Low Positive for HSV 2

[stella525]

To Terri,

My boyfriend and I have been in a monogamous relationship for 4+ years.
We are professionals, in our 40s, and in (what I consider to be) a very low risk group for transmission of STDs.
A few weeks ago, he went in for a routine physical and mentioned to his Dr. that he was feeling some pains in his genitals and was asking her if it was a bladder infection.  By the time he went in, the pains were gone, but she said it didn’t sound like a bladder infection, but similar to herpes symptoms and asked him if he wanted to be tested.  He said sure and shockingly, the result came back positive for HSV 2.  The result was 2.28. (Negative for HSV 1)  I did a LOT of research, so I learned that is a low positive and I told him he should be retested and to get the western blot.  He asked for it, but his Dr. ignored him, so the 2nd test was another herpeselect.  The result was 1.94.  

We got a copy of the results and see that the ELISA inhibition assay was also performed.  That result says positive at 1.94.  

I was IGG tested and my results are negative for both hsv1 and 2.

I'm having difficulty accepting his diagnosis.  He is age 48 with maybe 5 partners prior to 22.  Then he was with his ex-wife for over 20 years.  After they divorced, he had sex with a condom twice with the same person and then met me a month later.  We have been together for 4 years with an energetic sex life and I am negative.  I have no doubt about his honesty or his faithfulness to me or his ex.

One thing that makes me pause is that he had bumps on his penis swab tested for herpes 10+ years ago when he was married but it came back negative.  He didn’t question the diagnosis.  Other than that, no outbreaks that he is aware of.  

I welcome your opinion.  Do you think it could still be a false positive even though two herpeselect tests as well as the inhibition assay were performed?  Is it worth pursuing the western blot for confirmation?  Or do I just need to accept this reality?  

Thank you

[Sara9185]

How could antiviral therapy possibly work? kindly elaborate.
Sara

[Terri Warren, RN, Adult Nurse Practitioner]

Antiviral therapy reduces the amount of virus that is present, therefore reducing the risk of transmission by 48%.  You are welcome to look up the reference - Corey, 2004, New England Journal of Medicine.  

Terri

[Terri Warren, RN, Adult Nurse Practitioner]

I'm glad you have some clarity here.  Now, in order to protect you, he should consider taking daily antiviral therapy.  This will reduce transmission by almost half.

Terri

[Terri Warren, RN, Adult Nurse Practitioner]

I'm glad you have some clarity here.  Now, in order to protect you, he should consider taking daily antiviral therapy.  This will reduce transmission by almost half.

Terri

[stella525]

I looked at the copy of the results and they are from the University of WA for the western blot.  Result is positive for antibodies to hsv 2.
At least we know now and hopefully I can get comfortable with it.   It's been a huge source of stress for me and a challenge for our relationship.

Thanks for all of your advice.

[stella525]

I would rather he did not talk to her about it.  I think he's hoping she will come clean with her affair and giving it to him, but I think he's living in lala land.  She's going to deny everything and there is no way to prove anything like you say.  

I asked him to get a copy of the results.
I'll follow up when I get a hold of it.

Thank you!

[Terri Warren, RN, Adult Nurse Practitioner]

Laurie, I don't think you need another test, no.
Had your husband never had another sexual partner besides his wife in his lifetime, and she, alledgedly had none other besides him?  If they both had had other partners in their lifetimes, there is simply no way to know where this came from.  
And with all the confusion about this testing, can you get a copy of his results and be absolutely sure it is a western blot result?

Terri

[stella525]

My BF received his results from the western blot.. POSITIVE.  I really had myself convinced he was going to be negative.
He wants to confront his ex wife for giving it to him during their marriage.  He feels that his primary outbreak was the time he went to the Dr about 14 years into their marriage when he had bumps on penis that the Dr swabbed and tested for herpes.  He had no reason to distrust her at the time, but he's learned some things about her since their divorce that are causing him to question her fidelity.

But before he opens that can of worms, I want to be certain that he didn't get this from me.  To my knowledge, I've never been with anyone with herpes and I've never had an outbreak.  However, out of the two of us, I am the more likely candidate for contracting the virus because I have been single and dating most of my adult life.  When he told me he was diagnosed positive, I was almost certain he must have gotten it from me and that I would test positive.

My IGG 1&2 test results were negative, but do you think there is a chance it could be a false negative?  My Dr. also ordered an IGM test, which I know isn't reliable, but that was also negative.  Do you think I should get another test?

Thanks

[Terri Warren, RN, Adult Nurse Practitioner]

oh my.  Seems like most anyone would know that serum is what you get what you spin down blood.  Duh!!! Hope they can accept it in this way. If they don't, your doctor should redraw his blood and have it run for free.  That's a pretty basic thing, you know?

Terri

[stella525]

Whew..  UW verified that the test is still in process.

I'll update with his results when they come back to close the story.

[stella525]

We did go through the process of sending the sample directly to the lab.  Not difficult, but it was tedious, making sure everything was in place.  I gave my BF all of the instructions and it still got messed up.  His Dr's office drew the blood for him and when he said (per my instruction) that the blood needed to be spun down, the nurse said 'No, that's not what the instructions say'.  The instructions specifically state 'serum' which means the spun down blood.  Anyway, he didn't argue with it and I could kill him!  I told him if there is ANY question, he should call the UW lab for clarification.  I was out of town for work, so he already fedexed the kit by the time I heard this.
The blood was received yesterday morning, so I called the lab to find out if they can work with the blood.  They said they're evaluating it and we'll find out today if it can be used.  Thank goodness they are so friendly and easy to work with.
Fingers crossed!  But we may be back to square one.

[Terri Warren, RN, Adult Nurse Practitioner]

We just ordered on this week in Philly, no problem at all.

Terri

[wdoml]

I also live in suburb in Philly, and was able to get test done easily, kind of a pain, but could get it. I could maybe give you a list of some places...my story is under my posts

[Terri Warren, RN, Adult Nurse Practitioner]

Well, I cannot imagine that you can't get a Quest lab in Philly to draw this test and send it to UW.  But if it just can't be managed, then just order the kit to be sent to your doctor from UW.  It is very efficient and workable.

Terri

[stella525]

I am in a suburb of Philadelphia.

[Terri Warren, RN, Adult Nurse Practitioner]

I agree that contacting the University of Washington to do it directly is the best way to go, and no, there isn't room for errors, no more than sending it through a big lab, perhaps less!

What town do you live in?

Terri

[stella525]

Thanks for your feedback.  I feel relieved that you're on the same page.

Over the past couple days, we checked into getting the WB test.  His Dr. reluctantly agreed to order the test through Quest, but then found out that the local Quest lab doesn't handle the test.  I called the lab and was told the same information and when I asked if they would send the sample to a Quest lab who would handle the test, they said No.  Upon my research on the quest website, I see that many of the quest labs do not handle the test.  The nearest lab to me that will handle it is in Massachusetts, about a 6 hour drive.
My next step was going to be contacting the University for the 'do it yourself' instructions.  Which I'm not looking forward to doing because it seems like there is a lot of room for error.

How does it work to become a phone patient and have the test ordered through your clinic?

Thanks

[Terri Warren, RN, Adult Nurse Practitioner]

Yes, it could be two false positive, but since he is HSV 1 negative, that is somewhat less likely.  The inhibition assay result is not 1.94, that comes in percentages, and they don't sound like this.  Having said that, I'm not in love with that particular test and it's results.

He needs a western blot!  If this provider won't do it, then he should ask someone else.  Plain and simple.  There is just little more to say about this until he has it done.  I agree that his sexual history doesn't sound too concerning, but with herpes, that is just less important than with some other STI's.  And the fact that he had a lesion swabbed at some point for herpes also adds to my concerns.  Please don't accept any reality until the further testing is done.  If he simply can't get his provider to do it, we can order it through the clinic for him, if he becomes a phone patient with us.  Let's take one step at a time - the first is confirming that he does or does not have HSV 2 infection.

Does that sound like a plan?

Terri