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Low positive 10 months after equivocal and negative results


Straight male visited massage parlors for hand jobs and oral. In August of 2012 after hand job I had intercourse for 1-2 minutes doggie style position to facilitate ejaculation - I wore a condom. I did not observe any skin condition indicating HSV-2 on the girl.

September 2012 - "HSV Type 2-Specific Ab, IgG" was performed by Labcorp. The result was: 1.04.

Week later Manhattan Labs test results were:

- HSV Type 1 AB IGG W/RFX: 0.02 (negative)
- HSV Type 2 AB IGG W/RFX: 0.01 (negative)
- HSV Type 1/2 Combined AB, IGM 0.34 (negative)

Continued to obtain massages limited to hand jobs and oral with condom. Kissed girls butt/thigh. Received 1 lapdance - both wore underwear. No genital to genital exposure.

Decided to give this up. Tested in July 2013 by Labcorp.

- HSV 1 IGG, TYPE SPEC:  <0.91 (negative)
- HSV 2 IGG, TYPE SPEC:  1.33 (positive of 1.09)
- HSV 1 IGM ANTIBODIES:  <1:10
- HSV 2 IGM ANTIBODIES:  <1:10

I have never seen any visible signs of HSV2. Bumps in my inner thigh area Doctors have viewed as folliculitis. No itchiness/redness/burning/sores or outbreak episode. Itchiness in my groin is short and I attribute from tight underwear in hot weather/sports/gym).

1) No known outbreaks and these low values, what do I make of this situation? Room to think this is a false positive?

2) Given 10 months have passed wouldn't my igg levels be much higher than the change from equivocal to low positive (from 1.04 to 1.33)?

3) Do asymptomatic carriers have lower levels? Shouldn't the igg antibody count increase above the 3.5 of a definite positive?

4) It appears recommended to take the Biokit or WB tests around 6 months. I'm nervous to ask if this is worth it.

5) The other person in my relationship has not shown any signs/visibility of HSV2.
5 Responses
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300980 tn?1194929400
MEDICAL PROFESSIONAL
Sorry we do not take questions onther than at this site.   EWH
Helpful - 0
Avatar universal
Thank you very much doctor. Is it possible to ask you a question through the systems private message or email? It would be a great deal in helping me to put this to bed with the person in my relationship. I doubt it would take more than 1 minute of your time.
Helpful - 0
300980 tn?1194929400
MEDICAL PROFESSIONAL
1) How does the role of negative HSV 1 igg play into false positives. I've read that in the absence of HSV 1 the probability of false positives are much less than when HSV 1 is present. Are there studies out there on individuals that have never been sexually active and produce low positive results?

While the presence of HSV-1 does increase the probability of low positive HSV-2 tests, there are many other contributors to false positve tests as well (too many to mention) and I have seen many persons who have false positve IgG tests who do not have HSV-2.

And yes, there are persons who are not sexually active persons who have false positve tests for HSV-2.

2) I've heard there are some people that just tend to produce equivocal/low positives even with no infections. Is this true?

Correct- that is also  logical conclusion to all I've said in my initial answer, as well as above.

3) In your professional opinion, should I just got about my life until something visible warrants further exploration?

I suspect you do not have HSV-2 and would suggest that you move forward without concern (inplied this before too).  EWH
Helpful - 0
Avatar universal
Thank you for the prompt response. The words are a GREAT deal of comfort. Following up I was able to find Manhattan labs website and search their test catalog. I suspected the test name characters were cut off and I believe this is the test HSV 2 test they ran: HSV TYPE 2 AB IGG W/REFLEX TO IGM ((http://testmenu.com/public/cltdDetail.aspx?crud=Retrieve|8044).

I called them up and they mentioned the test was a chemiluminescence. Doing some online research I found this: "Detection of type-specific antibodies to HSV-1 and HSV-2: comparative analysis of a chemiluminescence immunoassay with a conventional ELISA." (http://www.ncbi.nlm.nih.gov/pubmed/22534561). The abstract notes the overall agreement of the chemiluminescence immunoassay versus the ELISA assay was 99.6% (HSV-1) and 100% (HSV-2). It makes me feel confident the test was reputable rather than a highly flawed one.

I have two follow up questions:

1) How does the role of negative HSV 1 igg play into false positives. I've read that in the absence of HSV 1 the probability of false positives are much less than when HSV 1 is present. Are there studies out there on individuals that have never been sexually active and produce low positive results?

2) I've heard there are some people that just tend to produce equivocal/low positives even with no infections. Is this true?

3) In your professional opinion, should I just got about my life until something visible warrants further exploration?
Helpful - 0
300980 tn?1194929400
MEDICAL PROFESSIONAL
Welcome to the Forum.  I'll be pleased to comment.  Your experience as described here is precisely the reason that we do not recommend routine HSV blood tests.  From the looks of things, in  addition, it appears that the tests performed at LabCorp and Manhattan Labs use different assays for HSV antibodies, further complicating things.  You do not provide much history from to 2012 (nor am I asking for it) but the history you provide suggests that your sexual activities are not particularly high risk for HSV, that you take appropriate precautions in terms of safe sex, and that you have not had clinical manifestations which suggest HSV.  In persons such as you, the low positive herpes IgG results you have are falsely positive over 75% of the time.  The odds are high that you do not have HSV and that if you did, it was not acquired by the massage parlor activities that you describe.  If you wish to get a more definitive test, you could seek testing with a Biokit assay or have a specimen sent to the University of Washington for their HSV Western blot test.  if the results are negative or equivocal, you can be confident that you do not have HSV.  

As for your specific questions:
1) No known outbreaks and these low values, what do I make of this situation? Room to think this is a false positive?
See above. More probably a false positive than not.

2) Given 10 months have passed wouldn't my igg levels be much higher than the change from equivocal to low positive (from 1.04 to 1.33)?
Typically but not always.  A very few people with HSV have persistently low positive IgG antibody levels.  As I said, however, this is uncommon.

3) Do asymptomatic carriers have lower levels? Shouldn't the igg antibody count increase above the 3.5 of a definite positive?
No, there is no correlation between symptom status and antibody levels.  

4) It appears recommended to take the Biokit or WB tests around 6 months. I'm nervous to ask if this is worth it.
That's you decision.  Either of these could be helpful in sorting things out.

5) The other person in my relationship has not shown any signs/visibility of HSV2.
This is not relevant to your concerns.  

I hope this is helpful.  As I said above, it is more likely than not that you do not have HSV-2.  EWH
Helpful - 0

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