Low Positive HSV2 Test?

[andrewdrew]

This has been an exceptionally challenging time with lots of stress from deaths where I have been the primary caregiver to a parent.  I have been happily married for 12 years; I have been faithful the entire time up until the last 18 months. In the last year I have received erotic massages (4-5 times).  I have never had intercourse, only manual stimulation.  In the last 10 days, during an alcohol binge, I received protected oral and vaginal sex during a one night stand.  I immediately knew I'd crossed a significant line and I became very worried about STDs and possibly infecting my wife. I am wracked by guilt and I want to confess to my wife about this my behavior, but I want to be sure of my medical situation.  5 days ago, I had a full panel of STD tests performed at a clinic and I was negative for everything including HSV1 but a positive low (1.2) reading for HSV2 - I believe the test was a Herpes 1&2 IgG ELISA. I received the results via phone. Based on what I have read, this might either be a false positive test, or my infection may be from a long ago.  To my knowledge, I have never been tested for STDs before, although I have regular physicals and life insurance medical tests, so they might be included.  I also do not believe my wife has been tested for STDs, although she might have been during the pregnancies for our children.  We have oral and vaginal sex for 14 years and we have both been entirely asymptomatic for STDs.  I have abstained from sex with her since my recent infidelity and I would like to re-test for HSV2 to confirm the results.  Again, We each had numerous sexual partners before we were married. I do not want to subject her to testing unnecessarily, but I have a couple of questions.
- Is HSV tested for normally in physicals, insurance exams or pregnancy testing?
- It seems unlikely, but would my most recent encounter have caused this positive test?  
- What is the appropriate confirming test? Biokit and WB? Would another IGg test be helpful?

[Edward W Hook, MD]

Welcome to the Forum.  I'm sorry to hear of your recent losses and the related emotional unrest you describe.  While I will provide more detail below, the bottom line is that the sorts of exposures you describe are VERY low risk for STD of any sort, including herpes.  I would be VERY surprised if your low positive HSV test result represented recent infection.  So, let's first get the facts straight and put your likelihood of infection into its proper place:

1.  The exposures you describe are very low risk for acquisition of HSV.
2.  Further, if you had acquired HSV you would most likely have had an outbreak which you would have noticed.  Most people do.
3. Your blood test.  The number of the result is important here.  The closer the number to the so-called "cut off" for defining positive tests, the more likely it is that your test is falsely positive. With values less than 2.0, 50-80% of so-called positive results are actually falsely positive.
4.  Given your history and circumstances, if you really do have herpes, as I said, it is unlikely to be a recent infection and it is more likely to be something you have had for years.  Indeed, we regularly do see partners in who one partner is infected and the other is not in which transmission does not occur.
5.  If you feel you must sort this out, either a Biokit assay (sometimes marketed as a SureVue) or a Western blot will serve the same purpose but taker longer and be more expensive. A negative test with either of these assays or an equivocal Western blot would mean that your test was falsely positive.

As for the questions you asked:
1.  No, HSV testing is rarely routine.
2.  See above, again, if you have HSV it is unlikely that this is a recently acquired infection.
3.  See no. 5 above.

I hope these comments are helpful.  EWH

[Edward W Hook, MD]

Sorry, I'm not sure where you might find it. You might ask on the MedHelp HSV Community site or check at the American Social Health Association as to where you might get a Biokit test. EWH

[andrewdrew]

Thank you, Dr. Hook.

I appreciate your thorough and rapid response, as it was quite reassuring.  I understand that the normal cut-off is 0.99 for the HSV2 test that I received, although I will confirm this with the clinic.  If I choose to receive at Biokit assay (or Surevue) where should I go to receive this test and what is the approximate time-frame for results?  I live in NY, so I would imagine the availability would be quite accessible.

Thank you, again.