What do you do when your herpes test results are inconclusive or confusing? 

After working within the herpes community for many years, this question is more common than one would think. Let’s review some of the most common scenarios and the appropriate interpretations of these results.

Scenario A: 
Patient presents with itching, redness and a few “bumps” in the genital region. 

Testing: Culture of “bumps”, DNA testing and Type Specific IgG Blood Testing for HSV-1 and HSV-2
Results: Tests come up negative for all of the above.
Interpretation: This could indicate that the “bumps” were caused by something other than HSV or that the results indicate a “false negative.” This scenario would warrant a re-test. Sometimes there is not enough virus in a lesion for the test to accurately come back positive. This often happens when a lesion is in the process of healing or if the lesion is the result of a recurring infection. If this is a recently exposed individual, then it would take some time for the body to build up antibodies to the virus. If future blood tests come back positive for HSV-1, HSV-2 or both, then this would most probably indicate a new herpes infection. It can take up to 6 months from exposure for a blood test to come back positive for those individuals who are infected.

Scenario B:
Patient presents with some redness and itching in the genital region. No lesions are present.
Testing: Type Specific IgG Blood Testing for HSV-1 and HSV-2
Results: A low positive for HSV-2
Interpretation: This would indicate that the patient might have been exposed to herpes, but future testing would be required. If future blood testing came back again as a low positive, I would recommend a Western Blot Test, a more expensive and yet more accurate test for HSV.

Scenario C:
Patient presents with no known genital symptoms, but does have a history of cold sores. 
Testing: Type Specific IgG Blood Testing for HSV-1 and HSV-2
Results: HSV-1 positive and negative for HSV-2
Interpretation: The positive test result for HSV-1 is not surprising since the patient reported a history of cold sores. Cold sores are caused by the HSV-1 virus. Unfortunately, a patient such as this can not rule out genital herpes, since 85% of the population has genital herpes and does not know it. A blood test can determine the presence of the virus, but it does not indicate the location of the virus in the body.

These are just a few of the many scenarios that people find themselves in when they are reviewing their herpes test results. While index values less than 1.1 should be considered negative and those greater than 3.5 should be considered positive, what about all those numbers in between? 

According to the literature, the Gold Standard for herpes testing is a test called the Western Blot. Due to the expense of this test, it is not not routinely performed as a primary screening for herpes. Where this test shines is in its accuracy. 

The Westover Heights Clinic is currently offering free herpes testing for those individuals interested in a clinical study. If you find yourself in a scenario where your results are inconclusive, a Western Blot test might be a great next step for you.

As with all of the blood tests for herpes, the results will indicate the presence or absence of the herpes virus, but it will not indicate the location of the virus. 

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