[Question #10612] possible HSV2 infection
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21 months ago
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Hi,
I'm a straight, married man, and I see CSW's monthly. Although I partake in unprotected oral sex, I always use condoms for vaginal intercourse, ensuring whole-shaft coverage, and never do bare genital-to-genital rubbing. I've never had a condom break.
Despite zero STI symptoms, an HSV2 IgG test came back today with index 1.35, "inhibition" pending. Moreover, I had unprotected sex with my wife 1.5 weeks ago (1st time in 2 years) and she has not complained of any symptoms, for now. Obviously, this is surprising and unsettling.
Can you speculate as to the likelihood of a false positive and do you suggest a Western blot?
Thank you
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21 months ago
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One other detail I forgot to mention is that I recently received the shingrix vaccine for shingles. First shot was in late August and the second was 2 weeks ago. There's some discussion online that this can confuse standard HSV blood tests. I hope that's what happened in my case.
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Terri Warren, RN, Nurse Practitioner
21 months ago
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We actually don't know what causes false positives on the IgG test but we do know that they are very common indeed. Do you have the inhibition assay back yet? We have seen false positives on that test as compared to the gold standard western blot so if positive, but you have no symptoms, I would recommend the western blot for confirmation. If the inhibition assay is negative, there is excellent agreement between people who get negative inhibition assays and subsequently, negative herpes western blots. I think with a 1.35, there is an 85% chance that this is a false positive. Your sexual activities have been careful with good condom use. Let me know the inhibition results, please, when you get them. I am assuming this is from Quest.
Terri
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21 months ago
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Thank you for your encouraging message, Terri.
I was hoping, and very much expecting, by this point to have that inhibition assay result back, but I do not. It's now been over a week since my blood draw! And yes, it's with Quest Diagnostics.
From what you say, it seems that the inhibition assay is a more reliable indicator than the initial IgG blood test index value, even if it falls short of the Western blot. Although I'm definitely hoping for a negative assay result, I'm considering doing the Western blot irrespective of the assay result.
The reason is that I have these little blemishes on my lips that come up on occasion. They're painless and quite small, no fluid inside, and have been diagnosed as peri-oral dermatitis by 2 dermatologists. And even though they mostly disappear with a course of doxycycline, I've always wondered in the back of my mind if they could be a herpes infection. A Western blot would provide a definitive answer.
At any rate, appreciate your thoughts on the matter and will certainly report back once the assay result materializes, if it ever does!
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Terri Warren, RN, Nurse Practitioner
21 months ago
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The symptoms that you describe around your lips sound nothing at all like HSV 2 to me. And even if they were herpes, they would be far more likely to be HSV 1 rather than HSV 2. HSV 2 doesn't like the oral area much, when there, they are at least tender, are fluid filled and are usually not something one might describe as quite small. And doxy would not impact the course of a herpes outbreak. Keep me posted on the inhibition assay
Terri
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21 months ago
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21 months ago
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The inhibition assay is finally back, but the meaning of the result is unclear. The result is stated as "IN RANGE", written in green font, like for other normal results in my tests, e.g., normal cholesterol. However, there is confusing language attached in the lab notes, which says:
The HSV-2 IgG screening assay was repeated on a
different platform as part of the inhibition test,
and the result was negative; thus the Inhibition result
could not be determined. Most samples exhibiting this
type of discrepancy have initial HSV-2 IgG index values
of 1.10-3.00. If early HSV-2 infection is suspected,
submission of another sample collected 2-3 weeks after
this sample is recommended.
This assay is intended only for samples giving a
positive index in the HSV-2 type-specific IgG
screening assay. A POSITIVE inhibition
interpretation indicates true HSV-2 specific
reactivity, whereas a NEGATIVE inhibition
interpretation suggests that the positive
screening index is falsely positive.
Are they saying they couldn't definitively determine if my initial result (index-1.35) was a false positive?
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21 months ago
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Apologies for the repeated messages -- this interface is difficult to work with and I hope it's improved.
Anyway, to be clear, I was confused by their statement that "the inhibition result could not be determined". So, am I "IN RANGE", or is their final result basically inconclusive?
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Terri Warren, RN, Nurse Practitioner
21 months ago
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They couldn't run the inhibition assay because the IgG on the second run was negative. The test results is now negative.
Terri
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21 months ago
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Thank you, Terri. I just spoke with a physician, as part of Quest's follow-up service, who confirmed exactly what you said, adding that it's likely my recent shingles vaccinations tripped the test.
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Terri Warren, RN, Nurse Practitioner
21 months ago
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well, we honestly have no idea what trips the artificially. We had false positives way before the shingles vaccine and lots of false positives in people too young for the vaccine. But glad you understand now
Terri
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