Please Help me with specific vs non specific igg test!!

[meibijoux]

Hi Doctor,here's my story goes.In my last week of pregnancy,doc asked me to take HSV 1&2 for both IGG&IGM test.The test results was using ELISA i believe it is:
First test (15 August 2011) :
- HSV 1 igG : 3.16 *positive
- HSV 1 igM : 0.53
- HSV 2 igG : 0.24
- HSV 2 igM : 1.60 *positive
The test shows that i have antibody for HSV 1, and recent infection (igM) for HSV 2
Second test (20 August 2011) :
- HSV 1 igG : 1.45 *positive
- HSV 1 igM : 0.48
- HSV 2 igG : 0.08              
- HSV 2 igM : 1.73 *positive
The test result came out on 22 Aug,we decided to go on under c-section.After c-section was done, my baby's doctor asked me to have him check and get a blood test.
Here is my BABY result :
- HSV 1 igG : 1.62 *positive
- HSV 1 igM : 0.07
- HSV 2 igG : 1.30 *positive
- HSV 2 igM : 0.12
I was really confusedddd... why my baby has made his own igg antibody for HSV 2 while mine is still positive in igm?Then i get retested again on 5 Sept 2011 :
- HSV 1 igG : 2.6 *positive
- HSV 1 igM : 0.29
- HSV 2 igG : 0.05
- HSV 2 igM : 1.57 *positive
The test results come out the same again that i dont have antibody for hsv 2 and my hsv 1 is a low positive! i read ur article that any number between (1.1-3.5) could be false positive. what i wanna ask is:
1) Am I really positive in HSV 1? and what's the difference between specific gg test vs non specific igg test? could my HSV 1 be a false positive? ive been in r/s with my hubby for abt 8yrs and marriage for almost 2 yrs. but his result for both hsv 1&2 for igg&igm is negative. or that test is accurate but just have to ignore the igm?
2) Im going to retest it again nx week using specific igg test. will the result be different? cos i dont have coldsores before or any other outbreak.sometimes when my lips dry and i not accidentally bite it theres a small bump but it healed in only an hour,and i ever got crotch rash cos my upper thigh is big due to pregnancy.. but it healed with only anti allergy powder. is that hsv 1? pls help me

[H. Hunter Handsfield, M.D.]

Thanks for the thanks.  However, I doubt your depression is due only to "all this", i.e. only the herpes business.  I'm worried about post-partum depression as an underlying illness.  Please believe me when I tell you that you have nothing to worry about with respect to herpes and your baby.  But do deal with the underlying problem.  Talk to your gynecologist or current primary care provider about it as soon as you can get an appointment.  Do not delay.

[meibijoux]

Yes, im very depressed and anxious about all this.I almost getting crazy..I spent almost 20 hour/day just to search all things related to hsv 1 because i never had any symptoms before and reading about all article, forum in internet really makes me feel more depressed. i dont understand why everyone just concern about hsv 2? i think hsv 1 is also very dangerous because it can spread/transmit it to genital, eye, and other part of the body and also can transmit it to other people without u knowing it. and somemore, i dont know when i get these virus, so i scared i might harm the baby by giving them the igg antibody that will make the virus reactive in their body anytime. If i knew i had this, i would never get married or give birth because i dont want to harm anyone.

sorry for my million questions, i asked you because i believe there's no other expert as you that know all information about this disease. especially in my country! u dont need to reply this thread,doctor. i just wanna say thank you and i really appreciate ur help. :)

[H. Hunter Handsfield, M.D.]

Your baby has a positive antibody test.  However, most likely that's simply because her blood contains some of your own HSV-1 antibody.  If your baby had HSV-1, she would be extremely ill -- you would know it for sure.  Discuss it with the pediatrician, who might recommend the baby be retested in a few months.  If that is done, I would expect the result to be negative.

You are remaining overly anxious about all this. It makes me worry that there might be another underlying mental health problem, such as post-partum depression (?).  Please discuss these things in detail with your own doctors.

That's definitely all for this thread; I will have no further comments or advice.

[meibijoux]

please help me with one more last question doctor.. this is about my baby..

- if i really had hsv 1, is that mean that my baby has antibody for hsv 1 too? because his hsv 1 igg is positive. and is that mean my baby gonna deal with herpes for the rest of his life? when would the outbreak occur for a baby? thanks

[H. Hunter Handsfield, M.D.]

Yes, but it isn't common.  If you have no oral cold sores, you can be confident you won't transmit the virus.

That will have to end this thread.  I won't have any further comments or advice.  Good luck.

[meibijoux]

can hsv 1 transmit without any outbreak, doctor? thanks for your reply. i really appreciate it.

[H. Hunter Handsfield, M.D.]

Most likely your IgG HSV tests were specific for HSV-1 and 2, so I do not believe the thread you cite is pertinent to your situation.

It is very unlikely your HSV-1 test result is false.  According to a study published 4 years ago (2007), 75-85% of Indonesian women have positive blood tests for HSV-1.  So you're just like almost all your countrywomen!  The numerical result on your test makes no difference:  if you were to have 10 more tests, you probably would see the number vary from 1.5 to 5.0; it doesn't mean anything either about symptoms or potential to transmit the infection to your children, husband, or anyone else.

So your HSV-1 test result really isn't something to worry about.  The good news is that you don't have HSV-2, which is a much more important problem than HSV-1.  But if you remain concerned, you can discuss it with the baby's doctor (as I already suggested) and your own doctor.  They will give you the same kind of reassurance I have done.

[meibijoux]

Thank you doctor. i am strongly believe that i don't have HSV 2. because i had post a discussion with gracefromhhp, therefore i know that igm test is a very flawed test especially in my case, i didnt have any sexual intercourse with my hubby during 9 months pregnancy. But im really aware with my HSV 1.

I read from this forum http://www.medhelp.org/posts/STDs/HSV-1-positive-with-no-syptoms/show/376699 and Doctor Edward w Hook said "If it tested for both IgG and IgM then this was not a gG-based blood test and thus is somewhat less reliable than the gG-based tests" because that person's hsv 1 igg is positive , hsv 1 igm is negative. and have both hsv 2 igg&igm negative. and when he tested with specific gg based test, both of his hsv 1 and 2 igg are negative.


In that forum, doc Edward also said "The non-specific tests are just not very reliable and tend to raise more questions than they answer. This is particularly the case when tests give low positive results and is so much of a problem that in many clinics, experts will not accept a positive serological test until the results are strongly positive ( with ODs >3.5 via Herpeselect"

I really wish i dont have this kind of disease, because i had two babies and a hubby that im afraid i will transmit it to them someday. so what i want to ask.. is there any possibilities that my non specific gG-based blood test is false positive ? and is there any chance when i take the blood test next week using specific gG based test my results will be negative? --->  http://www.medhelp.org/posts/STDs/HSV-1-positive-with-no-syptoms/show/376699 (like this person case and also like what ur article says that every number between 1.1 - 3.5 can be a false positive??) or does that false positive range number only for hsv 2?

and can hsv 1 transmit without any outbreak? im really depressed right now, i dont dare to kiss my baby, i dont dare to kiss hubby or giving oral sex to him. because im afraid i could transmit it to his genital. i don't know what cold sores are. and so far, i never met a person with a cold sore outbreak ever in my life. so i'm not really sure what it is. Maybe that's common in US, but not here in Asia.  

what's the difference between hsv 1 genital and hsv 2? the outbreak still showing lesions right? and i also read from other forum that any number above 3.5 is strongly positive, but now u're saying mine is also positive while i have never had any outbreaks before.
and saying if i really have HSV 1 .. could it be my igg will increase to be greater than 3.5 and will increase more in the future? or the number just really no meaning at all?

and about my baby, if im positive with hsv 1 that means my two babies had that hsv 1 antibody as well right? then what is the risk for them?

and if somebody gets pregnant, but the virus hsv 1 suddenly reactive without any outbreak, then how can someone know about it?

im sorry if i asked too many questions doctor... but i really wanted to know how can these things can be really confusing. its like everything is so blur. and its really hard to make sure about it. i really appreciate your help. thanks.

[H. Hunter Handsfield, M.D.]

Welcome to the forum.  I have good news for you:  although you are infected with HSV-1 (like half the US population), you do not have HSV-2.

First, your IgM test results can and should be completely ignored.  It is a very poor test, does not accurately distinguish older from newer infections, does not accurately distinguish HSV-1 from HSV-2, and positive results are often false.  Your IgG results show that your apparently positive IgM HSV-2 results are false.  Here is a thread that explains the IgM test problems in more detail:  http://www.medhelp.org/posts/STDs/Confusiion-over-other-IgM-Herpes-posts/show/248394

Your baby's weakly positive IgG test for HSV-2 undoubtedly is false.  Your test results prove you do not have HSV-2, therefore it is not possible the baby was infected.  And although a value of 1.30 is technically positive, most truly positive results have values of 3.5 or higher.  Here is a thread that goes into this aspect of HSV-2 blood tests:  http://www.medhelp.org/posts/STDs/IGG-Test-Result-Confusion/show/593272

To your specific questions:

1) As for HSV-1, even though your later results had low-positive numbers, it is quite certain you are infected with HSV-1.  First, your initial test was strongly positive; and, unlike HSV-2, HSV-1 values on ELISA testing often vary widely.  As noted above, half of all adults in the US (more in some countries) have positive blood tests for HSV-1.  Most of these are the result of oral herpes, often in childhood and often without symptoms like recurrent cold sores.  You should be on the alert for possible oral herpes outbreaks (cold sores, etc), and if that happens, take precautions to protect transmission to your baby, especially before a month of age (e.g., no kissing if you have an outbreak).  It is normal for couples to be married for years without HSV-1 being transmitted, so your husband's negative test results are not a surprise.

2) These symptoms do not suggest herpes, and in any case for sure you don't have HSV-2 and it is unlikely your HSV-1 infection is genital.  I see no need for you to have any additional testing for HSV.

My final advice is that you bring your baby's pediatrician up to speed on all this.  Make sure s/he knows your testing history, the baby's test results, etc.  The chance you will infect your baby with HSV-1 is low, but s/he will be able to confirm my advice above and fill in any additional questions you may have about it.

So all is well.  Neither you nor the baby has HSV-2 and there shouldn't be any problem with your baby's health.

I hope this helps.  Best wishes--  HHH, MD