Aa
HerpeSelect false negatives // reasons to test
This is a question if possible for Dr Handsfield since he has answered many in this general topic range before...if at all possible. Here goes...I have previously asked doctors to include a HerpesSelect 1/2 test (one that differentiates between the types) when I've gone in for yearly STD checks. This has never been an issue. My most recent doctor now says he doesn't like to do this test due to the possibility of false negatives, which was news to me until I started researching on the forum...
1.) I have previously tested negative for BOTH types of HSV, 1 and 2. In a case like this, how common is it that the HSV2 number would 'bump' up above the 1.0 range, generating what could likely be a false positive? From the forum it seems like this has happened to quite a few people, but perhaps they are the outliers??
2.) Let's say since my last HSV1/2 test I managed to contract oral herpes of the type 1 variety. Would this recent infection then lead to the possibility of having my HSV2 number jump up abnormally into the potential false positive range of 1-3?
3.) Overall, do you recommend HerpesSelect testing as a normal STD check-up type thing, in the absence of either lesions/sores in the genital region or some other concern (i.e. a past partner saying they are HSV2+?) If one simply got the HerpesSelect every year as a general precaution, as I tend(ed) to do, would the chances of a false positive at some point be pretty high?
And lastly, an unrelated question regarding symptoms...I've been experiencing a range of symptoms that I've brought to my doctor, mainly a slight pain after urination (lasted about a month, I imagine it's a UTI), also a bit of muscle pain in back and lower back, plus intermittent pins-and-needles tingling which can occur on BOTH sides of my body...Do any of these symptoms on their own suggest HSV, or would they generally be accompanied by visible sores?? And would 'symptoms' like this warrant HerpesSelect testing in your mind?
1.) I have previously tested negative for BOTH types of HSV, 1 and 2. In a case like this, how common is it that the HSV2 number would 'bump' up above the 1.0 range, generating what could likely be a false positive? From the forum it seems like this has happened to quite a few people, but perhaps they are the outliers??
2.) Let's say since my last HSV1/2 test I managed to contract oral herpes of the type 1 variety. Would this recent infection then lead to the possibility of having my HSV2 number jump up abnormally into the potential false positive range of 1-3?
3.) Overall, do you recommend HerpesSelect testing as a normal STD check-up type thing, in the absence of either lesions/sores in the genital region or some other concern (i.e. a past partner saying they are HSV2+?) If one simply got the HerpesSelect every year as a general precaution, as I tend(ed) to do, would the chances of a false positive at some point be pretty high?
And lastly, an unrelated question regarding symptoms...I've been experiencing a range of symptoms that I've brought to my doctor, mainly a slight pain after urination (lasted about a month, I imagine it's a UTI), also a bit of muscle pain in back and lower back, plus intermittent pins-and-needles tingling which can occur on BOTH sides of my body...Do any of these symptoms on their own suggest HSV, or would they generally be accompanied by visible sores?? And would 'symptoms' like this warrant HerpesSelect testing in your mind?
MEDICAL PROFESSIONAL
Some labs start with a non-type specific HSV antibody test, which checks for antibodies to HSV-1, 2, or both. I think this is the test that was done in your case. If positive, the lab automatically does the type-specific tests to tell which type of antibody is present. However, a negative result is highly reliable. That said, I believe Quest always does the truly type-specific tests, so if your specimen was tested at a Quest lab, most likely it included both HSV-1 and HSV-2 type-specific tests. Either way, this information doesn't change my opinion or advice. You can be confident you aren't infected with HSV.
That should wind up this thread. Take care, and try to stop worrying about herpes.
That should wind up this thread. Take care, and try to stop worrying about herpes.
Thank you again for your help, this is really the last, last follow-up.
I went back to read my correspondence with the doctor who'd done the last HSV test for me. His response simply said that the "HSV1/2 test was negative," which got me concerned that instead of ordering the two type specific tests he'd ordered the combined 1/2 test, which I know no one recommends. As I said, I've previously been negative for type 1...so if he did order the COMBINED 1/2 and got a negative result, can I rest easy knowing that this simply means I'm negative for BOTH types?
Also I don't know if he ordered the IgM or IgG test...this was through Quest...does that matter?
I went back to read my correspondence with the doctor who'd done the last HSV test for me. His response simply said that the "HSV1/2 test was negative," which got me concerned that instead of ordering the two type specific tests he'd ordered the combined 1/2 test, which I know no one recommends. As I said, I've previously been negative for type 1...so if he did order the COMBINED 1/2 and got a negative result, can I rest easy knowing that this simply means I'm negative for BOTH types?
Also I don't know if he ordered the IgM or IgG test...this was through Quest...does that matter?
MEDICAL PROFESSIONAL
You have it right. You can be 100% confident you don't have genital herpes. I urge you to try to stop worrying about it. Stop testing for HSV and go on with your life.
Just to clarify a previous comment:
"Although herpes can cause a variety of nonspecific symptoms, some of which may be similar to yours, such symptoms are rarely if ever the only symptoms of herpes."
Meaning that if one experienced any 'nonspecific symptoms' (pain urinating, muscle or back pain, etc) they would almost in all cases be accompanied by visible lesions or herpes sores? And that any of those nonspecific symptoms in the absence of visible sores are likely from another cause?
"Although herpes can cause a variety of nonspecific symptoms, some of which may be similar to yours, such symptoms are rarely if ever the only symptoms of herpes."
Meaning that if one experienced any 'nonspecific symptoms' (pain urinating, muscle or back pain, etc) they would almost in all cases be accompanied by visible lesions or herpes sores? And that any of those nonspecific symptoms in the absence of visible sores are likely from another cause?
MEDICAL PROFESSIONAL
The numerical results are provided by the lab to the doctor. They were never designed to be transmitted to patients -- i.e. your doctor is following protocol by just telling you the negative result without conveying the number. However, in today's world, with so many patients expecting to participate more directly in their care, they often are given the full results including numerical values. This is fine as long as the patient understands the details -- but a lot of people having HSV test are confused exactly on this point, i.e. an apparent change of value from say 0.7 to 0.4 or vice versa; some have trouble accepting that the numerical difference is meaningless. It has to do with the technology of the test, and does not imply variation in a small amount of anti-HSV antibody.
Thanks doctor, this is INCREDIBLY helpful, esp. the linked post.
When results come back to your primary care though, it's not left up to the determination of the doctor though, right? Meaning the if the value is less than .85 it'd read NEGATIVE, if it's between .9 and 1.1 there'd clearly be the word EQUIVOCAL, and so on? I only ask because my last primary care doctor was somewhat of an incompetent curmudgeon, and he delivered my HSV1/2 results via EMAIL simply by saying they were both negative, without clarifying the #s themselves. I'd just like to know that he was simply reading whatever the print-out from the lab specifically said, rather than making any judgment calls on his own...since I wouldn't trust those.
Thanks again!!
When results come back to your primary care though, it's not left up to the determination of the doctor though, right? Meaning the if the value is less than .85 it'd read NEGATIVE, if it's between .9 and 1.1 there'd clearly be the word EQUIVOCAL, and so on? I only ask because my last primary care doctor was somewhat of an incompetent curmudgeon, and he delivered my HSV1/2 results via EMAIL simply by saying they were both negative, without clarifying the #s themselves. I'd just like to know that he was simply reading whatever the print-out from the lab specifically said, rather than making any judgment calls on his own...since I wouldn't trust those.
Thanks again!!
MEDICAL PROFESSIONAL
4) Yes. All results below the cut-off are truly negative. There is no difference, for example, between ELISA values of, say, 0.3 and 0.85.
5) You are correct that most false positive results are in the gray range. Official interpretation of the commonly markted HSV-2 tests (incluidng HerpeSelect) is that any value over 1.1 is positive. (0.9 to 1.1 is officially equivocal.) However, the likelihood of a true positive result rises with increasing numerical values. Probably only 10-20% of values of 1.2 are truly positive; around 50% of those at 2.0; and it's only values of 3.5 and higher that are definitely positive.
Here is a thread that explains why there is a difference between the official cut-off values (according to the test manufacturer) and the reliable results according to herpes experts: http://www.medhelp.org/posts/STDs/IGG-Test-Result-Confusion/show/593272
5) You are correct that most false positive results are in the gray range. Official interpretation of the commonly markted HSV-2 tests (incluidng HerpeSelect) is that any value over 1.1 is positive. (0.9 to 1.1 is officially equivocal.) However, the likelihood of a true positive result rises with increasing numerical values. Probably only 10-20% of values of 1.2 are truly positive; around 50% of those at 2.0; and it's only values of 3.5 and higher that are definitely positive.
Here is a thread that explains why there is a difference between the official cut-off values (according to the test manufacturer) and the reliable results according to herpes experts: http://www.medhelp.org/posts/STDs/IGG-Test-Result-Confusion/show/593272
One thing I forgot to include--
4.) If a HerpesSelect HSV2 result is just shy of 1.0, is it definitely safe to assume that it is indeed NEGATIVE? Or since these numbers seem to bounce around quite a bit, should one be retested?
5.) If the HSV1 result is negative and the HSV2 number is ABOVE 1.0, is the chance that the HSV2 is a false positive much less? It seems like most of this false positive business has to do with situations in which HSV1 is positive and is somehow affecting or bumping up the HSV2 number into a sort of grey area range...
OK, that is really all. Thank you!!!
4.) If a HerpesSelect HSV2 result is just shy of 1.0, is it definitely safe to assume that it is indeed NEGATIVE? Or since these numbers seem to bounce around quite a bit, should one be retested?
5.) If the HSV1 result is negative and the HSV2 number is ABOVE 1.0, is the chance that the HSV2 is a false positive much less? It seems like most of this false positive business has to do with situations in which HSV1 is positive and is somehow affecting or bumping up the HSV2 number into a sort of grey area range...
OK, that is really all. Thank you!!!
MEDICAL PROFESSIONAL
Welcome to the forum. FYI (and for other users), it is only by chance that I was online when your question arrived and that I am answering and not Dr. Hook. We take questions interchangeably, disregarding requests for one of us or the other. We both answer questions on all topics with equal frequency and competence, and our views never differ significantly -- even if our styles are somewhat different from one another.
To start, my advice agrees with your doctor's. In fact, this question offers an opportunity for a blog-like response in anticipation of future questions about use of the HSV blood tests.
Bood testing to screen asymptomatic persons for herpes is controversial. Some experts believe there is rarely a need and almost never recommend it. My view doesn't go that far. However, I would not recommend yearly testing in anyone, except in those at particularly high risk for genital herpes, such as the regular partners of known-infected persons. Of course diagnostic testing is also often necessary in people with symptoms that suggest herpes, but most sexually active people without symptoms should probably not be tested regularly. One good approach would be to wait until you are planning a permanent, committed relationship; e.g. someone about to marry after several years as a sexually active single. To your specific questions:
1) If I may rephrase it, you are asking how often someone with definitely negative HSV blood test results might in the future experience minor low-positive results. There has been no research to answer it directly. However, clearly there is at least a small chance. This is one of the arguments against routine screening, i.e. a chance of low-level false positive results that require substantial re-testing to sort out the truth, usually accompanied by substantial emotional distress.
2) False positive low-level HSV-2 results indeed appear to be someone more common in people with HSV-1. But I cannot put a numerical estimate on this.
3) See my opening comments.
4) The symptoms described do not suggest herpes and would not be a suitable basis for HSV blood testing. Although herpes can cause a variety of nonspecific symptoms, some of which may be similar to yours, such symptoms are rarely if ever the only symptoms of herpes. For example, herpes lesions may burn or tinging, but burning or tingling sensations of the genitals without visible lesions are rarely if ever due to herpes.
I hope this helps. Best wishes-- HHH, MD
To start, my advice agrees with your doctor's. In fact, this question offers an opportunity for a blog-like response in anticipation of future questions about use of the HSV blood tests.
Bood testing to screen asymptomatic persons for herpes is controversial. Some experts believe there is rarely a need and almost never recommend it. My view doesn't go that far. However, I would not recommend yearly testing in anyone, except in those at particularly high risk for genital herpes, such as the regular partners of known-infected persons. Of course diagnostic testing is also often necessary in people with symptoms that suggest herpes, but most sexually active people without symptoms should probably not be tested regularly. One good approach would be to wait until you are planning a permanent, committed relationship; e.g. someone about to marry after several years as a sexually active single. To your specific questions:
1) If I may rephrase it, you are asking how often someone with definitely negative HSV blood test results might in the future experience minor low-positive results. There has been no research to answer it directly. However, clearly there is at least a small chance. This is one of the arguments against routine screening, i.e. a chance of low-level false positive results that require substantial re-testing to sort out the truth, usually accompanied by substantial emotional distress.
2) False positive low-level HSV-2 results indeed appear to be someone more common in people with HSV-1. But I cannot put a numerical estimate on this.
3) See my opening comments.
4) The symptoms described do not suggest herpes and would not be a suitable basis for HSV blood testing. Although herpes can cause a variety of nonspecific symptoms, some of which may be similar to yours, such symptoms are rarely if ever the only symptoms of herpes. For example, herpes lesions may burn or tinging, but burning or tingling sensations of the genitals without visible lesions are rarely if ever due to herpes.
I hope this helps. Best wishes-- HHH, MD
You are reading content posted in the STDs Forum
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.
