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Possible false positive HSV-2 IgG, Western Blot vs. PCR?


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I recently started a new relationship with a girl and we both agreed to get tested for STDs. We both disclosed to the other that we both had HSV-1 with occasional cold-sores. Well, to my surprise, my HSV-2 result also came back positive. That didn't make any sense to me, as I'd been in a monogamous relationship (with someone who does not have HSV-2) since the last time I was tested many years ago. So of course the Googling began....

 

The result of my online lay research was that I seem to be a prime candidate for a false positive for HSV-2, based on the following factors:

1. My HSV-2 IgG test came back at a level of only 2.2, which is quite low and in the gray area (although the official level for a positive result is only 1.1)

2. I definitely have HSV-1 (since childhood), which is known to cause false positives for the HSV-2 IgG test.

3. I've never had a genital outbreak of any kind.

4. I've had no known exposure to HSV-2 as my only partner since my last battery of STD tests is negative for HSV-2.

 

I read a variety of online articles like these:

1. https://consults.blogs.nytimes.com/2010/08/27/getting-tested-for-herpes/

2. https://www.statnews.com/2017/01/26/herpes-testing-false-positives/

3. http://jamanetwork.com/journals/jama/fullarticle/2593575

It seems like the HSV-2 IgG test is not ideally suited to my situation, especially considering that my level came back as only 2.2. I wonder why the HSV-2 IgG test has an "indeterminate" level of 0.91 - 1.09, because it seems that the test is pretty indeterminate all the way up to a level of 3.5 or so, based on the online literature.

 

The advice on all the online articles I read was to get a Western Blot test for HSV-2, which everyone proclaims as the "gold standard" and much more reliable than the HSV-2 IgG test. But yeah, good luck with that... The test is apparently only done at the University of Washington, and needs to be ordered by a doctor. (Because, god forbid I choose to pay for a medical test myself without a mystical doctor's permission. Imagine the resulting calamity if we allowed such a thing. But I digress...).

Anyways, I printed out the following information for my doctor:

http://depts.washington.edu/herpes/pages/frequently_asked_questions

And took this information to my primary care doctor and told them I wanted them to order this test and to call the listed phone number and follow the instructions on that page. Well, turns out the U of Washington phone number is out of service. My primary care doctor had never heard of such a test, so he scoffed at the idea anyways.

 

Whatever. I guess you can't get this magical Western Blot test anywhere, despite numerous articles about it online.

 

Anyways, my primary care doctor ordered the following 3 tests, which he claimed are the "gold standard" for HSV-2"

1. HSV 1/2 PCR

2. HSV Type 2- Specific Ab, IgG

3. HSV 1 and 2 IgM Abs, Indrect

This recommendation runs contrary to everything I've read online about HSV-2 detection.

 

Regarding test #1, my understanding was that a PCR test could only be done by swabbing an active sore, which of course I don't have any active sores. But the doctor argued that HSV-2 PCR test can be serologically. This didn't make any sense to me as I thought the HSV-2 virus was not present in your bloodstream, but rather lived in certain nerve tracts. So how would PCR be able to detect the virus in a blood sample?

 

Regarding test #2, this is the same test that already came back positive, so I expect to get the same result again.

 

Regarding test #3, my understanding was that the IgM test (as opposed to IgG) was more suited to detecting the antibodies that occur during an active infection. And of course I don't have an active HSV-2 outbreak now.

 

Anyways, the doctor drew a blood sample for those 3 tests (no swabbing was done), which will come back with results in 10 days. So, good times ahead.... thanks for reading.

 

 

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Sounds like you've done your homework! You're on the right track. I would find a new doctor and start googling/calling numbers for UW. I also had a low positive for HSV2 on my IgG and tested positive on the WB. I just happened to do that through the Westover Heights Clinic before they closed their doors. My lab results from a year ago doesn't have a number, but there's an address for the UW medical center on 1959 NE Pacific St in Seattle, Room NW 220 - Clinical Lab, and lists Dr Mark H Weber as the lab director. Everything you stated about the other tests (to the best of my knowledge) is correct. I'd keep working toward the WB with a new doc. Hopefully this will give you a new lead in finding the phone number. Good luck!

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p.s. You may not have been tested for HSV when you last tested years ago. That's what happened to me. I had no major symptoms--just some itching I attributed to yeast infections. I also have HSV1 and have never had a cold sore. I found out after my divorce. My ex tested negative for both types and we were married for 15 years using no condoms or antivirals because I had no idea I had HSV!

 

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@antibody6

To get a Western Blot :

https://www.westoverheights.com/herpes/getting-a-western-blot/

 

:)

Thanks so much for the replies!

 

So I was actually on that web site before I made my original post here, and I had actually started signing up for an "eVisit" with Terri Warren though the Westover Heights center. However, there is a message that appears right before you book your online consultation that says the following, "We can no longer order the western blot for you– at least for now, but we are working on that. But you can order through the University of Washington directly if your health care provider will agree to order it for you."

 

The other option that Westover Heights provides is the following message, "After seven years of doing our western blot study, Quest laboratories will no longer transport our western blot samples for us. If you live in a city or can travel to a city that has an AnyLabTestNow, we can use them to draw your blood, spin and ship it." So obviously, you need to have an "AnyLabTestNow" clinic in your area that you can physically go to. In my case, there was such a lab about 15 minutes away, but it closed about 6 months ago. The next nearest AnyLabTestNow clinic is 400 miles away.

 

Based on that, I didn't follow through with the online consultation. I couldn't find anywhere else to get the Western blot test ordered, except through a primary care physician. I mean god forbid I should be able to simply pay for a medical test on my own body... can't have *that* now, can we...

 

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I got my results back from my doctor's re-test for HSV-2 today. As predicted, the whole thing was a waste of time. Check this crap out...

 

HSV-2 IgG test. Same result as the first test with value of 2.68. So I tested a low positive, which by all accounts, is pretty inconclusive. So, no surprise there, I got the same result as the first test.

 

HSV 1/2 IgM test. Negative for both HSV-1 and HSV-2. Totally worthless test. I definitely have had HSV-1 since childhood, but as we all know the IgM test just isn't even worth having.

 

HSV 1/2 PCR test. Negative for both HSV-1 and HSV-2. Again, this was not a "swab" on a sore; this was a blood test. They were looking for HSV DNA in my blood... How the hell are they going to find HSV DNA in my blood? The virus doesn't live in your blood-- it hides out in your nerves. WTF are these people doing when they order these B.S. tests?

 

I also had a brief consult today with the doctor, to discuss these results. Well this girl tried telling me that since the PCR test came back negative, then I don't have HSV-2. But that's b.s. because the PCR test also came back negative for HSV-1, and I DEFINITELY HAVE HSV-1. I explain this to her, and she just mumbled some nonsense that escapes me right now. Worse, her interpretation of my IgG positive result for HSV-2 was the following: "I've been "exposed" to the virus at some point in my life, but I don't have the infection now." Ummm WTF? Once you get herpes (1 or 2) and your body starts making antibodies, you have the virus for life, period.

 

So, all in all, my doctor was a complete waste of my time.

 

I remain optimistic that my "low positive" IgG result for HSV-2 is a false positive, based on the criteria in my original post. The doctor was of zero value in helping me determine this. So I'm off to find another doctor who will order the Western Blot from U. Washington for me.

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