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Chances of positive HSV type 2 test being false positive.

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Hello doc. I recently went in to do a full STD work up and was surprised to find out I tested positive for HSV Type 2. My last full STD work up was in May of 2013 and I tested negative for everything. I was able to call back and talk with my physicians nurse who was able to tell me the type of test administered but not the manufacturer. I was given an HSV Type 2 IGg test. The reference rages are as follows. 0-0.9 is negative, 0.9-1.1 is equivocal. I got a 1.2. I am worried and concerned. I believe that this is a false positive. My last sexual encounter was in March so it has been the appropriate 4 month window for antibodies to form. I am wondering if I was truly positive wouldn't my number be higher? I am getting an HSV type 1 test and a second HSV type 2 test, the western blot, sometime next week. I guess I am wondering the chances of this being a false positive based on the information I have provided. Thanks.


Category: Sexually Transmitted Diseases(STD)Specialist

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Expert:  Dr. Deepu Sebin Sebastian replied 4 Days.

Hello.
Thank you for your query at DoctorSpring.com.
I understand a positive HSV 2 can be disconcerting, especially in the absence of symptoms.
A level of 1.2 is unequivocally positive and you are most likely to be having an asymptomatic infection. Repeat testing is not recommended but you can go ahead for your satisfaction.
There is a very low chance, only about 4% that it is a false positive result because the test done is highly accurate (96%). Also, a level 1.2 is not low and even lower levels can be found in positive individuals.
HSV 2 causes genital herpes and the presentation and severity of disease varies among individuals. Prior HSV-1 infection increases the likelihood of asymptomatic HSV 2 infection by three-fold. You could have acquired the infection from any partner within the last year as your test done more than a year ago was negative. Transmission of HSV 2 can occur even from asymptomatic infected individuals.
However you need to worry excessively as it can be controlled effectively with the available anti-virals and you do not have to suffer. Daily therapy, which is quite safe, can even reduce the rate of transmission.
I hope this was helpful.
Feel free to discuss further.
Thank you.


Patient replied :

What is your opinion and expertise regarding other STD/HSV specialists who state that any reference number between 1.1 and 3.5 is considered a low positive and requires confirmatory testing


Expert:  Dr. Deepu Sebin Sebastian replied 3 Days.

Hello. Thank you for writing to us again.
HSV2 IgG test with a value of 1.2, in my opinion indicates that you're infected with HSV. IgG antibodies, theoretically can be in the latent phase and sometimes can even take years to develop. And the numbers don't really suggest much. Some people with very good immunity will have just borderline positive around the range of 1.5-2. Some people who are highly infectious can even range upto 5. So i won't go by the value. In my experience when we get someone with IgG more than 1.1 we consider it to be positive. It is better to get the WESTERN BLOT done as it will make the picture much clearer.
I know it can be really stressful at the moment, since it shows you have been infected. However it can be controlled and even the transmission rate can be brought down with proper treatment considerably.
Once you get the WESTERN BLOT done, we can take a decision based on your results. You can also get an alternate test done if it's possible for you. Even though the test is highly accurate, there are still 4-5 % false positives. Hence just for the confirmatory sake, you can go ahead and do one more test before the WESTERN BLOT.
Feel free to discuss further,
Regards


Dr. Deepu Sebin Sebastian
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Experience: 
MD, Internal Medicine - Stanley Medical School
Medical School - MBBS - Govt. Medical College, Kottyaam

Diagnostic Prediction - Stanford School of Medicine
Received Specialty training in Critical Care, Cardiology, Neurology, Gastroenterology, Nephrology from Stanley Medical College and in Endocrinology, Rheumatology.

Hematology and Geriatrics from Madras Medical College.
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