Dealing with uninformed family physicians re (HSV2)

[hadley07]

The focus of my post is how to deal with a family doctor who is uninformed about HSV, a topic I have not seen covered in much detail.

Per request my doc gave me a type specific test, because I have had cold sores, albeit rarely.  My results were:
IgM: Not Detected.
IgG HSV1 >5
IgG HSV2 1.35
(I called the company, Quest, it was a HerpeSelect test.)
No history of genital o/b, symptoms or risky behavior/partners. 1 partner w/in last year. I am male – 27 y/o.

I asked about a confirmation test and got a blank look, but was told he could reorder the same test in 4 weeks.  I asked about BioKit or Western Blot, he had not heard of BioKit and said a Western Blot was for HIV.  He said if I wanted to research the topic and possible tests and drop off some research he would look at it despite the fact I told him about the other available tests.  I was disappointed that my doctor would put the burden of researching a medical topic on an untrained patient.  I don’t think he knew much about the IgG test, possible false positives or alternative tests.  

My questions are essentially two fold:
1. What reading/literature would you recommend to a doctor with little knowledge of HSV or testing methods/best way to educate dr.   I want to bring the following:

The following threads which I found very helpful:
http://www.medhelp.org/posts/show/360840
http://www.medhelp.org/posts/show/577241?post_id=post_3187770
http://www.medhelp.org/posts/show/593272?post_id=post_3258954
http://www.medhelp.org/posts/show/581379
http://www.medhelp.org/posts/show/605868?post_id=post_3313416

The following study:
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1276011
Indicates that for tests in the range of 1.1 – 1.5 there can be a false positive rate of 85-90%!  

Material on the tests from the ASHA website.

2. Is below testing is appropriate to rule out false positive:
Another HerpeSelect w/ Inhib Assay and a Biokit - WB to confrim if BK is postive.

[Edward W Hook, MD]

Thanks for the update.  Glad to hear of the good communications between you and your doctor.  The Biokit is the way to go.  I look forward to hearing the results.   EWH

[Edward W Hook, MD]

Actually, I think that you are in pretty good shape here.  You have a doctor who is willing to learn from you, something that, sadly, not all health care professionals are open to.   I am not making excuses here but it is important to point out that in the past 10 years everything that we thought we knew about herpes has been turned inside out. IN fact, the "older", no longer correct information is still taught in some medical schools.  The concepts of asymptomatic shedding, suppressive therapy to prevent transmission and new insights about diagnostic testing have changed just about everything about how herpes is now approached.  In addition to the materials you have found, your doctor can also get something from his Glaxo Smith Kline representative called the "Herpes Toolkit" which is also a good teaching tool.  

As for your situation, from what you say and the results you provide, the odds are quite high that your "positive" HSV-2 test is actually false positive. A Biokit or Western blot will confirm that this is the case.  If your doctor calls his laboratory they can find out where he can get a Biokit or can send your serum to the University of Washington for a Western blot.  Alternatively, I'll bet if you contact folks on the MedHelp Herpes community (the link is on the right side of this message) someone there may be able to suggest where you can get a Biokit test performed locally.

I hope this is some help.  As I said, your situation is better than the all too common situation of doctors who would not be open to information from you.  EWH

[hadley07]

I also wanted to say thank you for your response to my first post and generally for talking the time to offer your expertise as your response on other threads have been invaluable.  Thank you!  

[hadley07]

Just wanted to update:

I gave the above referenced materials to my doctor and I recieved a receptive response.   Upon discussion we agreed additional testing was warranted.  My Dr. ordered another HerpeSelect, but w/ Reflex to inhibition.  Only tested for HSV2 as my prior HSV1 was 5+.  Results were as follows (test was done 14 days after 1st test):

HSV 2 IGG, Herpeselect = 1.63H EIA value.
HSV 2 IGG Inhibition, ELISA = Positive
XE

My current partner's results came back at less that .15 for both HSV1 and HSV2.  I've been exclusive with my current partner for 9+ months so I don't believe I have a risk for recent exposure.

Based on what I have read here it seems the positive ELISA test is not definitive and I am also not sure how the two tests differ.  The only reference to the differences between the tests I could locate was at http://www.medhelp.org/posts/show/609101.  There,  Dr. Hook indicated that the two test are very similar and can't be considered different results.  

My Dr. is now checking into obtaining a Biokit test.