Jack101

Hello, I am a laboratory medicine physician (pathologist) and given your history of no symptoms, a high positive result only after a week from a sexual encounter, and having only been with one person previously I can say the following: If you have HSV-2 you did not get it from your previous sexual encounter. You should have your wife tested for HSV-2 to see if she is positive. If she is negative, you should proceed to have a western blot test done. You can have one done right away if your recent sexual encounter was negative, otherwise I would wait 12 to 16 weeks. Your infectious disease physicians should be aware of the limitations of the ELISA antigen antibody tests and not label you with HSV-2 without symptoms until you have a western blot test. It was true that the ELISA test had a high sensitivity and specificity when it was tested, but whether that holds true now is uncertain. What I mean by that is think of the ELISA test as looking for a Prius (HSV-2). When it first came out, in order to identify the Prius you just had to look for a dual electric and gas engine. This would identify greater than 99% of the Prius and not many other hybrids were represented. Fast forward today; many other hybrids are on the market (i.e. new diseases have emerged). Now just looking for the dual electric and gas engine will still net you greater than 99% of Prius, but given that other hybrids have arrived and increased their market share you will also pick up more non-Prius. In essence, as more diseases arrive on the market ELISA tests tend to become less specific. Now think of the western blot as looking for a dual electric and gas engine, the toyota logo, and the prius logo. As it is looking for more antigens, it is less prone to false postives. In addition, simply repeating the same test is not productive. If you were a false positive once, you will likely continue to be a false positive. Of note, recently there has been a uptick in false positives above 3.5. This may be due to the above mentioned reasons in paragraph 2. I have heard of false positives up to 14 on the Elisa tests and the CDC recommendations for testing people with a confirmation test if you are only below 3.5 may not be as valid when testing people with no symptoms. Unfortunately, the makers of this test cannot be held liable for false positives, as this test is not a screening test for herpes in low risk asymptomatic individuals or areas of low prevalence due to the very fact it is known to have a high rate of false positives. Referring back to epidemiology, it doesn't matter how high the sensitivity and specificity of a test is if the prevalence of the disease is low. The positive predicative is the number that matters.