[Question #7086] HSV 2 Test Results

7 months ago
My daughter was raped 6 months ago and I took her to get tested for STD's.  She received an HSV2 index of 2.01, which is considered a gray area according to this website.  I took her to a doctor today who just read the test results and said "yep, you have it."  She only went by this result and did not do any sort of exam.  So, does my daughter really have it?  I thought that if she has a 2.01, then it isn't a definite YES.  Please help us!  We are so devastated by this.  I can't stop crying and I'm looking for any hope that my daughter will be ok.  She has never had any symptoms.  Thank you.  
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
7 months ago
I would very strongly disagree with her doctor.  Clearly, the doctor is not familiar with the CDC STD treatment guidelines of 2015.  In this it says that anyone who tests positive with an index value of 1.1 to 3.5 needs a confirmatory test, due to the face that 50% of the positives in this range, are false positives.  Your daughter is definitely in this range and needs a confirmatory test, the best one being the herpes western blot.  It is done only at the University of Washington in the US but people living anywhere can get it done.  You can work with your own provider, though clearly they don't know about it.  Or I can work with her to get this at my website, westoverheights.com, with an evisit on the internet.  The chance that your daughter got this through a single sexual encounter is very low.  She absolutely needs this test.  I think there is an excellent chance that this is a false positive - better than 50-50.

Terri
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7 months ago
Thank you for hope!  Are false positives in this index range common?  Why do they happen?  The doctor insisted that these igg tests are pretty accurate with no room for error.  Also, should  my daughter have received an exam, though she has not had any herpes symptoms?  And I was wondering if it would help for her to be on something like valitrex to stop any outbreak before it starts as a preventative?
7 months ago
Hi Terri,

Even though you haven’t had a chance to answer my last questions yet,  I have a couple more.  (Sorry, as a mother I am in agony right now. Can’t sleep or eat).  Why are indexes under 3.5 considered a gray area?  Also, you mentioned in your response to me that the chance that my daughter got infected from a single sexual encounter is low.  Could you elaborate more on that?  I thought it only took one time.  Thank you for your help!
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
7 months ago
I would definitely NOT suggest antiviral medicine until she obtains a confirmatory test as these medications.  There is simply no reason to do that at this point. 
Your doctor is simply not aware of the limitations of the IgG test.  Here is what the CDC says about this issue:

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 the 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 the 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).

There are now multiple studies in the scientific literature about the problem with false positives on the IgG test.  About half the positives between 1.1 to 3.5 are false positives.  The closer the value is to 1.1, the more likely a false positive. 

While someone can certainly be infected at a single encounter, it just rarely happens because someone with herpes does not have virus present in the genital every day - they are only present intermittently and the likelihood that the virus would be present on exactly the day she was raped, IF the person who raped her had herpes, are very low.  Has this person been charged?  It may be possible from a legal point of view for this person to be tested to see if they are infected. 

I would very strongly urge you to pursue the herpes western blot for your daughter and now.  You and she need a clear answer about her herpes status to avoid more sleepless nights.  You can get the process going by contacting the University of Washington for the kit needed to get the test - call at 206-685-6066.  There is no cost for getting the kit.



Terri
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7 months ago
Last question. .. I don’t think it was an Elisa test though.  Does this matter?  It was by Quest Diagnostics .
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
7 months ago
The ELISA is a type of IgG test.  And Quest does IgG testing that is as accurate as IgG testing gets.  I'm closing this thread now.  I so hope you will get the blot for your daughter.

Terri
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