[Question #13355] Nutty Numbers -- "Equivocal" HSV2?

1 months ago

Losing my mind here. I (56F) am one of the MOST demanding people when it comes to INSISTING (potential) new sex partners get tested, and yet here I am.

Got tested with an ex-partner 4 years ago. Came back HSV 1 (oral) positive/HSV 2 negative. No sores. Relationship lasted 5 months, got my HSV 1/2 test one week before we broke up (in Sept 2021), and negative for both (whew)! Then a three year dry spell for me.

Get new/current sex partner November 2024. We get tested for the "big five" but not HSV (they don't test w/o symptoms). I see a pimple-type thing on his inner thigh that TWO doctors call an "ingrown hair" (under a mag glass; I see the hair in it). They tell us it's not HSV and there's “nothing to swab”.

Fast forward August 2025. Sadly I get suspicious my partner (48M) has "strayed" so I insist on new STD tests, full panel. He has no visible sores (they examine him with a magnifying glass). His blood test comes back HSV2 "equivocal" at 0.97 (Quest Diagnostics, HSV 2, IGG, Type Specific AB). HSV 1 comes back negative (just on the nose at 0.90). I am FREAKING out. Doc says it's "probably" a false positive, suggests that I don't get tested, and to "go live my life." I can think of NOTHING else.

QUESTION--Is there a chance he has HSV2 with this "equivocal" result with no (apparent) clinical symptoms? I am terrified he may have given me HSV2. (I really don’t think I gave it to him, and even so, would be HSV1, yes)? With his "equivocal" result and no symptoms, what are the chances he has HSV2?

Terri Warren, RN, Nurse Practitioner

1 months ago

There is a chance, but I keep track of these things (equivocal IgG, western blot performed) and only one person with an equivocal IgG our of 24 people went on to test positive on the western blot, the most definitive test for HSV. People have equivocal results for a couple of reasons - one is that they have a new infection and would go on to have a positive test weeks later. But the vast majority either remain equivocal or go to negative.

Terri

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1 months ago

Hi Terri. Thank you for your response. I realize nothing can ever be 100 certain, but your medical opinion and particular expertise in this area means a great deal. So thank you for alleviating my fears (somewhat).

Follow-up questions:

1. What other factors or conditions, (other than potential recent infection as you said) could cause "equivocal" HSV2 results, especially when there are no clinical symptoms? And how quickly can an "equivocal" result come up after a "potential" exposure? Does the type of sex matter? (Genital, oral, anal).

2. What is the risk of acquiring HSV2 from deep kissing and mutual masterbation (but NO penetrative sex, genital fluid exchange, or oral sex of any kind)? I did have a 3-year dry spell but I did have two or three sexual "encounters" like this.

3. Lastly -- since his "equivocal" I have been spraying everything with Lysol, including bed sheets, toilet seats, doorknobs, etc. I got scared because my sister came over and used my toilet and perhaps used one of his towels to dry her hands (it was not damp and was indeed "dry", but still). I'm even scared to hug or shake hands with people in case I accidentally press my cheek against theirs (no kissing anyone's cheek anymore!) Am I overreacting? My partner and I barely hug at this point since this "equivocal" came back. I want to believe the doctor who (strongly) advised me not to get tested and go "live my life." And of course you suggesting there is a very small chance of this being anything.

I realize Im rambling, but I am truly scared. My therapist told me things like this (STDs, etc) hit sexual abuse survivors particularly hard psychologically.

Terri Warren, RN, Nurse Practitioner

1 months ago

An equivocal on HSV 2 would likely, if due to a new infection, be related to genital and anal sex, not oral sex. Other factors are the inability of the test to separate herpes antibody proteins from other other proteins in the blood. That's probably the most common reason. The brand of test that gives equivocal results is poor compared to the new IgG test that labCorp uses now.

Not a risk.

You are indeed overreacting. HSV 2 is a sexually transmitted infection It is not shared w tith household members who are not sex partners. I would suggest that your partner get a herpes western blot to get clarity on his HSV 2 status

Terri

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1 months ago

Thank you, Terri. Follow-up/clarification requested on a few points, please.

1. What types of medical conditions or infections could confuse the blood-drawn HSV 1/2 test? (You said "an inability of the test to separate herpes antibody proteins from other other proteins in the blood" is a common reason for equivocal results).

2. If my partner were to get the Western blot as a follow-up to the equivocal test, how long should he wait after receiving the equivocal result? (Or does that matter)? He insists he did not have sex outside our relationship since we became exclusive in November 2024. (Still...)

3. In summary--your own experience is that out of 24 equivocal tests only one ended up going on to be HSV2 positive (so roughly a 4 percent chance). So hopefully (based on my partner not having clinical symptoms, his equivocal result, and his insistance that he did not have sex outside of our relationship since November 2024) my own chances of having caught it are...low? I had an odd UTI at the end of March 2025 (ie, felt like a UTI but my urine tested negative and it went away on its own, just took Tylenol). No sores/outbreaks observed. That was my only weirdness this year. I really feel severely triggered just by the thought of getting a test and would rather not if my chances of infection are low

Thank you for your patience, Terri.

Terri Warren, RN, Nurse Practitioner

1 months ago

We don't know what the other proteins are or where they come from, unfortunately.

The timing is appropriate for your partner to test now with the blot if he wanted to and I would be happy to help him with that or he could go through his own provider as well.

I think the chances of you being infected are really low

Terri

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