[Question #2826] follow up to question #2267

94 months ago

Please reference question #2267 from 4 months ago. I never asked a follow-up question. I waited 4 months to do a specific hsv ab 1 and 2 retest and my 2 test came back negative, but my 1 test came back (again) positive. So my initial tests results detailed in my #2267 were incorrect. What do you think I have, if anything?

Terri Warren, RN, Nurse Practitioner

94 months ago

I'm so sorry but I am unable to locate that question. Could you remind me about the content please?

Terri
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94 months ago

My original question was: I was recently diagnosed with HSV2. I am in a 1 + year monogamous relationship and am confident that there are no issues of infidelity. So I am assuming my gf was unknowingly infected and subsequently infected me, but I wanted to ask for clarification on my lab results to better understand things. After going to doctor with painful vesicles in the genitals, I was tested via an HSV 1 and 2-specific Ab, IgG; HSV 1/2 PCR; and HSV NAA. The IgG came back negative for HSV2 but positive for HSV1. I know from prior blood work that I've been HSV1 positive for 20-30 years and I also understand that almost everyone is HSV1 positive. So this was not surprising. The PCR DNA tests both came back negative for both HSV1 and HSV2. The HSV NAA came back positive for HSV2 but negative for HSV1. My diagnosis was a new infection of HSV2. My question is how accurate is the HSV NAA test for differentiating between HSV1 and HSV2? I clearly need to have a conversation with my gf, but I'd really like to resolve the possibility that the HSV NAA test was wrong, that I really am infected with HSV1 not HSV2, and that perhaps she is not infected at all? Thank you for your help in this matter.

Your response was: The HSV NAA is very good at distinguishing between HSV 1 and HSV 2. All the labs that you have reported here suggest new HSV 2 infection, yes.

This may be an uncomfortable conversation for you to have but keep in mind that 80% of those infected with HSV 2 are completely unaware of their infection. She will need an HSV 2 IgG antibody test. If she is indeed infected with HSV 2 and you are also infected, then there is no longer a concern about herpes when you are sexually active. Please let me know what other questions you might have about your new infection.

Flash foward to 4 months later. I retested my HSV 1 and 2 specific AB and my HSV2 test is still negative. So I don't have HSV2. That means my results from 4 months ago were incorrect. Is it more likely that I have genital HSV1 or that I have nothing at all? I would think that either the PCR or NAA would have shown positive for HSV1 if that is what I truly have. But both were negative. My only positive test was the HSV2 NAA, but now I know that was incorrect. But I also wonder the likelihood of a false positive for the NAA - it seems more likely that it would have missed the type, not whether it was truly negative for HSV. Thanks for your help.

Terri Warren, RN, Nurse Practitioner

94 months ago

Your HSV NAAT was done from painful vesicles so I would believe the swab test over your most current antibody test. Have you been taking antiviral therapy daily? If yes, that can cause a false negative on the antibody test. Also, the IgG test misses 8% of HSV 2 infections.

Terri
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