[Question #1295] Herpes testing, blood vs. swab, correct time, IGG vs IGm, false positives?

49 months ago
Recently I had unprotected sex with a friend several times about mid August. About a month ago I felt a lesion in my vagina and had a blood test done by my doctor who told me it had come back positive for HSV 1. When I spoke with my partner he told me he hahad cold sores as a child. I genuinly believe he didn't know this was herpes and at the time niether did I. However, I followed up with my ObGyn who told me I was actually positive for both type 1 and 2. She said not to worry too much, there basicly the same thing but everything I've read says they are not and Type 2 will cause me to have more outbreaks and be sick more often as well as bieng contagious to many more people. My blood test came back as follows: Herpes Symplex 1+2 AB 1GG REF () IV, 3.46, EMHerpes Simplex 1+2 AB IGM Ref<=0.89IV, 1.10 (H), HSV 1AB IGG Ref <=0.90IV, 0.13 and HSV2ABIGG Ref<=0.90, 0.10. I've been reading up and found a lot of conflicting information about blood vs. swab tests, when they should be given, IGm vs IGG, etc. Please help me make sense of this. Obviously I'm very upset and scared. Is it possible I should be retested? Is there a test that is recommended? Could I have been given the wrong test or been tested to soon? Is it possible to have a false positive? Do my results sound conclusive for both Types 1 and 2? Wouldn't I have more than one lesion? Thank you.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
49 months ago
I'm a little confused by your blood test results.  Your combined test is positive , which only means that you have one or the other of HSV and/or HSV 2.  I have also seen the cominbed test be positive and the type specific tests both be negative.  Don't know what to make of that.  But that's actually what I am seeing here, if I am reading this correctly.  Your IgM blood test is a low positive, just barely, and if very often wrong. 
So did you have any swab testing done or just blood testing?  Was a swab taken of the lesion in your vagina? 
The blood test you should pay attention to is the IgG, not the IgM.  It is possible that you tested too soon after a new infection, yes, that's possible.
The other possibility is that you are infected with HSV 1 and the test missed it in the type specific test (at 0.13).  The HSV 1 IgG misses 30% of infections, compared to herpes western blot. 
It is also possible that you don't have either type, but if I had to take a wild guess, I would guess that because the combined test is pretty high, you have HSV 1 only. 
What really should have been done is a swab taken from the lesion and that,if positive, should have been typed (1 or 2).  I'm a little confused that your doctor told you first that you had HSV 1 because your HSV 1 IgG is negative, as I read it here. 

How long after your last contact with this partner did you have testing done?  Did you take any antiviral medication?

Terri
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49 months ago
Hi Terri, Thanks so much. This is all so confusing to me and test results like these are basically impossible to interpret without professional help.  I presented to my Primary care Dr. about 3 days after I noticed the lesion, which is the soonest I could get in. At that time it was itchy but not overly painful. They did not take a swab, they took a blood test only. About a week later my primary told me I was positive HPV 1 and prescribed Acyclovir 400mg to be taken 2 tablets 5x a day for 10 days which I've completed. About a week after seeing my primary I saw my ObGyn to discuss results, effects, etc.. She talked with me about test results, looked at the lesion, told me it was already healing  and no further tests were needed. I believe the lesion is gone but I've felt fluelike for close to a month. I first noticed the lesion about a week after last encounter with partner but I had been having  back pains for about two weeks, just didn't realize they could be realted to an STI. Could you please advise what my best course of action is now. I didn't know at the time swab test was best and that I should have requested it. I'd like to know if there is a test I can take, do I need to wait for another lesion and have a swab test performed or wait till a certain amount of time passes and test for IGG antibodies? 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
49 months ago
Well, from what you wrote me at first, you've already had an IgG test.  I cannot figure out why someone told you that you were positive for HSV 1.  your combined test was positive, but that could have been because you were positive for HSV 1 or HSV 2 or both or neither, it is such a poor test.  But as you can see now, your IgG tests are both negative.  I can certainly see why you are confused!  There are several possibilities as I listed before.  I would suggest that you wait 12 weeks from the time of the lesion and redo the IgG type specific tests.  If you are still negative for both and want to be more clear about your status, you should consider the herpes western blot from the University of Oregon.  It is far more sensitive for HSV 1 than the IgG test and slightly more sensitive for HSV 2.  has your partner had an IgG test?  You know that he has HSV 1 because of his history of cold sores, but what you don't know is if he has HSV 2 infection.  It would be good if you could find that out.  If you decide to do the western blot, you should wait 16 weeks from the lesion for that one, but remember that if you become positive for either HSV 1 or 2 on the IgG test, you don't need to take the western blot - you would only do that test if you were still negative for both types at 12 weeks post lesion.

Terri
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Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
49 months ago
And obviously if you get another lesion, you would want to get that swab tested right away.

Terri
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49 months ago
Obviously this is a very complicated issue and your help is so appreciated. My partner is planning to go and be tested on Thursday. If you don't mind I have some other questions. You may have heard some of them before but I'd appreciate it.  From what I understand I am more contagious during my first year after contracting and will become less so with time? Whichever type I have I can pass it on by kisssing on the mouth? If I do find out I am HSV-1 pos. and am with a partner who is also HSV-1 pos. can we infect each other with another strain? Bieng HSV-1 pos does not make you immune to HSV-2 or the other way around? If it does turn out I am positive for both, should I expect outbreaks more often? Will the HSV-1 virus and HSV-2 virus attack at different times or will they both attack when my immune system is low? Will they shed at the same time? If I do have both should I expect outbreaks in the same place? Am I less contagious after an outbreak? Is there any testing to know if my viral count is low or when I'm less contagious? If I can only expect outbreaks vaginally do I need to be as concerned about kissing in a relationship post outbreak? Maybe you can tell the idea of never kissing anyway again is terrifying me. Thank you so much for all your help time and concern.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
49 months ago
Correct, people are most infectious during the first 6 months of infection and that decreases over time.  If you have oral infection regardless of type, you can transmit it orally. HSV 1 is far more infectious orally than HSV 2.  If you are both infected with HSV 1, I don't think you need to worry about the various subtypes.  Having HSV 1 does not make you immune to HSV 2, but the reverse is true - if you have HSV 2,  it is almost unheard of to then acquire HSV 1.  Both HSV 1 and HSV 2 are more likely to recur if your immune system is suppressed.   Even if you had daily home swabbing available to you, it would be very unlikely that you could acquire information about viral count.  It would be unlikely that you would have both HSV 1 and HSV 2 in the same location.  A more common situation is to have HSV 1 orally and HSV 2 genitally.  since about 56% of the US population has HSV 1 infection, I think your concerns about HSV 1 transmission may be a little overblown. 

Terri
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