[Question #1606] HSV Test Results/Course of Action

66 months ago

I recently got a blood panel done for STDs and the results came back positive for HSV2 with a reading of 2.29 H. I am wondering if it is possible these results are wrong and what I should do as far as next steps?

Just some additional relevant information:

  • The test type was IgM (called Flexitest 1, provided by Quest labs)
  • No HSV1 results were provided though it did say "This assay utilizes recombinant type-specific antigensto differentiate HSV-1 from HSV-2 infections." (full results shown below)
  • I would say I have been asymptomatic, though I did have what I thought was a zit on a hair follicle on my penis as well as chafing after a day at the beach.
  • This past year I have had 4 sexual partners, 3 of which I had intercourse with and used a condom each time; the last 1 was oral and manual stimulation only.
  • Prior to that I had 3 total sexual partners including 1 virgin, 1 lady who slept with only one other guy, and one who had been tested (and whom I dated for a while).
  • None of these 7 partners disclosed any positive HSV1 or HSV2 results to me or exhibited symptoms that I was aware of.
  • I also suffer cystic acne on my back and face (not sure if that's relevant but it is another skin condition)

    Terri Warren, RN, Nurse Practitioner
    65 months ago
    So it appears that your test was not an IgM but rather an IgG.  HSV 1 testing appears not to have been done.  With an index value of 2.29, there is a 50-50 chance that this is a false positive result.  Your history seems low risk to me for having acquired HSV 2 due to your excellent use of condoms and/or having sex with partners who have had no or few other partners.  If you were my patient, I would strongly recommend that you obtain a herpes western blot from the University of Washington to clarify this result.  When we try to evaluate the likelihood of a false vs true positive IgG result, we consider the index value, the presence of symptoms, and past sexual history.  All of this information, for you, suggest a false positive to me, but the western blot would be your best bet to get a clearer answer. 

    If you have an IgM result somewhere, I would ignore it - the CDC also says it should not be done. 

    65 months ago
    Thank you for following up Dr. Warren, I appreciate your input. You are right about the test being IgG and not IgM. I will definitely pursue the herpes western blot test that you recommend. Not sure what etiquette is on posting multiple questions in a response, but there were a few items I was curious about.

    Regarding the HSV1 testing/possibility of a false positive, I have had sores in my mouth but they looked more like canker sores than cold sores. For that reason HSV1 never really entered my mind. With that in mind, do my IgG results indicate with certainty that I am HSV positive, but what is unclear is whether it is type 1 or type 2? Or does a false positive mean that I could also not have HSV at all? 

    As for my risk factor, I have to admit that I do not know the sexual histories of the partners I have had in the past year. These were really the first casual encounters I have had. Also not sure if this matters, but one of them experienced her period while I was fingering her and I kissed another one on her inner thigh but did not perform oral. Do these raise the risk factors substantially?

    Lastly, I do remember sometime in the month or so experiencing irritation on the tip of my penis after a prolonged masturbation session. From what I recall it just looked like redness, not like anything that contained pus or like any pictures of herpes I have seen before, so I didn't think anything other than I was a bit overzealous. There had been times even in years prior where I had soreness or uncomfortable urination after masturbation. Is any of that normal for someone who is HSV negative?

    Any additional insight you can provide would be apprecaited.

    Terri Warren, RN, Nurse Practitioner
    65 months ago
    Your IgG results did not address your HSV 1 status, only your HSV 2 status unless there is something else you didn't post.  Your HSV 2 was positive. Nothing about HSV 1 was posted - we know nothing about that at his point.

    Neither fingering someone while they had their period not kissing an inner thigh is a risk for herpes
    I would say that some men who experience aggressive masturbation can have soreness that is completely unrelated to a herpes infection.