Aa
HSV Results
Two weeks ago, I had unprotected sex with someone that claims to be STD free. To date I have not exhibited any symptoms, but to be on the safe side I had complete early detection STD testing done. They said that this test was more sensitive and would detect any STDs present within less than the normal suggested 6-week range for testing. My results came back yesterday and everything came back negative except for my HSV results. They were as follows: HSV 1 IgG, Type Spec = 3.98 (Positive) and HSV 2 IgG, Type Spec 0.95 (Equivocal). In addition, my CBC showed my Neutrophils slightly high at 77 (normal range being 40-74) and urine analysis showed Crystals Present (Abnormal). They did not give me the impression these were in any way related, but I am trying to provide you with as much information as possible.
I tested positive for HSV 1 several years ago, so I was not at all concerned by those results. However, I have never tested anything but negative for HSV2 so this is alarming. The testing center told me that I need to be tested again a later date to determine if these results are an indicator of early infection.
These are my questions: How long should I wait to test again? What type of test should I request to ensure accuracy? Is an index of 0.95 for HSV 2 at two weeks post incident a good indicator that I will be positive later? What does this number really mean to me considering it is the first time I have ever had results that were not negative? Just curios if I am putting the nail in the coffin too soon or if there is any peace, you can give me that this number means very little at this point.
I tested positive for HSV 1 several years ago, so I was not at all concerned by those results. However, I have never tested anything but negative for HSV2 so this is alarming. The testing center told me that I need to be tested again a later date to determine if these results are an indicator of early infection.
These are my questions: How long should I wait to test again? What type of test should I request to ensure accuracy? Is an index of 0.95 for HSV 2 at two weeks post incident a good indicator that I will be positive later? What does this number really mean to me considering it is the first time I have ever had results that were not negative? Just curios if I am putting the nail in the coffin too soon or if there is any peace, you can give me that this number means very little at this point.
MEDICAL PROFESSIONAL
Welcome to the STD forum. I'll try to help.
In general, HSV blood tests are not recommended in asymptomatic people who don't have a high suspicion of genital herpes -- and your results are an excellent example of the reasons. The tests are not perfect, and even positive results for HSV-2 (and certainly equivocal ones) often are false in persons not at high risk. And in any case, the advice you received from the testing lab was just plain wrong (and perhaps intentionally misleading): you were tested much too soon. If it were positive, it would not be from the sexual encounter 2 weeks earlier.
You clearly have HSV-1, which you have known for a long time -- most likely an oral infection acquired in childhood, whether or not you have a history of cold sores. HSV-2 test results in the equivocal range usually are actually false; and the risk of false positive results is especially high in people who have HSV-1, as you do. In the 15+ years since HSV blood tests entered the modern era and have been frequently done, I have never seen a patient (or even heard of one) with an equivocal result who turned out to actually have HSV-2.
So my belief is that you do not have HSV-2 and do not need additional testing. However, if you require additional reassurance about it, you could have another test 6-8 weeks after exposure, or even at 3-4 months if you want absolute reassurance.
CBC and urinalysis are irrelevant to STD evaluation. No STD expert would have done those tests had you sought professional care. And my guess is you likely had other blood tests that were unnecessary and done too soon. There is no blood test for any STD that comes up positive in only 2 weeks. If your urine was tested for gonorrhea and chlamydia, those results are reliable. But those are the only ones.
I hope this helps. Best wishes-- HHH, MD
In general, HSV blood tests are not recommended in asymptomatic people who don't have a high suspicion of genital herpes -- and your results are an excellent example of the reasons. The tests are not perfect, and even positive results for HSV-2 (and certainly equivocal ones) often are false in persons not at high risk. And in any case, the advice you received from the testing lab was just plain wrong (and perhaps intentionally misleading): you were tested much too soon. If it were positive, it would not be from the sexual encounter 2 weeks earlier.
You clearly have HSV-1, which you have known for a long time -- most likely an oral infection acquired in childhood, whether or not you have a history of cold sores. HSV-2 test results in the equivocal range usually are actually false; and the risk of false positive results is especially high in people who have HSV-1, as you do. In the 15+ years since HSV blood tests entered the modern era and have been frequently done, I have never seen a patient (or even heard of one) with an equivocal result who turned out to actually have HSV-2.
So my belief is that you do not have HSV-2 and do not need additional testing. However, if you require additional reassurance about it, you could have another test 6-8 weeks after exposure, or even at 3-4 months if you want absolute reassurance.
CBC and urinalysis are irrelevant to STD evaluation. No STD expert would have done those tests had you sought professional care. And my guess is you likely had other blood tests that were unnecessary and done too soon. There is no blood test for any STD that comes up positive in only 2 weeks. If your urine was tested for gonorrhea and chlamydia, those results are reliable. But those are the only ones.
I hope this helps. Best wishes-- HHH, MD
I forgot to mention that I did see my Gyno's NP a couple days prior to the blood and urine testing. She did a pelvic exam and said everything looked normal and nothing showed up on the wet mount ( I believe that is what she called it). However she did prescribe me a Diflucan pill that I took that evening. Not sure if any of this matters but I wanted you to have the whole story.
MEDICAL PROFESSIONAL
I'm glad to see that you got professional advice. Did the NP recommend the tests you had? She should have known that it was too early for any blood tests. Or did you do that part independently, perhaps through an online lab?
The NP apparently believed you have a yeast infection. That's the only thing treated with fluconazole (Diflucan).
The NP apparently believed you have a yeast infection. That's the only thing treated with fluconazole (Diflucan).
I did the testing on my own not under her direction. I went through a website, but now it sounds like the $750 they charged me was worthless. I have the results in a PDF that I can send you if it would help to see if they are accurate. If I don't develop any symptoms is it worth me getting retested? If so for what and when is the optimal time for the most accurate results? Thank you very much.
MEDICAL PROFESSIONAL
Thanks for the follow-up comment. This gives me an opportunity to write a blog-like response about self-directed or online STD testing services, which I will bookmark for later use in reponse to similar questions. I don't need to see the details of your test results.
Online testing has its advantages, but there are lots of options and high variability in quality, including the quality of pre-testing advice. Many (most?) services offer a broader range of tests than STD experts recommend, sometimes at great expense. This is the first time I heard a price level of $750. I believe many sites offer pretty comprehensive panels for $300-400. You can be quite sure the online folks who took your credit card information paid a whole lot less than $750 to the lab that did the actual testing.
Guessing at some tests you might have had given the high cost, in my STD clinic we rarely test heterosexual men or women for HCV or HBV, and never test for Ureaplasma or Mycoplasma. And certainly a CBC and urinalysis are not recommended. Routine screening tests in women and straight men generally can be limited to urine for chlamydia and gonorrhea, and blood tests for syphilis, HIV, and sometimes HSV. Gonorrhea and chlamydia testing are reliable within a week of exposure; all blood tests require at least 3 weeks and generally 6 weeks is best.
In general, my advice is that online testing or other self-directed testing, without professional advice, is OK for screening, e.g. an annual test for someone who has been sexually active but not at particularly high risk. When there are symptoms or if there is concern about a particular exposure, it is usually best to see a health professional and follow his or her advice about what tests are necessary. A typical office visit, plus the costs of all necessary tests, will generally be a lot less than having the tests on line.
Finally, if online or other self-directed testing is to be used, users should spend a substantial amount of time researching different options and also calling services in an attempt to judge their professionalism, quality of pre- and post-test counseling, etc. Almost anybody, with little or no training, can easily set up a website and develop a contract with a national laboratory, like Quest or Labcorp.
So you can chalk this up to lessons learned, and I hope these comments will allow other users to learn from your experience.
Online testing has its advantages, but there are lots of options and high variability in quality, including the quality of pre-testing advice. Many (most?) services offer a broader range of tests than STD experts recommend, sometimes at great expense. This is the first time I heard a price level of $750. I believe many sites offer pretty comprehensive panels for $300-400. You can be quite sure the online folks who took your credit card information paid a whole lot less than $750 to the lab that did the actual testing.
Guessing at some tests you might have had given the high cost, in my STD clinic we rarely test heterosexual men or women for HCV or HBV, and never test for Ureaplasma or Mycoplasma. And certainly a CBC and urinalysis are not recommended. Routine screening tests in women and straight men generally can be limited to urine for chlamydia and gonorrhea, and blood tests for syphilis, HIV, and sometimes HSV. Gonorrhea and chlamydia testing are reliable within a week of exposure; all blood tests require at least 3 weeks and generally 6 weeks is best.
In general, my advice is that online testing or other self-directed testing, without professional advice, is OK for screening, e.g. an annual test for someone who has been sexually active but not at particularly high risk. When there are symptoms or if there is concern about a particular exposure, it is usually best to see a health professional and follow his or her advice about what tests are necessary. A typical office visit, plus the costs of all necessary tests, will generally be a lot less than having the tests on line.
Finally, if online or other self-directed testing is to be used, users should spend a substantial amount of time researching different options and also calling services in an attempt to judge their professionalism, quality of pre- and post-test counseling, etc. Almost anybody, with little or no training, can easily set up a website and develop a contract with a national laboratory, like Quest or Labcorp.
So you can chalk this up to lessons learned, and I hope these comments will allow other users to learn from your experience.
You are reading content posted in the STDs Forum
Herpes spreads by oral, vaginal and anal sex.
Herpes sores blister, then burst, scab and heal.
STIs are the most common cause of genital sores.
Millions of people are diagnosed with STDs in the U.S. each year.
STDs can't be transmitted by casual contact, like hugging or touching.
Syphilis is an STD that is transmitted by oral, genital and anal sex.
