[Question #6972] HSV 1 & 2 IgG test results

10 months ago
I just recently did HSV 1 & 2 IgG testing because I was curious even though I haven't had any symptoms ever that I can remember and because I recently started dating a new woman.  The backstory is I started to date a new woman a little over a month ago and we kissed and made out on these separate occasions. Then about two weeks ago I pick her up for another date and notice she has  what appears to be a small scabbed coldsore on her lip. I managed to avoid kissing her on that date (that was an awkward date cause she kept trying to). The other times she had no visible symptoms. I have health anxiety and start reading up on HSV to see if it's possible I could have gotten it from kissing her before even without a coldsore. So this instance led me to get tested anyway. I know you are supposed to wait like 3 months for the most accurate results but I couldn't wait, perhaps I will do another test in a couple of more months. I am 29. Again, I have never had anything that resembles a coldsore on my lips (that I can remember, maybe when I was younger?) or genitals (def not). I do have mild acne and sometimes cystic which can make things confusing and me anxious especially when I get some below the belt, but i'm like 90% sure these are pimples and nothing else (they never ooze, scab, or are in clusters, and never are actually on the gentials usually like waistline or between thighs). Here are the results I just got. It seems I am in the Equivocal range, how would you interpret this, am I likely negative for HSV2 and 50/50 HSV 1? 
HSV 1 AB IgG: High, 1.07 Index 
HSV 2 AB IgG: High, 0.97 Index
Index Interpretation
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<0.90 Negative
0.90-1.09 Equivocal
>1.09 Positive
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
10 months ago
So your equivocal result could be present for a couple of reasons. 
1.  You have recently acquired HSV 1 and are in the process of making antibody
2.  It means nothing - some people have a protein in their blood that tricks the test and it looks reactive when it actually has nothing to do with herpes.
3.  You've been infected with HSV 1 for a long time and the test, which is particularly poor for HSV 1, is showing some reactivity but because this test misses 30% of HSV 1, it is not picking it up fully.

The only way to get a clearer answer here is to wait a while and retest.  You've been kissing this woman for a month, right?  I would wait another month and retest and see what you get.  If it's a lot higher, you'll know it's a new infection.  If it's about the same, then I doubt it's a new infection.  Unfortunately, there's just no way to make the time go faster.  The other option, if you are anxious and want an answer to rule out #3, you could do the herpes western blot and see if you are already HSV 1 positive. 

So have you and this partner talked about whether she gets cold sores??

Terri
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10 months ago
Thank you Dr. Yes, I have been kissing this new partner for about a month when I had gotten tested. However didn't kiss her when she had the cold sore. I haven't talked to her about it yet, as i'm doubtful she knows that cold sores are considered herpes and don't want to freak her out or make her feel bad. I don't plan to kiss her again in the meantime until I can get an accurate answer if I already have it. If I don't have hsv, I will most likely ask her to get tested or stop pursuing a relationship with her otherwise. 

1. Would you say it is pretty safe to assume she has hsv if I saw a cold sore? 
2. Do you think I should be concerned about my hsv2 result if I have never had blisters on or around my penis? I have not had sex with this new partner so I have no new risk for gential hsv2. I don't believe I need to wait for that value to change correct? 
3. If I retest in a month or two and my results are equivocal again, what does that mean? You mention if they stay the same it likely means a old infection but my understanding was the values I have don't mean neither positive or negative?  Would it be better to go straight to the western blot?
4. What are the typical values of someone who is definitely positive? 

Thanks so much for your help Dr. This is very confusing and making me very anxious. Very much hoping that this is #2 and I can be more careful now that I am getting educated about this virus. 
  

Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
10 months ago
1. Would you say it is pretty safe to assume she has hsv if I saw a cold sore?

Yes, if it was indeed a cold sore

2. Do you think I should be concerned about my hsv2 result if I have never had blisters on or around my penis? I have not had sex with this new partner so I have no new risk for gential hsv2. I don't believe I need to wait for that value to change correct?

You are correct.  HSV 2 is not an issue here.

3. If I retest in a month or two and my results are equivocal again, what does that mean? You mention if they stay the same it likely means a old infection but my understanding was the values I have don't mean neither positive or negative?  Would it be better to go straight to the western blot?

So what I mean is someone can have an equivocal result on the IgG that doesn't accurately reflect the truth.  The truth could be that that person could have been infected for years.

4. What are the typical values of someone who is definitely positive?

In our research, everyone with an index value of >3 on HSV 1 confirms by western blot but there are certainly people who test below those who do not confirm.  It's likely that you are not infected but because of the poor quality of the IgG test for HSV 1, we cannot be sure.  If you tested with the blot now and it was negative or equivocal, it wouldn't be useful, but if positive, that would be definitive.

Terri
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10 months ago
I will then test again in another month or two and see if anything changes. If the results are the same or lower would it be safe to assume I am negative? And then if the results for hsv 1 are a lot higher (closer to 3) I have a new infection. I will also obviously avoid kissing in the meantime. Also can you direct me to the best way to obtain a western blot in the case that I have cannot get a definitve answer on my second test. Thank you for your service!  
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
10 months ago
That sounds like a very reasonable plan. 
You can work with your own health care provider to obtain the blot or if that doesn't work for you, you can work with me to obtain it by going to westoverheights.com.  The test comes from the University of Washington, 206-685-6066.  You can order the kit for the test to be sent to you, regardless of who is actually ordering the test.

Terri
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