[Question #3994] HSV test accuracy/recommended?

32 months ago
I have had cold sores since I was in high school. I take lysine everyday, so I haven't had one in awhile (knock on wood). About 6 months ago I had unprotected sex with someone I did not know well. It was very unlike me to do something so careless, but since then my OCD/Anxiety has been putting me through complete torment. I have not had any symptoms, and have been tested for every std with an answer of negative. I haven't however, been tested for herpes as each doctor i have talked with has stated its not recommended unless there are symptoms. But my anxiety gets the best of me. I have read online, that some tests will tell someone who already knows they have hsv1, that they have hsv2, even if they don't. Thus giving a false positive. Like I said, I have not had any symptoms, other than minimal vaginal irritation. But I believe some of that is anxiety induced. 1. Would you recommend getting testing without symptoms?  2. Would a type specific igg test give a false positive? What is the liklihood of that? 3. Would the test mistake hsv1 for hsv2? In other words, would i be more likely to show hsv2 positive becasue i have hsv1, even if I am hsv2 negative?
32 months ago
I also wanted to clarify, my vaginal irritation usually occurs around the time I shave or am on my period that subsides/goes away with over the counter products. I have not noticed any sores/blisters. 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
32 months ago
There are various opinions about herpes antibody testing and I'll try to answer your questions.  1.  given a single exposure without any specific sores, I don't think that testing is necessary but if you just can't relax, then you may wish to do it 2.  In our practice, we looked at the incidence of low positives (where most of the false positives fall) and found that 6% of everyone who tested, tested in the low positive range.  About 50% of those are false positives.  3.  It isn't that the test mixes up the types, it's that it could say you are infected when you are not (about 3%) or it could miss an HSV 2 infection about 8% of the time.  There are slightly more false positives on the IgG test for HSV 2 if you are positive for HSV 1, yes.

Terri
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32 months ago
So would you recommend a test without symptoms knowing the possibility of a false positive? It doesn’t sound too rare to recieve a false positive and i don’t want to put myself through that if it is untrue and unneccesary. Would minimal irritation every now and then make you suspect hsv? 

Also, I had mentioned i had been tested for other stds since that encounter. At one point i was very concerned with hiv. My doctor prescribed me pep for a month, to ease my anxiety even though she believed it to be low risk. I have taken a total of 5 tests. A pcr test a week after, another pcr test two weeks after, a gen 4 a month after, a pcr about two months after, and then a fourth generation 4 months after potential exposure. All negative. Are these conclusive or do i need to test again? I also tested negative for hep c at 4 months. 
32 months ago
On top of that, i have a few more questions regarding herpes blood testing. 

If you test postive, how do they confirm it is not a false positive? How likely is it to recieve two or three consecutive positives? If i recieve a negative after 4-5 months, is that conclusive? How accurate are negative igg tests at that time?  And knowing i have hsv1 with cold sores, would you recommend getting tested or is the risk of a false positive because of that too great?

Thank you all your help. My anxeity is through the roof and i’m seeking help for that as well. I appreciate any insight you can give me.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
32 months ago
Your HIV testing sounds fine. 
If you test low positive on the herpes test, you can obtain a herpes western blot confirmatory test.  A negative western blot at 12 weeks is considered conclusive by the University of Washington.  A negative IgG test at 12 weeks picks up about 92% of HSV 2 infections.  Given your high anxiety, you might just want to start with the gold standard western blot instead of doing the IgG test at all.  You've had a great plenty of time to become positive if you are going to be positive so that would be my recommendation - to just start with the blot.  You can work with your own provider to get this, in most states, or I can help you get it if that doesn't work out.  You can call for the kit now 206-685-6066 to get started if you decide to do that.  I think the odds of you being infected are really low but doing the blot should help you put this issue to bed.

Terri
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32 months ago
Upon some thinking I went and recieved an Igg type specific yesterday. Which was 16 weeks after PE.  I was <.9 (negative) for both types 1&2. I was a bit confused since i believe i’ve had cold sores in the past. But upon reasearch and my memory, i believe pus to have come out so it could have been pimples. Is this likely? Is false neg on hsv1 igg likely? Would that impact if my hsv2 was accurate?

In regards to hsv2 i was like i said <.9. It doesn’t show my exact number. Does that number matter if it is uner the .9?  Do i need to know it? Also at the top of my chart, it says “in range, out of range, and reference range” with “out of range” highlighted. Do you know what that means? I thought maybe it meant just that it was below .9. 

I may consider the western blot test to ease my anxiety if it persists, but in your opinion, do you think I can move on with a <.9 at 16 weeks for Hsv2? Part of my ocd training is to not keep testing over and over for reassurance as its a ritual so i’m hoping to accept and move forward unless you feel there is a need. 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
32 months ago
I think you can be certain about your HSV 2 result with 92% certainty and probably 70% certainty for HSV 1 but then you know that you have probably had cold sores so that one doesn't matter. I'm not sure about all of your risk factors, but 92% is quite good and if you have limited risk factors, even better.

Terri
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