I have a positive herpes simplex virus type 2 (HSV‑2) immunoglobulin G (IgG) result (1.17 × cut‑off) with negative testing for all other sexually transmitted infections; what does this indicate and how should I be managed?

HSV-2 IgG Positive Result: Interpretation and Management

Your Result Indicates Past HSV-2 Infection, But Requires Confirmatory Testing

Your HSV-2 IgG result of 1.17 is in the low-positive range (index value <3.0) and has only a 39.8% chance of being a true positive—meaning there is approximately a 60% probability this is a false positive result. 1

Critical Issue: Your Result Needs Confirmation

Your index value of 1.17 falls into the problematic low-positive range where false positives are extremely common:

• Index values of 1.1-2.9 have only 39.8% specificity (60% are false positives) 1
• Index values ≥3.0 have improved specificity of 78.6% (still 21% false positives) 1
• False positives are particularly common in individuals with HSV-1 infection (which you have, with an index of 24.50) 1

Recommended Next Step

You should obtain confirmatory testing with a second test using a different glycoprotein G antigen before accepting this as a true HSV-2 diagnosis. 1, 2, 3

• The Biokit HSV-2 rapid assay as a confirmatory test improves specificity from 93.2% to 98.7% 1
• Western blot/immunoblot is the gold standard but has limited availability 1, 2

If Confirmed Positive: What This Means

Interpretation of True HSV-2 Positive Result

• A confirmed positive HSV-2 IgG indicates past exposure and ongoing latent infection with HSV-2, with antibodies persisting indefinitely 1, 3
• The test cannot distinguish between recent and long-standing infections, as antibodies develop within several weeks and persist for life 1
• Most HSV-2 infected individuals (approximately 91%) remain unaware of their infection because they never develop recognizable symptoms or have such mild manifestations they don't recognize them 2

Clinical Significance

• You can transmit HSV-2 even without symptoms through asymptomatic viral shedding 2, 4
• HSV-2 is associated with higher rates of symptomatic recurrences and subclinical viral shedding compared to HSV-1 genital infections 1
• Most genital herpes transmission occurs from persons who are asymptomatic or unaware they have the infection 2

Management If Confirmed Positive

Counseling Points

You should be counseled about: 3, 4

• The natural history of disease and potential for recurrent episodes
• Asymptomatic viral shedding and sexual transmission risk
• Avoiding contact with lesions or intercourse when lesions/symptoms are present 4
• Using safer sex practices in combination with suppressive therapy, as transmission can occur even without symptoms 4
• Sex partners should be advised they might be infected even if they have no symptoms 4

Treatment Options

Two main treatment strategies exist: 1, 2

1. Episodic therapy: Treatment initiated at first sign or symptom of an outbreak

   • Most effective when started within 24 hours of symptom onset for recurrent episodes 4

2. Suppressive therapy: Daily medication to reduce recurrences and transmission risk

   • Reduces but does not eliminate subclinical viral shedding 2
   • Safety data available for up to 1 year in otherwise healthy patients 4
   • Safety data available for up to 6 months in HIV-infected patients 4

Important Caveats

• HSV-2 is not curable—this is a lifelong infection 4
• Suppressive therapy reduces transmission risk but does not eliminate it 2
• Type-specific serologic testing of asymptomatic partners can determine whether risk for HSV-2 acquisition exists 4

Your Other Test Results

All other sexually transmitted infection tests are negative (HIV, hepatitis B, hepatitis C, syphilis, chlamydia, gonorrhea, trichomonas, mycoplasma genitalium, and ureaplasma species), which is reassuring.