[Question #646] STD Testing

51 months ago
Hello,

was hoping you could help clear up some info involving HSV testing I've had done over the past several years. My doctor seems to have a bit of archaic knowledge when it comes to HSV testing and I have received somewhat of conflicting responses from them. First let me provide you with my testing results

6/17/2009
HSV 1 - 1.52 IgG positive 
HSV 2 - .19 IgG negative 

1/13/2010
HSV 1 - 0.1 IgG negative 
HSV 2 - .06 IgG negative 

2/24/2012
HSV 1 - <0.01 IgG negative 
HSV 2 - <0.01 IgG negative 

6/20/2015
HSV 1 - .15 IgG negative 
HSV 2 - .07 IgG negative 

Each test also states that the assay is type specific for HSV 1 and HSV 2 IgG

Now my doctor also ordered an IgM test along with the IgG, but everything I've read on here and the CDC website states that they shouldn't be used with adults in diagnosing HSV. Would that be correct? I've brought this up with my doctor and they didn't seem to know anything about it and also charged me for the IgM tests even though I never request them when getting tested. Hence why I think their knowledge of HSV is a bit archaic.

I've also asked my doctor why my first test for HSV 1  back on 6/17/09 was positive, but the subsequent three after we're all negative. I asked if it could've been a false positive, but they have never given me a direct answer. I'm lead to believe it is, but never knew for sure. My questions are as follows. Based on my IgG results, is it safe to say that I do not have HSV 1 or HSV 2? Could my first test for HSV 1 on 6/17/09 be a false positive? I've also never had any classic symptoms  of HSV and each test was administered a minimum of 3 months after my last sexual encounter. I'm just looking for some clarity so I can move on. Thank you very much for your help!
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
51 months ago
I believe this is a duplicate posting from one that you did earlier and we've been going back and forth with, is that correct?

Terri
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51 months ago
Yes, I believe you are correct. I first tried to post under a username, but it wasn't processing correctly (or so I thought) so I setup a new one. It looks like the first one finally processed. Apologies.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
51 months ago
No worries at all!  We want to get your questions answered for you so please - if you posted twice, spend your money and ask more questions!

Terri
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H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
51 months ago
Greetings. Suspecting your new user name and selecting the STI category might mean you were hoping for a second opinion, I agreed to add a comment.

I agree exactly with Terri's responses in your other thread. The business about low positive ELISA ratios in the HSV antibody tests indeed applies to HSV2, i.e. a gray zone result like your value of 1.52 would be considered a false positive for HSV2. However, HSV1 results have not been carefully studied in this regard, so most experts would consider that result positive. Therefore, at this point your HSV1 status remains uncertain. Given the subsequent clearly negative results, my best guess is that you don't have it, but it is possible that it's the later results that are falsely negative.

That said, I really don't think you need worry about HSV1. Having had no symptoms to suggest either oral or genital herpes, it is likely you will never any, and probably will never infect another person.

As for HSV2, all results are solidly negative and for sure you aren't infected. Unlike HSV1, the HSV2 antibody test picks up all infections for practical purposes. In case you're concerned about the slighly variable HSV2 numbers, they are not a consideration. Such variation is normal and the test is definitely negative as long as the ELISA ratio is under 0.9 (and yours are well under that level). Even the very same specimen tested several times will give different numbers.

In summary, you can move on without worry about any of this. Best wishes--

HHH, MD

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51 months ago
Thank you Dr. Handsfield. My apologies for the working of an anxious mind today. I sincerely thank you and Terri for your help. I know my obsessive compulsive thinking causes a lot of my anxiety and I need to learn and accept that everything cannot be certain. I do have one more question and you have my word it will be the last. I completely understand both your and Terri's explaination as to why you can't say with 100% certainty whether or not I have HSV-1.  I noticed you also did say that your guess would be that I don't based on the three negative results after. Would you however, and I know this may  not even be feasible, be able to quantify the percentage of the chance that I do not have it? I just want to gauge whether or not to get a western blot test done to help give me peace of mind. Thank you both again for your time and service. 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
51 months ago
I don't have a percentage because in our most recent study we've seen people with completely negative HSV 1 IgG tests with positive western blots.
Unless Dr. Handsfield has something to add, we're finished here.

Terri
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