[Question #7718] Hsv 2, and hiv testing

1 months ago
Hey doctors so I’ve had a recent question few days ago regarding hiv testing and std testing.

I came out positive at 0.90 for hsv2 and everything else came out negative. 

My question about the hiv test was that the test use was a 5th generation test, I’m located in California and her have heard about such test. I called the lab and said that’s the newest test.

Is the window period for this type of test smaller or more accurate ? 

I told in the previous post about me taking pep for 5 days, is this test at 6 weeks after pep a good sign or has it happen that people will change to positive after testing later again ?? 

My risk was unprotected vaginal sex with a sex worker .


Thank you so much 
Edward W. Hook M.D.
Edward W. Hook M.D.
1 months ago

Welcome back to the Forum although I'm sorry you felt the need.  As we discussed in your prior interaction, your risk for HIV from the exposure you describe was low and unfortunately, at least from a theoretical perspective, your brief PEP may have prolonged the interval until you can absolutely consider your F/U results conclusive.  Having said that, I remain confident that you did not get HIV from the exposure you have described, based both on. 

Your blood test for HSV may well be falsely positive which is the reason we recommend against such testing.  HSV- blood tests in the range you report are falsely positive more than 50% of the time.

The so-called "5th generation HIV test, which shows the results of testing for HIV-1 antibodies, HIV-2 antibodies and HIV-1 p24 antigen separately but does not provide any meaningful advantage over 4th generation tests when negative.  As I have said before more than once, despite your taking PEP, I would be most surprised if your test were to now become positive and I once again suggest that you go forward without concern.  EWH

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1 months ago
When is the recommendation for re testing for hsv test? I looked up online and it says That range 0.90 is equivocal,  or unclear.


And about the hiv testing I guess I’ll have to move on from it, I guess. A 6 week 5th generation test after only 5 days of pep should be good enough of  a good result 


Thank you 

Edward W. Hook M.D.
Edward W. Hook M.D.
1 months ago
I am not sure I understand what you mean when you say “when is the recommendation for the HSV test?”. Most experts, including the CDC, do not recommend routine blood tests for HSV unless a person has a questionable lesion or a sex partner with known herpes. The test is not good enough for routine testing and leads to confusion of the sort that you are experiencing.  The equivocal test value that you have is just that. It is non-specific. It does not mean that you have herpes and as I said above it is more likely than not in your situation, given the apparent lack of typical symptoms, that it is a all it is a negative result.  Unless you have specific symptoms suggestive of herpes my advice is to forget about this test result. 

I agree with your decision to except your negative test results for HIV and move on.EWH
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1 months ago
Okay I’ll do that, because I haven’t had any outbreaks of what so over in my genitals or anything like that and from what I’ve read these outbreaks usually come within 3 weeks of exposure. And mine was around 7 weeks now. 

Any other symptoms that I should be aware or take on consideration of hsv2?

Would testicular pain be a symptom ? 

I’m sorry for all the questions,but the medical clinic where I took my std panel really didn’t have any explanations for anything, they just saw that the ohh test came at 0.90 and that the range was 0.90  and told me I had herpes
Edward W. Hook M.D.
Edward W. Hook M.D.
1 months ago
The classical signs or genital herpes are the appearance of multiple small fluid filled vesicles (tiny blisters) which go on to break open after a day or two.  They may be uncomfortable when they are present.  

Testicular pain is not a sign of HSV.

I understand how the values may be confusing.  Interpretation of the test is confusing and, as I mentioned above, the test is not very reliable.  That is part of the reason that routine testing of the sort is not recommended although, unfortunately, all too often the test is ordered for the wrong reasons.  

I hope this information has been helpful.  As per forum guidelines, with this 3rd response for this set of questions, this thread will be closed shortly.  Take care.  Please don't worry about HSV-2 at this time.  EWH
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