question about lab metrics

[Himmelhund]

Dear Dr.

I have only had three sexual partners. I have been married twice, in both cases I know we were monogamous.  I have been in a monogamous relationship (on my part) with another woman for three years. I just found out that she did have an a short affair and, she has tested positive for HSV-2, in mid-December about four days after two sexual encounters with the same person--- as she had an outbreak and it was tested (although not typed she has just told me: she was but on a round of anti-viral medicne and is asymptomatic now. Her doctor, I take it assumes she has HSV-2.

I received only oral sex from her *before* she found out and that is it. I have never had symptoms of genital herpes in my life and still do not although I am  aware one can be asymptomatic for life (but still shed virus).  I am a 54 four year old heterosexual male.  I decided to get tested on off chance one could contract HSV-2 from oral sex.

First test: IgM:
1.54.

Second test:  IgG for HSV-1  was 0.33
                     IgG for HSV-2  was 2.00

I am confused and I wonder if the numbers may have been transposed.  I have, all my life had oral herpes and, as noted above, suffered quite bad bouts. However the second test suggests I *don't* have HSV-1 at all; but instead, *only* have have HSV-2. I am not sure what to make of these results.  hat the heck was the 1.54 result? And why did the second typing test not demonstrate oral herpes, but *only* HSV-2.  Do these test results and the history I just described make any sense? Of course there is the possibility my girlfriend may have been previously infected and asymptomatic until recently, she has had more partners than I have had. When she was on birth control we did have unprotected sex. Often, most of the time I did use a condom as she was not on birth control. We did engage in unprotected oral sex.  

Thanks very much for whatever light you might shed on this matter.

[Edward W Hook, MD]

Several comments about blood tests for HSV are relevant to your situation.  

First, with regard to your IgM test.  Forget it.  The IgM test for herpes virus is not recommended by any expert in our field. There are far too many false positive tests and interpretation is close to impossible.  We do not recommend IgM tests and when our clients have them, we urge them to ignore whatever result one gets.

Second, you may not have any sort of HSV at all.  Sometimes people mix up cold sores due to oral infection with HSV-1 with canker sores which are similar but tend to occur inside of the mouth and are not caused by HSV.  To find out if your oral sores are due to HSV, I would suggest that the next time one appears get a culture or PCR test taken from the lesion as soon as possible after it appears.  

As for your HSV-2 test result, it is in the range where over 50% of tests are actually falsely positive and reflect the cross reaction of other antibodies in your system with the test, not HSV.  Since the tests have come to market, subsequent research has shown that over 50% of type-specific HSV-2 tests which are reactive in the range of 0.0 to 3.5 are falsely positive. To find out if you truly have HSV-2, you need to have a second test such as the Biokit or Sureview tests or to have a blood test sent to the University of Washington for a Western blot test (more expensive and takes longer to come back). These tests are based on protein fragments unrelated to the proteins used in the HerpeSelect-type test which is what it sounds like what you were tested with.  If the Biokit/Sureview result is negative, you do not have HSV-2, you have a false positive HSV-2 test.

Finally, if you do have HSV-2, the test cannot tell you how long you have had it or how long you have had it.  About 90% of persons who have HSV-2 do not know they have it.

To learn more information about herpes can be obtained by accessing excellent informational web sites such as the one run by the American Social Health Association (disclosure, Dr. Handsfield and I are both on the Board of Directors of ASHA).

Hope this helps.  EWH

[Himmelhund]

Dr. Hook,

Thanks very much for you response. Yes I have the cold sores very badly in my life...and canker sores. I do appreciate the information you supplied and will have another test.  Again, thanks so very much.