Last week I had my STD tests updated.  Just routine I really felt all would be OK.  All were normal except for HSV 1 and 2.  HSV-1 was positive at 2.24 (This is new to me I’ve never had a positive for HSV-1 and I’m 44 years old) and HSV-2 was equivocal at .95 both with the IGG tests.  I’ve never had an outbreak of any kind nor have I had any cold sores.  My last unprotected sex was 5 months ago and my last single incident of protected sex was six weeks ago.  Both partners claimed to be clean.  I don’t have reason to doubt them.

I’m wondering what your opinion on these results are?  I had a low positive HSV-2 ten years ago and then two negative tests after that over the course of a couple years.  It was a terrible mind swirl that I went through.  I remember telling myself after reading about how many false positives there are that I’m never testing again unless I have sufficient reason to believe I could be at risk.  Yet here I am again.  Any advice would be great.  I don’t want to alert these past partners and put them through the wringer until I’m more sure about what is going on.  Thank you!

If you have had a false positive HSV 2 antibody test in the past, that suggests that you have a protein in your blood that artificially trips the antibody test.  The protein is a similar weight as one of the proteins that make up the HSV 2 antibody and it can trip not only the IgG test but also the western blot, making that look indeterminate  If it has been 5 months since your last unprotected sexual encounter, I would believe that you do not have HSV 2 infection.  BTW your test is not positive at this point, only equivocal. I cannot tell you with 100% certainty that you didn't acquire HSV 2 at the single protected encounter 6 weeks ago, but it seems unlikely.  Do you know anything about the herpes status of this partner?  it surely would be nice to know she tests negative. 
As for the HSV 1 positive, are you absolutely certain you've been tested for that in the past?  When was your last HSV 1 test?  I think at 2.24 there is actually a good chance that that one is accurate.  If you want confirmation of that, you can get a western blot from the University of Washington.  About 56% of the US population between 14 and 49 is infected with HSV 1, so you are in the majority.  Some of that is oral and some genital and if you've never had a cold sore in your lifetime and never a genital lesion, then you cannot know where your infection is (if it confirms positive), only that you have it somewhere and you will never know where unless or until you have an outbreak in either location. 

In my experience, once a person has a false low positive, they frequently have it again.  In this situation, I don't recommend using the IgG screening test again unless a person has symptoms of genital herpes because, as you are seeing, it can cause great consternation.  Instead, with a symptomatic presentation, a swab test would be superior or a western blot. 

In our research done with UW, we find positive HSV 1 IgG results over 3.0 to confirm 100% of the time with western blot and with HSV 2, we find false positives at higher levels than 3.0. 

Terri
---

Hi Terri-  How would one go about getting a western blot for the hsv1?  I've read that it's a bit of a process?  To answer your question I know I have had hsv1 testing in the past.  The last I know for sure was when I had the false positive for hsv2 several years ago.  I don't think I ever tested after that as it was negative.  In really rethinking and searching my soul I may have had a cold sore in the past it's hard to be absolutely certain.  I know I've had pimples on my lips that popped like one.  It's a mind swirl all of it I tell you.

Let's stop and think for just a moment - if a western blot confirmed that you have HSV 1, what would you do differently?  You can get a western blot one way or another if you chose to do that.  They will send you a kit and you can take it to your own provider and have it drawn or I can help you get it from a lab near you - perhaps - depending on where you live.  But first I want you to think about what you are going to  do with that information.  I know that might seem a silly question but sometimes people don't think that far ahead and I'm asking you to do that.  A cold sore would have clear fluid blisters associated with it, not pus. 

Terri
---

No I don't think it's a silly question and I think I understand where you're going with it.  My behavior as to the results would coincide with the advice of a well educated provider. 

haha.  Great response!  If your plan would be to disclose your HSV 1 status to potential partners, then I think you should find out if you have the western blot.  Not all experts do advise disclosure, though I do.
If you do decide you want this test, then Google herpes western blot University of Washington and you will find their number.  Give them a call to find out more details.  It would be very helpful if your doctor or other provider would draw the blood, spin it and ship it back.  If they won't, then you and I may be able to work together to get this done as part of a research study, depending upon where you live.
Best
Terri

---