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Positive and Negative HSV2 Results
Folks, I really don't know what to think. I had a protected contact with a female, whose status I did not know. I got nervous and got STD tests done about 3-4 weeks after contact. All tests have come back negative, except the following scenario. The first HSV test was an IGG test (not sure if it was type specific) at Planned Parenthood. The test result came in positive for HSV2 (HSV1 was negative) - at about 1.36. I then took a type specific HSV1/2 IGG test a few days later (done through Labcorp) that was completely negative for both HSV 1 and 2. I went to my doctor at about week 4, and he tested me for all STDs. Everything was negative, except the IGG HSV2 test, which was positive at about 1.34. So, in this 4 week window, I had one slightly positive test (not sure the type of test run by Planned Parenthood), one type specific test at Labcorp which was negative, and one IGG test from my doctor that was slightly positive. There have been no other contacts since this last contact.
During this time, I was feeling some irritated skin sensations underneath the base of my penis - between the penis and scrotum. I have noticed that I think I have sebaceous prominence underneath the shaft of my penis, but I'm not sure if this can cause any skin irritation. It's amazing what you find when you are really looking! I also have what my doctor has determined is come kind of heat rash on both sides of the inside groin area - which I have battled for quite some time - between the leg and groin area. It doesn't really bother me at all, but I wonder if it is a bacterial infection?
Here is the part that I just can't understand. It is now week 12, and I took the IGG HSV1/2 Type Specific test again (done through Labcorp) and HSV1 and HSV2 are both negative. What the heck am I supposed to believe? Am I negative or positive for HSV2?
I am still feeling some irritation between my penis and scrotum, but I have never had an outbreak of any kind. I have several questions that I need help understanding:
1) Is 12 weeks after contact a reasonable amount of time to feel pretty good that I do not have HSV2?
2) Are my previous HSV2 positive test results so low that they could be false positives?
3) If one were really positive for HSV2, wouldn't the level of antibodies increase in the body, making the HSV2 test result numbers significantly higher after 12 weeks?
4) At 4 weeks, I tested negative for gonorrhea, syphillas, clamydia, and HIV was negative after 12 weeks. Are there other STDs that could cause this irritation if it is not from HSV2? What about HPV? I have not been tested for this.
Thanks.
During this time, I was feeling some irritated skin sensations underneath the base of my penis - between the penis and scrotum. I have noticed that I think I have sebaceous prominence underneath the shaft of my penis, but I'm not sure if this can cause any skin irritation. It's amazing what you find when you are really looking! I also have what my doctor has determined is come kind of heat rash on both sides of the inside groin area - which I have battled for quite some time - between the leg and groin area. It doesn't really bother me at all, but I wonder if it is a bacterial infection?
Here is the part that I just can't understand. It is now week 12, and I took the IGG HSV1/2 Type Specific test again (done through Labcorp) and HSV1 and HSV2 are both negative. What the heck am I supposed to believe? Am I negative or positive for HSV2?
I am still feeling some irritation between my penis and scrotum, but I have never had an outbreak of any kind. I have several questions that I need help understanding:
1) Is 12 weeks after contact a reasonable amount of time to feel pretty good that I do not have HSV2?
2) Are my previous HSV2 positive test results so low that they could be false positives?
3) If one were really positive for HSV2, wouldn't the level of antibodies increase in the body, making the HSV2 test result numbers significantly higher after 12 weeks?
4) At 4 weeks, I tested negative for gonorrhea, syphillas, clamydia, and HIV was negative after 12 weeks. Are there other STDs that could cause this irritation if it is not from HSV2? What about HPV? I have not been tested for this.
Thanks.
I'm honestly not sure what your question is.
I suggested previously that you repeat the WB at the 6 month mark and they will compare both tests to hopefully get you the final answer. I also suggested you stop valtrex previously. I have no other advice to give.
grace
I suggested previously that you repeat the WB at the 6 month mark and they will compare both tests to hopefully get you the final answer. I also suggested you stop valtrex previously. I have no other advice to give.
grace
Grace,
Get this. I had a routine physical exam from my doctor, and he decided to test for HSV2 one more time - almost a year after a suspected contact. I am still measuring very low positive about 1.4 with the HerpeSelect test. All of my test results have generally been between about 1.1 and 1.4. I have not had any other contacts since the last suspected contact, almost a year ago. Of course, I did the WB at 22+ weeks and it was indeterminate. My doctor is now starting to think that these are false positives, but can't be conclusive. I have never had an outbreak of any kind. He is a good doctor, but isn't too up to snuff on the HSV2 data on this site. I apologize for the lengthy post below, but I hope this compilation of info can be of use to others here.
I have read a lot of info on this site from both Dr's. There are many opinions, but both Dr's seem to agree here that it would be very, very unusual not to have higher antibody levels after a significant amount of time (almost 12mos for me now) - even while taking suppression therapy. Here are a couple of Dr comments about antibody levels:
by H. Hunter Handsfield, M.D., Mar 03, 2006 12:00AM
To: (deleted)
Antiviral therapy does not affecte the blood test results. You don't need to stop acyclovir.
by Edward W Hook, MD, May 22, 2008 10:02PM
3. They don't delay it much (I am inserting "antivirals" here, as it was part of the discussion). To be retested now would be very low yield. You had exposure to a low risk partner and were negative at 12 weeks. I would suggest that you should accept that you did not get herpes.
HHH, MD
************************
The Dr's also seem to suggest that in RARE cases (of which I hope I am not one), it is possible that the production of antibodies could be delayed by starting suppression therapy soon after diagnosis. I have been taking 500mg of Valtrex since I was first diagnosed, mostly because I didn't want to deal with an outbreak.
by Edward W Hook, MD, Apr 19, 2009 05:49PM
Among experts there has been discussion of rare patients with initial HSV-2 who have DELAYED antibody development as measured by both HerpeSelect and Western Blot which has been attributed to immediately starting suppressive therapy after diagnosis. In these anecdotes, when the patient is taken off suppressive therapy they sometimes go on to develop antibodies (and recurrences). This is a rare occurrence and there are no studies of this phenomenon at this time.
********************
Dr. Hook seems to indicate that if antibodies have not increased substantially (in the below example after only 4 more weeks and in my case now 11+ months), then this increases the odds of a false positive reaction.
by Edward W Hook, MD, Apr 14, 2008 10:12PM
To sort things out, I would repeat the HerpeSelect about 4 weeks after your last test. If the result is in the same range, this would even more strongly suggest a false positive reaction. If the result has increased substantially (to above 2.5-3.0) then you may have acquired HSV-2.
**********************
In this post by Dr. HHH, he seems to indicate that it would be virtually impossible to still test low positive after a year and be truly infected.
by H. Hunter Handsfield, M.D., Aug 14, 2008 03:46PM
You were misinformed about test interpretation. At least 90% of people with supposedly positive results, but with ELISA ratio values around 1.0 to 1.2, do NOT have HSV-2. And since you have not had sex for 2 years, it is not possible for you to have acquired HSV-2 recently. That would have been an unlikely explanation for the results you had, even if you had been at risk -- but in your case, a new HSV-2 infecion (infection) is simply impossible. And cross reaction with HSV-1 also isn't possible in the presence of a negative HSV-1 test result.
So the answers to your specific questions: "Would it be possible to contract it in September (or two years earlier, more likely) and still be reading such low numbers?" No, impossible.
"Or is the more likely explanation HSV-2 oral transmission?" That is also impossible, for all practical purposes.
You can move on in life confident you don't have HSV-2. Don't worry about it. (But if you want still more reassurance, ask your provider to do a confirmatory test, using either the BiokitUSA HSV-2 test, or the Western blot test. If you'll use the search link, you can find a large number of other discussions on all these points.)
Best wishes (and congratulations on being uninfected with HSV-2!)-- HHH, MD
***********
In this post by Dr. HHH, he indicates that a primary outbreak (which I have never had) would be followed by another outbreak (in most people) within 6 months, even if suppressive therapy is given.
by H. Hunter Handsfield, M.D., Jan 08, 2007 12:00AM
Too bad culture wasn't done. Why not? Culture shoud be done for every first episode of genital herpes.
Most likely your "primary outbreak" was not herpes at all. That's quite a bit more likely not developing measurable IgG antibodies after 6 months. Also, most people given suppressive therapy this soon after initial herpes would have had symptomatic recurrences within 6 months, despite Valtrex treatment. So if you have had no further outbreaks, that also suggests you didn't have herpes in July.
********************
In this post by Dr. EWH, he indicates that an indeterminate WB (which I have had) and low positives from other test assays (I believe HerpeSelect was referenced in the below post) are likely false positives. Also, evidently there are many things which can cause one to test slightly positive for HSV2 using the HerpeSelect test.
by Edward W Hook, MD, May 28, 2008 03:46PM
The indetrminant tests (on Western Blot I presume) just makes it more likely that this is not HSV. As to why your blood tends to be somewhat reactive- I cannot say. Ther are many potential reasons. Taking all that has gone on, my opinion is that it is unlikely that you have herpes. Hope this helps. EWH
by (deleted), May 28, 2008 04:16PM
To: Edward W Hook
Dr. Hook,
I really appreciate your time and perspective. They suggested a WB again in 3 months. Is it worth it, or should I just leave well enough alone.
by Edward W Hook, MD, May 28, 2008 04:25PM
If indeterminant or nagtaive at that time you will know that you do not have HSV. EWH
Get this. I had a routine physical exam from my doctor, and he decided to test for HSV2 one more time - almost a year after a suspected contact. I am still measuring very low positive about 1.4 with the HerpeSelect test. All of my test results have generally been between about 1.1 and 1.4. I have not had any other contacts since the last suspected contact, almost a year ago. Of course, I did the WB at 22+ weeks and it was indeterminate. My doctor is now starting to think that these are false positives, but can't be conclusive. I have never had an outbreak of any kind. He is a good doctor, but isn't too up to snuff on the HSV2 data on this site. I apologize for the lengthy post below, but I hope this compilation of info can be of use to others here.
I have read a lot of info on this site from both Dr's. There are many opinions, but both Dr's seem to agree here that it would be very, very unusual not to have higher antibody levels after a significant amount of time (almost 12mos for me now) - even while taking suppression therapy. Here are a couple of Dr comments about antibody levels:
by H. Hunter Handsfield, M.D., Mar 03, 2006 12:00AM
To: (deleted)
Antiviral therapy does not affecte the blood test results. You don't need to stop acyclovir.
by Edward W Hook, MD, May 22, 2008 10:02PM
3. They don't delay it much (I am inserting "antivirals" here, as it was part of the discussion). To be retested now would be very low yield. You had exposure to a low risk partner and were negative at 12 weeks. I would suggest that you should accept that you did not get herpes.
HHH, MD
************************
The Dr's also seem to suggest that in RARE cases (of which I hope I am not one), it is possible that the production of antibodies could be delayed by starting suppression therapy soon after diagnosis. I have been taking 500mg of Valtrex since I was first diagnosed, mostly because I didn't want to deal with an outbreak.
by Edward W Hook, MD, Apr 19, 2009 05:49PM
Among experts there has been discussion of rare patients with initial HSV-2 who have DELAYED antibody development as measured by both HerpeSelect and Western Blot which has been attributed to immediately starting suppressive therapy after diagnosis. In these anecdotes, when the patient is taken off suppressive therapy they sometimes go on to develop antibodies (and recurrences). This is a rare occurrence and there are no studies of this phenomenon at this time.
********************
Dr. Hook seems to indicate that if antibodies have not increased substantially (in the below example after only 4 more weeks and in my case now 11+ months), then this increases the odds of a false positive reaction.
by Edward W Hook, MD, Apr 14, 2008 10:12PM
To sort things out, I would repeat the HerpeSelect about 4 weeks after your last test. If the result is in the same range, this would even more strongly suggest a false positive reaction. If the result has increased substantially (to above 2.5-3.0) then you may have acquired HSV-2.
**********************
In this post by Dr. HHH, he seems to indicate that it would be virtually impossible to still test low positive after a year and be truly infected.
by H. Hunter Handsfield, M.D., Aug 14, 2008 03:46PM
You were misinformed about test interpretation. At least 90% of people with supposedly positive results, but with ELISA ratio values around 1.0 to 1.2, do NOT have HSV-2. And since you have not had sex for 2 years, it is not possible for you to have acquired HSV-2 recently. That would have been an unlikely explanation for the results you had, even if you had been at risk -- but in your case, a new HSV-2 infecion (infection) is simply impossible. And cross reaction with HSV-1 also isn't possible in the presence of a negative HSV-1 test result.
So the answers to your specific questions: "Would it be possible to contract it in September (or two years earlier, more likely) and still be reading such low numbers?" No, impossible.
"Or is the more likely explanation HSV-2 oral transmission?" That is also impossible, for all practical purposes.
You can move on in life confident you don't have HSV-2. Don't worry about it. (But if you want still more reassurance, ask your provider to do a confirmatory test, using either the BiokitUSA HSV-2 test, or the Western blot test. If you'll use the search link, you can find a large number of other discussions on all these points.)
Best wishes (and congratulations on being uninfected with HSV-2!)-- HHH, MD
***********
In this post by Dr. HHH, he indicates that a primary outbreak (which I have never had) would be followed by another outbreak (in most people) within 6 months, even if suppressive therapy is given.
by H. Hunter Handsfield, M.D., Jan 08, 2007 12:00AM
Too bad culture wasn't done. Why not? Culture shoud be done for every first episode of genital herpes.
Most likely your "primary outbreak" was not herpes at all. That's quite a bit more likely not developing measurable IgG antibodies after 6 months. Also, most people given suppressive therapy this soon after initial herpes would have had symptomatic recurrences within 6 months, despite Valtrex treatment. So if you have had no further outbreaks, that also suggests you didn't have herpes in July.
********************
In this post by Dr. EWH, he indicates that an indeterminate WB (which I have had) and low positives from other test assays (I believe HerpeSelect was referenced in the below post) are likely false positives. Also, evidently there are many things which can cause one to test slightly positive for HSV2 using the HerpeSelect test.
by Edward W Hook, MD, May 28, 2008 03:46PM
The indetrminant tests (on Western Blot I presume) just makes it more likely that this is not HSV. As to why your blood tends to be somewhat reactive- I cannot say. Ther are many potential reasons. Taking all that has gone on, my opinion is that it is unlikely that you have herpes. Hope this helps. EWH
by (deleted), May 28, 2008 04:16PM
To: Edward W Hook
Dr. Hook,
I really appreciate your time and perspective. They suggested a WB again in 3 months. Is it worth it, or should I just leave well enough alone.
by Edward W Hook, MD, May 28, 2008 04:25PM
If indeterminant or nagtaive at that time you will know that you do not have HSV. EWH
Grace,
How long should I stop the Valtrex before taking the WB test again? It is beginning to sound like I do actually have it, from what you are saying. Am I reading you correctly?
We don't know exactly how much starting suppressive therapy early on would delay detectable igg herpes antibody detection. Seems that in some folks it does and in others it doesn't. Since you have had such a convoluted time of testing, it's worthwhile stopping it and testing one more time.
grace
grace
Carphone,
I'm trying to understand what you are saying. So, if I read your comments correctly, you are intimating that I may actually have hsv2, but the valtrex is not allowing the creation of antibodies, is this correct? How is this possible? Is there cited research data that you can direct me to that suggests Valtrex can delay the creation of antibodies?
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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.
