Help! Herpes test results after a protected encounter

[Bart 17]

My question pertains to the likelihood of HSV1 &2 transmission from a one time protected encounter with an Asian masseuse at a massage parlor? Approx 1 week ago I went to a massage parlor and ended up being offered sex by the masseuse. She put the condom on before any sex act and it was intact after the 5-10 minutes we engaged. I have had no other exposures outside of my long term partner for the last 10 years plus. 

 

I’ve felt a huge amount of guilt over this and ended up paying for a 10 panel STD test 4 days post exposure. The blood draw was done at lab pro which I believe to be reputable. The next day I received the results and the igg grade for hsv 2 was 1.06 equivocable and for hsv 1 the igg grade came back 1.88 which looks positive. 

 

I’m doing research it appears my exposure was on the very low end being that I’m a male and a condom was used but I’m at a loss to the result from the std blood test. 

 

I have not noticed any symptoms or sores or anything.   

 

Please advise if there could have been an issue with the HSV tests and where I should go from here. 

 

Many thanks in advance. 

[mr_hopp]

First off, good job taking responsibility for your sexual health and getting tested. That's a proactive step towards staying informed and taking care of yourself.

And about the likelihood of HSV-1 and HSV-2 transmission in your situation, the use of a condom greatly reduces the risk of transmission (by around 50%). Condoms are highly effective in preventing the spread of sexually transmitted infections, including herpes. So, that's definitely a positive aspect of your encounter. It just all depends on if she does have herpes, then sometimes outbreaks happen in places that a condom won't cover (base of penis, for example).

Now for the blood test results: The IgG test measures the presence of antibodies to the herpes viruses, indicating past exposure to the virus. A result above a certain threshold is considered positive. In your case, your HSV-1 result of 1.88 is considered positive, indicating that you have been exposed to HSV-1 at some point in your life. HSV-1 is the virus commonly associated with oral herpes or "cold sores." It's important to note that the test doesn't specify the location of the infection, so it could be oral or genital. The HSV-2 result of 1.06 is equivocal, which means it falls in a gray area and is not definitively positive. Further testing may be needed to confirm the presence of HSV-2 antibodies.

It's worth mentioning that IgG tests can sometimes yield false-positive or false-equivocal results, especially at low values. There can be variations in test accuracy and sensitivity. If you want to be absolutely sure, then you should get the Western Blot test. It's a couple hundred dollars, but it's the gold standard. But to get an accurate reading for this recent exposure, you need to wait 3-4 months (via the CDC) to give antibodies enough time to build to detectable levels (the exact time frame varies depending on where you look; Western Blot literature says 2 months). Even the best blood tests available do nothing for detecting recent infections. 

In terms of symptoms, it's important to remember that not everyone who is infected with herpes will experience noticeable symptoms or sores. Many people with herpes, especially HSV-1, are asymptomatic or have very mild symptoms that go unnoticed. So, the absence of symptoms doesn't necessarily rule out the possibility of infection. 

All in all, you're right — a one-time encounter has a very small likelihood of transmission, but it has been known to happen. Sorry, there's just no definitive answer I can give you. It's all a game of chance and odds. 

Try not to be too hard on yourself. We all make choices, and it's important to learn from them and take steps to protect our health going forward. If you have any further questions or need more support, feel free to reach out. Take care of yourself, and remember that knowledge is power when it comes to your sexual health.

Wishing you the best!

[ylu09]

hi @Bart 17, thanks for sharing your experience, I have a similar encounter as you, a protected oral and viginal sex, do you have any symptoms after you posted ? For me, I have some frequent urination problems and constipation 

[Bart 17]

Hello,

no symptoms to note and I have been checking my genitals what seems like every 5-10 minutes since this ordeal happened. 
 

I’ve read online that if symptoms do occur, they usually happen in the first 2-20 days (most within 2-12 days). Hoping I can take some solace in the fact no symptoms have shown and the fact that the labcorp igg test has been noted to come back with false positives/equivalents. I purchased the first test through www.stdcheck.com and along with the result I got a notice that “Due to the increased possibility of false positives on the test you ordered, we HIGHLY SUGGEST you complete an HSV-2 Confirmation Test. ”

@mr_hopp I’ve paid for the additional testing through std check. The test is an hsv2 igG inhibition, IA test through quest diagnostics. Do you have any thoughts on this test and accuracy in determining a false positive? From what I’ve been able to research online, it appears reputable.

any opinion/responses would be much appreciated.

 

[mr_hopp]

IgG tests is the industry standard blood test for herpes, but there are enough false positives and false negatives to not give a definitive enough answer. This is why I always suggest getting a Western Blot test, which is the gold standard and will give you unmatched accuracy. It costs a couple hundred bucks, but it's worth it for peace of mind and knowing for sure whether you have it or not. The only thing about blood tests that is important to know is that for them to be accurate, you need to wait 3-4 months (via the CDC) to give antibodies enough time to build to detectable levels (the exact time frame varies depending on where you look; Western Blot literature says 2 months). Even the best blood tests available do nothing for detecting recent infections. 

[Bart 17]

@mr_hopp coming back with some other questions I’m hoping you may be able to offer an opinion on.   
 

After the initial igg test, it was recommended by stdcheck that I obtain additional hsv2 testing and the quest inhibition test was suggested. I did the blood draw on 7/5 and results came back a week later as follows:

HSV-2 IGG screening index <0.90 (in range)

The HSV-2 IgG screening assay was repeated on a different platform as part of the inhibition test, and the result was negative; thus the Inhibition result could not be determined.

 

From what I can tell, when quest ran the igg screening (initial was done at labcorp) I received a negative result so the inhibition assay was not done, correct?

 

is the question test more reliable than the initial labcorp test?

 

if this second test is accurate I can deduct the initial test was a false positive as it was done to early to pick up anything from my encounter 3 days before I did the initial igg. 
 

since I have had no other partners other than my long time partner of 10+ years, the only thing that could potentially change my status would be if I hsv2 was transmitted during the one time protected encounter which I’m seeing as either a 1 in 1000 chance or 2% depending what you read, and that is also assuming the masseuse was hsv2+ and also shedding at that particular moment. This seems like a rather low possibility/probability. 
 

I have also not had anything resembling an outbreak or any lesions/sores and I’ve been hyper aware on this front. 
 

any additional thoughts on where to go from here would be appreciated. 

[mr_hopp]

The screening index result of <0.90 is considered negative, and since the HSV-2 IgG screening assay was repeated on a different platform and also came back negative, the inhibition result couldn't be determined. This means that the second test did not detect any HSV-2 antibodies in your blood.

Given these results, it's reasonable to consider the possibility that your initial LabCorp test was a false positive. It's essential to be cautious about interpreting low positive results, especially when they fall within the equivocal range. False positives can happen, and that's why confirmation tests like the Western Blot are so valuable for providing a definitive diagnosis.

Regarding transmission from the one-time protected encounter, you are correct in saying that the risk is relatively low, especially with condom use. However, as you mentioned, the only way to know for sure is to get tested again after the appropriate waiting period, which is usually around 3-4 months for HSV-2 (and 2 months for the Western Blot).

Since you haven't experienced any symptoms resembling an outbreak, that's a positive sign. But do keep in mind that not everyone with herpes experiences noticeable symptoms, so the absence of visible sores doesn't necessarily rule out infection.

If you want to be absolutely sure about your HSV-2 status, wait for the appropriate time frame (3-4 months since your last potential exposure) and get tested again using the Western Blot test. This test is highly reliable and will provide a definitive answer.

In the meantime, try not to stress too much about the situation. It's essential to take care of your mental well-being, and obsessing over the test results can add unnecessary anxiety.

[Bart 17]

@mr_hopp thank you for the response and you are right about not trying to over stress but it’s definitely not the easiest thing to do!

A couple follow up questions and then hopefully I can try to relax and wait this current potential exposure out. 
 

1. being that the supplemental test came back negative, that would mean I’m negative for hsv2 outside of the protected exposure that took place 3 days before my initial Labcorp test as my only other partner is my long term partner of 10+ years. 

2. what would the earliest antibodies would start to develop from the current exposure? I’m guessing I wouldn’t get a 1.06 equivocal or 1.88 hsv1 igg if this was related to the encounter 3 days before the Labcorp test, correct? Trying to see if these values were somehow related to the recent event or not.  From what I’ve read online, antibodies don’t start to show up until 21 days plus. Is this accurate?

3. with a 1.88 hsv1 igg if this was a previous infection, I would think the number would be a healthier number, at least above 5-6, right? Many folks online that are known positive are in the double digits from an igg standpoint vs the 1.88 I received. 

[mr_hopp]

1. being that the supplemental test came back negative, that would mean I’m negative for hsv2 outside of the protected exposure that took place 3 days before my initial Labcorp test as my only other partner is my long term partner of 10+ years. 

Correct. It's a good data point to have so you can know your status pre-encounter. 

2. what would the earliest antibodies would start to develop from the current exposure? I’m guessing I wouldn’t get a 1.06 equivocal or 1.88 hsv1 igg if this was related to the encounter 3 days before the Labcorp test, correct? Trying to see if these values were somehow related to the recent event or not.  From what I’ve read online, antibodies don’t start to show up until 21 days plus. Is this accurate?

The timing of seroconversion (the development of detectable antibodies) for HSV can vary. Typically, IgM antibodies might start to appear within a week or two after exposure, but they can be difficult to interpret due to cross-reactivity with other viruses (which is why IgM tests suck). IgG antibodies, on the other hand, generally take longer to develop. It can take anywhere from 2 to 12 weeks (and occasionally longer) for HSV IgG antibodies to become detectable in the blood following a primary infection. The specific values you mentioned (1.06 equivocal or 1.88 for HSV1 IgG) would not likely be related to an exposure only 3 days before the test. These values would more likely be related to a past exposure.

3. with a 1.88 hsv1 igg if this was a previous infection, I would think the number would be a healthier number, at least above 5-6, right? Many folks online that are known positive are in the double digits from an igg standpoint vs the 1.88 I received. 

You know, figuring out HSV IgG test results can be like reading tea leaves sometimes. It's just not as simple as looking at a number and knowing what's going on. People are different, labs are different, and those numbers can mean various things.

Think of it like a scale: anything below 0.9 is generally considered a no-go, meaning negative. Anything above 1.1, and you're in the positive territory. But those in-between numbers? They're kind of like being in limbo and can be tricky to pin down. The tests themselves might even have different thresholds, so it's best to check with the doc or the lab to know exactly what's what.

Now, about that 1.88 you mentioned. That's typically a yes – a positive for HSV-1. But here's the thing: it doesn't come with a timestamp. You can't tell when you got it or how strong your body's response is just by that number.

And let's not forget that these numbers can be finicky. Different labs, methods, even your own body can make those numbers dance around. Comparing your 1.88 with someone else's double digits? It's like comparing apples to oranges. It doesn't mean one's more robust or "healthier" than the other; it's just different.

[Bart 17]

@mr_hopp

 

Coming back to provide some additional info and testing results. 
 

I ended up paying for and taking two UW HSV Western blots. One at 6 weeks and another between 12-13 weeks. Both returned as hsv 1 & 2 negative. based on these results would you consider the initial igg test as a false positive for both hsv1&2? Should I trust the two blot results and move forward as I have been?

 

Assuming I should put more faith in the supplemental quest inhibition test and two Western Blots but my mind wonders to that initial igg test every once in a while. 

[mr_hopp]

Hey @Bart 17,

Great news about your Western Blot results! Given that they came back negative for HSV1 & 2, it's a strong indication that your initial IgG test was indeed a false positive. The Western Blot is considered the gold standard for herpes testing due to its high specificity, so you can trust these results. In fact, it can detect HSV antibodies with a sensitivity of around 99.5% for HSV-2 and a bit less for HSV-1, compared to the standard IgG tests which vary in sensitivity. 

It's completely natural to have your doubts, especially after the emotional roller-coaster of testing and waiting for results. But rest assured, the Western Blot at both 6 weeks and between 12-13 weeks gives you a reliable snapshot of your status. 

Remember, testing can be a stressful process, and it's okay to seek peace of mind. But with two negative Western Blots, it sounds like you've done your due diligence. Take care, and don't hesitate to reach out if you need more support.