Q. My results showed positive for HSV-1, but I do not have any symptoms. Why?

Answered by
Dr. Sadaf Mustafa
and medically reviewed by Dr. Preetha J
This is a premium question & answer published on Oct 20, 2020

Hi doctor,

Two years back, I got STI testing and asked for all of the tests available. I am starting a new relationship and wanted to be thorough. The results showed positive for HSV type 1 (which I knew). I got cold sores when I was a kid and mildly positive for type 2. It was something I researched and learned about false positives with IgG and the Western blot test. I took the western blot test, and the results showed negative. I am starting a new relationship and so got tested again. Type 1 shows 37, and type 2 shows 5.0. It has been over six months since I have had any sexual contact with anyone. Could the 37 the type 1 be making the type 2 antibodies high? If I had type 2, it would have been from a contact at least six months ago. Would not the IgG be higher than 5.0? I never had any rashes or any genital symptoms. I have not had any cold sore in these years, either.



Welcome to icliniq.com.

Usually, the herpes simplex virus stays dormant in your body and produces IgG antibodies, which indicate chronic infection or exposure. The IgM antibodies indicate more acute exposure or response. Under normal circumstances, HSV type 1 and type 2 make distinct antibodies, and we do not see cross reactivity. You had two positives and one negative test for HSV-2. This could be an old exposure; it could be months or even years old. These antibodies are prevalent. If it is feasible for your partner, he or she can get tested as well. That way, you will have peace of mind. This result does not necessarily mean that your exposure is recent. We can see false positives, which is why repeating the same test or a different method of looking for HSV-2. Usually, there has to be an underlying pathology to have false positives. Let me know if you have any other questions. Thank you.

Hi doctor,

Thank you for your answer.

One of my positive tests was less than 2.0, which have a high likelihood of being false. My second positive, which is two years later, is 5.00. Is it common for people who have had an infection for a long time to have only a 5.00 IgG? What could be an underlying pathology for the repeated false positives?



Welcome back to icliniq.com.

Yes, you can see repeated elevated levels and the antibody titters could fluctuate. We usually think about autoimmune disorders if we are thinking of false positives but this is due to cross reactivity to other antigens, it is usually unlikely to have multiple false positive tests even if there is an underlying alternative etiology. If you can get the HSV-2 IgG inhibition assay more than once it should be able to distinguish between true and false positives. I hope it helps.

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