[Question #114] hsv1&2 results

38 months ago
just recently received hsv 1 & 2 results (igg 50.1 and 2.17 respectively).  Have read a lot about false positive and want to ask my dr about doing western blot test.  I am a kidney transplant patient (2005) and have been on immunosuppressants for 10 years now (prograf 2mg 2x day and celcept 500mg 2x day).  Although history of high steroids due to SLE w/nephritis, none after 2005.  Also history of HPV. Any thoughts or recommendations? should I even entertain the idea of a western blot or should I just face the fact that I have indeed HSV 1 &2.  thank you. 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
38 months ago
Yes, this index value does meet the criteria for a value which need confirmation with another test.  I would strongly recommend a western blot for you.  Though you may be on immunosuppresants, you have mounted a substantial immune response to the HSV 1.  With a 2.17 index value, there is less than a 50-50 chance that you have HSV 2 infection.  Even if the western blot turns out positive (and the odds are against that), you will know that you have done everything that you can to get the clearest answer possible.  You don't mention if you have had symptoms or why you had testing done.  Can you clarify for me? 

Terri
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38 months ago
Thank you Terri.  No, I have not had any symptoms that I know of. The reason I had testing done is because I am in a newer relationship and this sweet man recently got tested for me - as I am immunosuppressed to give me piece of mind.  He is negative on all counts.  I decided it would be a good idea to get testing done as well. Imagine my surprise.  I have a call in my doctor for tomorrow regarding the western blot but already got a somewhat negative response from the nurse I talked to today.  She said they usually don't give western blot for HSV, just HIV.  I do live near Uw though.  What can  I do if my dr refuses to get me the test?  Can I buy it?  Thank you.  G
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
38 months ago
A western blot can be obtained in one of two ways.  Our clinic can place an order for you at a lab near you to be drawn and shipped to UW or you can contact UW directly, they will send you a test kit, you can take it to your doctor's office to have your bloods drawn and spun and then shipped back to UW.  I really would encourage that.  Clearly, the nurse is unaware of the herpes western blot, which is pretty common unless this is your specialty.

Terri
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38 months ago
Thank you Terri. My obgyn wasn't aware of this test either. What number do I need to call to have you or Uw  send me a test kit? Also do you know what the cost would be for me. At this point I think I would probably have to pay for it. Not sure if insurance will cover, nevertheless I want it done. 
 I imagine that you have my email address through this site. G
38 months ago
To make Matters worse, I just received an email from my OB/GYN and she recommends not doing anything. She believes that it is unnecessary for me to do the western blot.. Of course, I disagree with her. Terry, what do you recommend I do? I'm going to have a problem finding a doctor ordering the test for me but read a post I might be able to get this done thru you, at my expense. Is this correct? If this is correct o would like to procreed. Thank you. G
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
38 months ago
Yes, you can get the western blot done through my clinic, absolutely.  And yes, it is at your expense.  I could not disagree with your doctor more.  She is uninformed about the statistics regarding the issues with IgG antibody testing with results in the low positive range.  I am attaching a link to the section of the CDC STD treatment guidelines, addressing this issue.  It would be useful for you to share this information with her for future patients, I believe.  I am out of the country right now but will work with you on this next week when I return if you like.  "Both laboratory-based assays and point-of-care tests that provide results for HSV-2 antibodies from capillary blood or serum during a clinic visit are available. The sensitivities of these glycoprotein G type-specific tests for the detection of HSV-2 antibody vary from 80%–98%; false-negative results might be more frequent at early stages of infection (330,332,333). The most commonly used test, HerpeSelect HSV-2 Elisa might be falsely positive at low index values (1.1–3.5) (334-336). Such low values should be confirmed with another test, such as Biokit or the Western blot (337). The HerpeSelect HSV-2 Immunoblot should not be used for confirmation, because it uses the same antigen as the HSV-2 Elisa. Repeat testing is indicated if recent acquisition of genital herpes is suspected. The HerpeSelect HSV-1 Elisa is insensitive for detection of HSV-1 antibody. IgM testing for HSV 1 or HSV-2 is not useful, because IgM tests are not type-specific and might be positive during recurrent genital or oral episodes of herpes (337)."  http://www.cdc.gov/std/tg2015/herpes.htm

Terri
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