[Question #8682] HSV Index Values and Western Blot for HSV2

41 months ago

Hi, hope you're well! I'm a straight 36 year old female, negative for hsv1&2. Always had new boyfriends fully tested before sex. Most recent guy showed hsv2+ IGG. He was shocked, claimed he had no knowledge, never had an outbreak, etc. He was tested twice by his PCP (standard IGG antibody test), results were 2.9 & 3.2, respectively. I'd read about the Western Blot, how a "low positive" could possibly be a false negative. Two months after these tests, we saw an infectious disease specialist and inquired further about WB. She had no info, and believed further testing unnecessary since "he was positive." I asked about index value and meaning of 'high' & 'low' positive, to which she replied, "We don't quantify results." She then ordered an ELISA assay. Result: "HSV2 inhibition assay true positive react." No mention of index value.

I've gone through 5 years of my own blood work and have noticed that, while negative, my value for both hsv types has fluctuated. hsv1 went from 0.1 to 0.77 to 0.2 hsv2: 0.06 to 0.16 to 0.24

So confusing! How can there be any value attached to something that doesn't exist? Do I have some virus, but not enough to outbreak? Will I continue to elevate hsv2 IGG until I'm positive? The only sexual contact we had was hand to genital and a few instances of oral (both ways). I tested negative, again, this month. I'd like a normal sex life for us, but fearful if he is truly positive. Would Western Blot be recommended in this situation, or a simple waste of time and hope? Doctors we've spoken to don't seem concerned, parroting things like, "asymptomatic transmission is unlikely, just use condoms, we don't test without symptoms." This has been emotionally stressful to a large degree, but I'd much prefer more definitive answers before moving into sex. It'd also be great to learn how to obtain the Western Blot, and steps needed on that front. Hoping for a vaccine/cure! The effects of this infection go beyond those who carry it. Thank you for your time!

Terri Warren, RN, Nurse Practitioner

41 months ago

Well, once again, we have an ID doc who is uninformed about herpes. Too bad about that. The IgG tests commonly used DO give a number and you got them and they are both in the low positive range. The positive inhibition assay gives more evidence that he may well be truly infected. However, I have certainly had patients who were positive on the inhibition assay and negative on the western blot.

Your scores as simply negative - an index value is assigned to all results and I don't recall ever seeing a zero. It has to do with optical density of your sample vs. a true positive, a low positive and a negative. You should not worry about the number assigned to your negative result. If he was my patient, I would order the blot, just to be sure. Since this is a lifelong concern, it should be the best test possible.

Terri

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41 months ago

Thank you! Any way you could help with ordering the Western Blot? I feel uneasy to simply order something online, and I have no idea what the next step would be. Do we take the kit to a clinic and have blood drawn? Does his PCP have to order the test? I was under the impression a doctor would need to do this, but the ID doctor hasn’t been much help. I am unsure if there was an index value from his inhibition assay, but I’d definitely like to move forward with getting him the blot. Lastly, I understand you’ve had patients turn up negative on the blot after positive inhibition assay. Does this happen relatively often when people get the blot, or is there a very slim chance of this occuring?

Thank you, again, so much. This all means the world to me, and your knowledge and quick reply are greatly appreciated.

Terri Warren, RN, Nurse Practitioner

41 months ago

You cannot order this online by yourself anyway.

Yes, I can help you at westoverheights.com. Follow the link to "get a western blot"

Inhibition assay's do not give you results, no.

I can't give you an exact number but I would say maybe 1/3 of positive inhibition assays do not confirm.

Terri

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41 months ago

Thank you! Looking forward to discussing more over at westoverheigts. I guess my final thoughts in this exchange would be:

-If, in the event, his Western Blot comes back negative for hsv2 - what is it about this test that eradicates all other positive test results? I've heard things about some people having some type of protein that cross reacts, or something similar, but will he always turn up positive, save on the WB? (I should mention he tested negative for hsv1, not sure if this is useful information in this case.)

- When doctors we've spoken to say things like, "Without ever having had an outbreak or any signs/symptoms, it is very unlikely you will pass this to a female partner, and using condoms would make it even more unlikely," are they just under-informed, or is there any truth to these statements? Two doctors have advised against antivirals, saying it would do no good to someone who never experiences prodrome or outbreak.

-Is there a location on a male that hsv2 tends to reside on a person whose never had outbreaks or symptoms in comparison with a person who does? Wondering if this may be why doctors claim using condoms would virtually eliminate transmission, though this doesn't seem very logical to me.

-What is the likelihood that giving oral sex to an hsv2 positive male would result in transmission of hsv2 orally? I have read on here that it is believed to be quite unlikely that hsv2 would infect and present as an oral infection, but I guess it would ease my mind to know a bit more about that, specifically.

This who exchange has been so helpful. This forum is such a great tool for people who suffer these issues, as well as people like me who would like to develop close relationships, but avoid having these issues myself. All the best!

Terri Warren, RN, Nurse Practitioner

41 months ago

yes, people that have false positive IgG test have some protein, we don't know what protein, that trips the test artificially. Also, some people have a high HSV 1 level of antibody and we see some cross reactivity with that on the HSV 2 test.

We know that people who have HSV 2 infection but have no symptoms, shed virus on about 10 out of 100 days, so those are days when transmission can happen. Those doctors are apparently uninformed about this data.

Men shed virus primarily from the shaft of the penis and the anus. Condoms do reduce transmission from males to females by 96%, so very effective.

We do believe that transmission to the mouth is unlikely but it isn't impossible - it has been documented in the scientific literature and I have personally seen it, but very rarely.

I"m so glad the forum has been helpful and also glad he is going to do the western blot

Terri

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