[Question #7022] Understanding test results

10 months ago
Hi, I took added the hsv test to my regular GYN appointment on May 26th. A week later I received a message to say I tested “high and positive” for hsv2. 
The score showed: HSV 2 IGG, TYPE SPECIFIC AB”
 1.09 index High Final

I then saw the following notes: Interpretation - <0.90 Negative 0.90-1.09 Equivocal >1.09 Positive. I did not challenge my doctor but I am concerned. The guidance further states that an equivocal should be followed by another test 4-6 weeks after recent exposure. My husband tested negative in November (I saw the results) and we have been each other’s only sexual partners for 8 years. What do you think? Should I have received a follow up test? The only other notes regarding testing were: 498X; 36126X; 91431X; 8472X; 11363X FASTING:NO FASTING: NO

Through my research I learned these were Riley codes Quest diagnostics uses for testing. Please help.
10 months ago
Follow up come (not a question)- Prior to meeting my husband I last saw another man sexually 8 months BEFORE I met my husband. He and I have had no other sexual partners. Had my doctor not said my 1.09 was positive and placed that note in my medical record I wouldn’t be so worried. I haven’t had any physical symptoms but I have been itching a lot since my appointment. I think that’s mental.  We were planning to try to get pregnant this year. This diagnosis has not stopped me from moving forward for now. 
10 months ago
Yikes excuse the typos!
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
10 months ago
I'm so sorry, I don't know how I missed this post.  You do not have a positive result, you have an equivocal result.  And given that you have only been with each other in the past 8 years, I think you are negative, not infected.  Do you have any concerns at all that your husband has recently had any new sex partners?  If not, then you've had 8 years to go from negative to positive, so waiting another 4-6 weeks is useless.  You likely have a protein in your blood that is artificially bumping the test slightly higher than the usual negative.  I feel this should have been handled very differently than it was.

Terri
---
10 months ago
Thanks for the reply! No concerns with my husbands behavior whatsoever! Luckily, we have been quarantined together for the last three months with nowhere to go. We also live in a city where we have no friends so we're default best friends. Honestly, I was having a slight emotionally breakdown (world events and work) that collided with my GYN appointment for the perfect storm.

A lot has happened since my original test. I also need to clarify an item. My original test was ordered by the nurse on duty. My doctor was not there. The nurse gave me my results and said they were positive. I then followed up with my doctor to ask her for more information and request the ability to retest and she concurred with the nurse and said frankly that I was positive and probably had HSV for a long time based on the fact that index was high. I went through this process of begging for follow up discussion up until Monday. After asking to elevate my call to the head doctor, I received a message from my doctor that simply said an equivocal can be retested but, she thought that if I needed anymore information I should go to an infectious disease doctor. The nurse that originally handled my call eventually messaged me back and admitted that my result was equivocal. Wow... what a roller coaster. I feel sorry for those that are less persistent! So, today I retook the HSV specific type test I was given in May. I should get the results next week hoping for a negative but, if my blood has this protein I assume I could get another equivocal (hopefully not a low positive).

Here are my questions:
1. You mentioned a protein. What groups normally carry this protein? Could this protein interact with other tests? I got a false positive on a Syphilis test last year. My doctor recognized it and told me to disregard. 
2. If HSV2 is asymptomatic could your index be equivocal and lying in wait in that moment and a stressful event trigger the antibodies to rise, thus revealing an infection that has been dormant for years?
3. Do you know of any other diseases or infections that contain any of the proteins found in HSV? For example some reports state that an equivocal for COVID could mean the test detected an antibody for a different illness and the immune system hasn't made an adequate amount of antibodies or the system could be detecting a waning immune response. Could any of this apply to the HSV test? I know they are totally different tests but, figured I would ask.
4. I have read through the forum and seen you mention that you have only had one person with an equivocal IgG test see their results change to Positive on the Western Blot.  In that case, did the person receive a high positive and if you can, please share what may have been the reason for the jump in the index (connecting this to question 2).
5. Can antibiotics change the test results? I took an amoxicillin a couple of days before my test (just one). I had an issue with my tooth that was treated by my dentist. 


Thank you and I look forward to hearing from you soon!
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
10 months ago
1. You mentioned a protein. What groups normally carry this protein? Could this protein interact with other tests? I got a false positive on a Syphilis test last year. My doctor recognized it and told me to disregard it.
We don't know much at all about this protein, only that it exists and trips the IgG artificially and can also show up as an indeterminate on the gold standard western blot.  But my personal experience with indeterminates (and I've had literally hundreds show up in my patients) is that I have yet to see an indeterminate in a person who has 1) waited 12 weeks from a concerning encounter to get the western blot and 2) has taken no more than 14 days of antiviral medication, be positive on a redraw 3 months later.  And I have only seen one person in all that time who had an equivocal on the IgG test positive on the western blot.  I suspect that you will, upon retesting, have either a high negative, an equivocal, or a low positive.  Let me know which.  You may not get the value of your negative, BTW, only that it is negative.

2. If HSV2 is asymptomatic could your index be equivocal and lying in wait in that moment and a stressful event trigger the antibodies to rise, thus revealing an infection that has been dormant for years?

Being symptomatic or not has nothing to do with index values on the IgG test.

3. Do you know of any other diseases or infections that contain any of the proteins found in HSV? For example some reports state that an equivocal for COVID could mean the test detected an antibody for a different illness and the immune system hasn't made an adequate amount of antibodies or the system could be detecting a waning immune response. Could any of this apply to the HSV test? I know they are totally different tests but, figured I would ask.

Again, we just don't know enough about why people have false-positive IgG results.  I sure wish we did, but we don't.

4. I have read through the forum and seen you mention that you have only had one person with an equivocal IgG test see their results change to Positive on the Western Blot.  In that case, did the person receive a high positive and if you can, please share what may have been the reason for the jump in the index (connecting this to question 2).

The western blot doesn't give a value, only positive or negative.

5. Can antibiotics change the test results? I took an amoxicillin a couple of days before my test (just one). I had an issue with my tooth that was treated by my dentist.

I doubt that the antibiotic would influence a herpes IgG test.

I have to say, you've had some bad advice, you need retesting, and you likely need the western blot.  I would bet a whole lot of money that you are NOT infected.


---
10 months ago
Good evening Terri and thanks for answering my questions. 

I just got my results back and I'm still negative for HSV1 (didn't mention that the first time) and showing equivocal for HSV2 but, now my index is 1.03 (was 1.09) on the IgG from Quest. This is insane! I'm definitely happy it didn't swing in the other direction to a positive. I would have been worried.

 I think I'm going to take a break from testing. I know the WB is available and I may look to that one day but, since I don't have any of the text book symptoms of HSV2 and my husband is negative I think I'm going to move on before I worry myself to death. I really appreciate the work you all are doing. Please let me know if you all have any research areas that require donations. While I don't believe I am HSV positive, I see the need for a cure. After reading these comments people need answers and are very scared. Thanks again!
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
10 months ago
I totally agree with your decision to move on and put this behind you.  Good for you!   ASHA always is willing to accept donations so if you are so inclined, I know they would welcome that.

Terri
---