herpes blood test, low positive

[helpme0775]

I called my doctor today and received some very confusing news. My herpes blood test, 90 days after possible exposure is still a very low positive. Let me explain: On dec. 13 2009 I had protected sex (condom) with a partner I later found out has "herpes", not sure type 1-2 or where. On Dec. 22 I was tested for all stds at the clinic. They found some bacteria in my urethra gave me antibiotics and all test for bacterial and hiv disease were negative. As far as the herpes results my biokit (in office) test was inconclusive, the test dot was barely visible, which the doctor said was either negative or in-determinate. My herpeselect was hsv1 = 0.60 hsv2 = 1.22. I had been tested in the past and my results were a clear negative, My numbers around 5-6 years ago (last time tested) were hsv1 = 0.60 hsv2 = 0.66, Biokit = neg.. On March 17, 2010 (3 mos. after pos. exposure) I retested with the same results. All bacterial and hiv disease negative. The biokit test stayed the same and the results for my herpeselect were hsv1 = 0.60 hsv2 = 1.24. I was expecting the test to be clear positive, end of story. My question is this, looking at all the details: having been totally negative in the past, no outward symptoms after 3+ months and my positive results being as low as they are, in your opinion do I have herpes? I have a scheduled western blot for the end of May. Assuming no symptoms between now and then can I trust the results of that test to be almost 100%? Can you give me more info. on low positive or false positive, what might make my number rise like that, if I am truly negative will my number ever go below 0.9 again? What are your feelings on testing negative 5-6 yrs ago and now having these low positive numbers? When I go for the western blot should I repeat the herpeselect and biokit test? Also, how does the number system work on the herpeselect test work? Are my 1.22 and 1.24 basically the same or would that be considered an increase?

[Terri Warren, RN, Adult Nurse Practitioner]

The numeric values are index values; they are a number that is arrived at in comparison to positive and negative controls that are run on the machine at the same time as your sample.  There are certain optical densities that the machine looks for, based on the amount of antibody detected in any given sample.  For example, if you look at a plate of 96 samples where some are positive and some are negative, you will see varying degrees of yellow color in the wells.  The dark yellow are positives.  This indicates a reaction that detects antibody.  But it all is in comparison to the controls that are being run at the same time.  I would say if you need more technical information you should look it up elsewhere on the internet, and I don't have a good reference for you.  Your values are all very close together, and to some degree, the cutoff values are not exact.  I would say that if you test negative on the western blot 4 months out from the exposure (it does not give a numeric value, just positive negative), you can be quite certain you are not infected.  That's as exact as I can get for you.

Terri

[helpme0775]

I wanted to ask you one other question. Can you explain to me how the number (results) for the herpeselect tests work? What do that numerical result actually represent? Is it looking for antibodies in the blood and getting that number based on the actual amount of detectable antibodies showing up? If so I'd have to think it would be a little more cut and dry to decipher results (esp. in the absence of hsv1)? Are there any Internet resources that could explain the testing process a little better?

[helpme0775]

Thanks for getting back to me so quickly. I know there aren't many clear answers for me right now. I just want to be as prepared as possible when I go for my western blot, have an outbreak, ect. When you say "I have seen people who test in this range both confirm and not confirm by western blot." do you mean there's a good chance the wb will come back equivocal? If my Western Blot is negative or positive at that point (4 mons.) should I stop all further testing? What if it does come back equivocal, should I retest at a later date? Also, what is your opinion on my negative test 5-6 years ago and now these 2 low positive tests. That is really making me believe I am truly +, why else would my numbers jump to the positive side like that? If I am truly negative will my numbers ever go back below the .9 cutoff?

If my numbers stay low positive, can I assume i've had the infection before my last partner and should tell my previous partners so they can also be tested? Before my partner in dec. I dated someone for about a year and that relationship ended in sept. 09.

BTW I read you book, great info and it made me feel much better, thanks for all your help.

[Terri Warren, RN, Adult Nurse Practitioner]

You have done the correct thing to schedule a western blot.  I wouldn't bother to repeat the ELISA or the Biokit tests anymore.  My guess is that you are not positive, but only time and testing will tell.   I have seen people who test in this range both confirm and not confirm by western blot.  You are in the classic situation that clinicians who don't want to test, describe.  Fortunately, there is a test that will hopefully sort this out for you.  I must tell you that there are also situations where the western blot will come back with an equivocal value with these low positives.  There is no significant change between the two test values, no.

I'm sorry this is not giving you the clear answer that I'm sure you would like to have, but right now, only time and the WB can give you more clarity.

Terri