is worthless.  I did test positive at 3.94 for HSV 1.  No surprise there since I have cold sores periodically.  After the 2nd test my doctor suggested that I get retested after 3 months to see if the HSV 2 would convert.  The 3rd test was done on 1/08/09 and the results were 0.11 for Type 2 and greater than 5.0 for Type 1.  

The swab was tested at the Mayo Medical Lab using Rapid PCR and "Type II DNA was detected."  The first blood test was performed at LabCorp and the second blood test was performed at Quest Diagnostics.

At this point with these coflicting lab results I just want to know whether I have HSV 2.  My doctor clearly believes that the first test is the definitive one and that I do have it.  Even tho the lab report clearly states that the Rapid PCR test has not been approved by the FDA.  Is this test fool proof?  Are the blood tests wrong?  Just trying to move on and deal with it if I have to.  Please advise and thanks in advance.
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55646 tn?1263660809
This is an interesting case.  I would personally trust the PCR swab test as well.  A PCR taken from a lesion (as opposed to just blindly swabbing the genital area for some reason) is virtually certain to be accurate.  And the tests used to do the typing both confirm that it is herpes and, with great accuracy, sort out the type.  

The antibody test for HSV 2 picks up 96-100% of the cases, depending on the study, in a STD clinic and/or OB population.  That means there are a few cases where HSV 2 antibody is not detected in a swab test positive person.  We have certainly seen these folks in our clinic as well.  Also, you may just need a bit longer to become positive on the antibody test.  You could also try being tested with the western blot antibody test through Quest labs.  However, regardless of the antibody test results, I'm with your doc - the PCR swab test from a lesion is very accurate and should be relied upon as the accurate diagnosis.

Terri
Helpful - 1
55646 tn?1263660809
Both the PCR and the western blot should be covered by insurance.  I think there might be something wrong with the billing if it wasn't covered, or, perhaps it went into your deductible.  I would check on that carefully.  High numbers would more likely be present with old infection than new infection.   But we certainly can see people who have long established infection with low numbers.  In general, the numbers are not very useful by themselves.  
If you've not had symptoms and are truly infected, then you are asymptomatic

Terri
Helpful - 0
Avatar universal
Thanks for your response and advice.  I have some additional questions -

1.  Is the western blot test covered by insurance?  I had to pay $300 that insurance didn't cover for the PCR.  Everything I have read about it on the net states that it is expensive.

2.  Do "high numbers" on positive antibody tests indicate a new or old infection?

3.  Since I have not had any breakout since Sept and none before that that I am aware of, could I be assymtomatic?  

Thanks again.
Helpful - 0

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