[Question #502] Confusing info from doc. Should I retest?

41 months ago
A previous girlfriend revealed she had genital herpes at the beginning of our relationship. She never had an outbreak but I took her at her word. We used condoms during intercourse some of the time but not all the time. Fast forward a couple years...My wife and I met. We have been together for several years, are 100% faithful and don't use protection. I recently discovered a rash on my upper buttocks. After seeing my doctor she said I had shingles. I asked if it could be herpes given my sexual past and she said it was unlikely. I've never had any sores, lesions or physical symptoms. I asked to be tested for all STDs so I knew my status. Results came back negative for everything for both wife and I: HIV, HSV 1/2, Chl and Gon. Sounded good to me! Until they said I needed to come back in a month again to test for HSV 1/2. They said that the diagnosis of shingles could have been inaccurate--and that it could take four weeks if my infection is herpes for the herpes anti-bodies to show up. I’m confused so I’m here for a second opinion.

Here were my tests and results: HIV AG/AB, 4th Gen: Non-reactive; HSV 1 IGM screen: negative; HSV 2 IGM screen: negative; Chlamydia RNA, TMA: not detected; Gonorrhoeae RNA, TMA: not detected

    1    Do you recommend I retest for HSV 1/2?
    2    Do you recommend I retest for HIV?
    3    Do you recommend I retest for anything?

I just want to know that my results and the information I receive about my tests are accurate. Thanks for help!
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
41 months ago
I think your doctor might be misinformed about how herpes testing works - the timing is not from when a lesion appears - it is from the date of INFECTION - which would have been years ago.  However, they actually did the wrong testing - you needed IgG not IgM testing.  Are you sure you didn't have IgG testing done and maybe didn't list it here for me?  The CDC recommends completely against using IgM testing for many reasons.  but if one is looking for established infection, you want IgG, not IgM.  And yes, I would recommend that you get an IgG test for HSV 1 and 2 if you want to rule out that the rash on your buttocks was HSV 2.

Terri
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41 months ago
Hi Terri,

I'm fairly confident that they didn't have IgG testing done--the lab report says this, quoted:

HSV 1/2 AB (IGM), IFA W/RFL TO TITER
-HSV 1 IGM SCREEN: NEGATIVE
-HSV 2 IGM SCREEN: NEGATIVE

There's then a note section that says: "The IFA procedure for measuring IgM antiodies to HSV 1 and HSV 2..." blah, blah, blah. The test was developed by Focus Diagnostics. Frustrating they didn't know what they were doing...

Ok, I will get an IsG test done to rule out HSV 1 and 2.
1. Where do you recommend I get the test?
2. Should my wife also retest then?
3. What about the HIV test I was given? Is that accurate?

Thank you!
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
41 months ago
You can get the IgG test anywhere - you can even order from an online lab service - the testing is the same.  It might be awkward to ask your doc to do it, but if it isn't awkward, you sure could.
Here is what the CDC says about herpes testing:  you could quote it for him/her.
"

Type-Specific Serologic Tests

Both type-specific and type-common antibodies to HSV develop during the first several weeks after infection and persist indefinitely. Accurate type-specific HSV serologic assays are based on the HSV-specific glycoprotein G2 (HSV-2) and glycoprotein G1 (HSV-1). Providers should only request type-specific glycoprotein G (gG)-based serologic assays when serology is performed for their patients (329-331).

Both laboratory-based assays and point-of-care tests that provide results for HSV-2 antibodies from capillary blood or serum during a clinic visit are available. The sensitivities of these glycoprotein G type-specific tests for the detection of HSV-2 antibody vary from 80%–98%; false-negative results might be more frequent at early stages of infection (330,332,333). The most commonly used test, HerpeSelect HSV-2 Elisa might be falsely positive at low index values (1.1–3.5) (334-336). Such low values should be confirmed with another test, such as Biokit or the Western blot (337). The HerpeSelect HSV-2 Immunoblot should not be used for confirmation, because it uses the same antigen as the HSV-2 Elisa. Repeat testing is indicated if recent acquisition of genital herpes is suspected. The HerpeSelect HSV-1 Elisa is insensitive for detection of HSV-1 antibody. IgM testing for HSV 1 or HSV-2 is not useful, because IgM tests are not type-specific and might be positive during recurrent genital or oral episodes of herpes (337).

Because nearly all HSV-2 infections are sexually acquired, the presence of type-specific HSV-2 antibody implies anogenital infection. In this instance, education and counseling appropriate for persons with genital HSV infections should be provided. The presence of HSV-1 antibody alone is more difficult to interpret. Many persons with HSV-1 antibody have oral HSV infection acquired during childhood, which might be asymptomatic. However, acquisition of genital HSV-1 is increasing, and genital HSV-1 also can be asymptomatic (318-321,338). Lack of symptoms in a person who is HSV-1 seropositive does not distinguish anogenital from orolabial or cutaneous infection, and regardless of site of infection, these persons remain at risk for acquiring HSV-2.

Type-specific HSV serologic assays might be useful in the following scenarios: 1) recurrent genital symptoms or atypical symptoms with negative HSV PCR or culture; 2) clinical diagnosis of genital herpes without laboratory confirmation; and 3) a patient whose partner has genital herpes. HSV serologic testing should be considered for persons presenting for an STD evaluation (especially for those persons with multiple sex partners), persons with HIV infection, and MSM at increased risk for HIV acquisition. Screening for HSV-1 and HSV-2 in the general population is not indicated.

I don't think your wife needs to retest unless you think she could have it independent of you?
The HIV test is fine.

Terri
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