HSV IgG results - HSV-2 Equivocal... what is next?

[SIG2011]

Hello,

30-year old hetero male, met someone new, and wanted to get tested before we got too serious.  I am in the military, which I believe only tests us for HIV, so I've never been tested before for anything else.  I utilized one of the online companies to have an 8-panel test, and had the labs drawn on Monday, 1/13 at the end of the day.  Late afternoon yesterday (1/16) my results came back.  Negative for everything except for herpes:

HSV-1  3.12 positive
HSV-2  1.08 equivocal

The lab was Quest Diagnostics, which it appears uses Herpeselect for the IgG test that was ordered.  So it sounds like I had the right test done, all things considered.

My last sexual encounter (with the exception of kissing this new girl lately) was seven months ago.  I contacted that girl from the previous relationship, knowing that she tested regularly.  She reported that she had been tested just three weeks ago and was once again clean.  She is currently looking into confirming which tests she had for HSV, as she did not know (and quite frankly, couldn't confirm that HSV was part of the tests at all.) Our encounters were unprotected.

I've been doing plenty of research these last 18 hours. I'm familiar with the different alternative tests that are available.  I could use some guidance on how to get a WB and/or BiokitUSA test run without having to have a military doctor involved to order it--I'd like to keep them uninvolved for the moment.

If results as high as 3.5 can are worth re-testing, that gives me some tentative comfort with the HSV-2 1.08 equivocal score, given that it has been seven months since last possible encounter. It also makes me wonder if I should skeptical of the HSV-1 3.12 result?

I do not believe I have had symptoms, but cold sores could have been mistaken for acne (constant issue) around the lips/mouth, I suppose. I have a second IgG test schedule with a different company/lab.  

Thoughts on my results and way ahead are welcome! Thanks!!

[Terri Warren, RN, Adult Nurse Practitioner]

Yes, I would expect the HSV 1 to be positive, not the HSV 2

Terri

[SIG2011]

Thanks Terri.  As I re-read your response, I assume you mean you'd expect the HSV-1 to show up positive, correct?  You did not mean that you'd expect HSV-2 also to be positive?

Just wanted to clarify, now that I thought of it. :)  

[Terri Warren, RN, Adult Nurse Practitioner]

Yes, Lisa T is very good.  I' glad you had a good discussion.
The is normally quite a bit of variability in the IgG tests
Will be interesting to see what the western blot says.  If I had to guess, it might be positive.

Terri

[SIG2011]

Another update to record her for other internet readers as much as for your thoughts:

First, my phone consult with Dr. T went well last night.  She was fantastic to chat with.  She agreed to a WB.

In the meantime, the extra IgG that I decided to do for short-term peace of mind came back today.  I went through HealthcheckUSA for that one, per your handbook's recommendation.

This one came back:

HSV-1:  1.24
HSV-2:  <.91  (no specific value given)

So that was certainly encouraging!  Considering my initial post's discussion of my situation/results, I think I can relax on HSV-2 concerns between now and the WB, expecting the WB results to confirm that negative result.

I think the HSV-1 result was very interesting.  I realize these numbers can fluctuate day-to-day, and in this case, week-to-week... but that seemed like a significant drop.  Still positive, nonetheless...so I am choosing to read this as "positive IgG + positive IgG = expecting likely positive WB result" for HSV-1, regardless of the fact that they were both "low" positives.  Does that seem like the most accurate expectation?

Thanks again!

[Terri Warren, RN, Adult Nurse Practitioner]

Good, hope that is helpful

Terri

[SIG2011]

Quick update:  My phone consultation with your clinic is scheduled for tomorrow afternoon.  Thanks again!

[SIG2011]

Ma'am, thanks kindly. It sounds like we are on the same page.

Does the ordering of the kit directly from UW require that I also find a doctor to authorize the labs?  Or does UW submit that lab order for me?  

If it still requires a doctor from outside of UW to submit the order, then I'll simply work through your clinic.  

Not that it is particularly relevant since I will continue to test with the WB, but have any studies been done showing the incidence of false positives in given ranges of scores on the IgG with either HSV-1 or -2?  I've seen various folks across the internet cite seemingly random percentages... (i.e., (paraphrasing) "I would say your score of 1.5 is probably 80% likely to be false in your case, given risk factors, etc") ... but is that just an educated assessment for that individual, or has someone been able to distill the probabilities further that such an assessment can be drawn from?  Just curious.  I can easily understand why such a study may not exist.

Thanks again for providing your insight!

[Terri Warren, RN, Adult Nurse Practitioner]

Remember that you test is not a positive result.  It is in an area where the results are simply unclear.  Your HSV 1 positive could be falsely triggering an HSV 2 equivocal test.  You've definitely waited long enough to be tested from your sexual encounter, and a western blot is what we would order as a confirmatory test if you were our clinic patient.  Both of your values are suspect, though if I had to guess, I would guess that you are HSV 1 positive.  The closer an index value gets to 3.5, the more likely it is to confirm, and yours is pretty darn close.  If you've never had an actual cold sore that you recall, you could have HSV 1 infection either orally or genitally.  Without a sore to swab, there is no way to know for certain.

Our clinic, Westover Heights Clinic, can assist you in getting a western blot where you are through a local lab.  also, you can send directly to the University of Washington for a test kit.  You would, however, have to have one of the military doctors or some lab where you are draw the blood to send back to UW.  

You've done good research and seem well informed about the herpes testing issues.

Terri