How should I interpret a serology panel that is negative for hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (HBsAb), hepatitis B core IgM antibody (HBc IgM), total hepatitis B core antibody (HBc total), hepatitis B e antigen/antibody (HBeAg/HBeAb), hepatitis C antibody (anti‑HCV), and rapid plasma reagin (RPR), but positive for herpes simplex virus type 1 IgG (HSV‑1 IgG, 34 AI) and negative for herpes simplex virus type 2 IgG (HSV‑2 IgG), and what vaccinations or treatment are indicated?

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Last updated: February 22, 2026View editorial policy

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Interpretation and Management of Your Serology Panel

You are susceptible to hepatitis B and require vaccination; you have past HSV-1 infection requiring no treatment; and all other infections are negative.

Hepatitis B Status: Susceptible and Requires Vaccination

Your hepatitis B panel shows complete absence of all markers (HBsAg negative, HBsAb negative, anti-HBc negative), which unequivocally indicates you have never been infected with or vaccinated against hepatitis B. 1

Vaccination is Strongly Indicated

  • You should receive the complete hepatitis B vaccine series (3 doses at 0,1, and 6 months) because you lack any protective immunity. 1, 2
  • The standard adult dose is 1 mL administered intramuscularly in the deltoid muscle—never in the buttock. 1, 2
  • Measure anti-HBs levels 1–2 months after the third vaccine dose to confirm protective immunity (target ≥10 IU/mL). 1
  • If your anti-HBs remains <10 IU/mL after the primary series, repeat a second complete 3-dose vaccine series. 1

Why This Matters

  • Hepatitis B infection can lead to chronic carriage (up to 90% in neonates, 6–10% in adults), cirrhosis, and hepatocellular carcinoma. 2
  • The hepatitis B vaccine is recognized as the first anti-cancer vaccine because it prevents primary liver cancer. 2
  • Antibody titers ≥10 mIU/mL confer protection against hepatitis B infection. 2

Hepatitis C Status: Negative

  • Your hepatitis C antibody is non-reactive, indicating no current or past hepatitis C infection. 1
  • No further action is needed unless you have ongoing risk factors (e.g., injection drug use, high-risk sexual behavior), in which case annual screening is recommended. 1

Syphilis Status: Negative

  • Your RPR is non-reactive, indicating no current syphilis infection. 1
  • Periodic screening is recommended if you have ongoing risk factors (e.g., multiple sexual partners, men who have sex with men). 1

Herpes Simplex Virus Status: Past HSV-1 Infection, No HSV-2

HSV-1: Positive (Past Infection)

  • Your HSV-1 IgG is positive (34.20 AI), indicating past herpes simplex virus type 1 infection with established immunity. 3, 4
  • No treatment is required for asymptomatic HSV-1 seropositivity. 3
  • This result reflects prior exposure (often oral herpes/cold sores) and does not indicate active disease. 3

HSV-2: Negative

  • Your HSV-2 IgG is negative (0.08 AI), indicating no past or current HSV-2 infection. 3, 4
  • No action is needed; HSV serologic screening among the general population is not recommended. 3

Important Context on HSV Testing

  • Type-specific IgG testing (like yours) reliably distinguishes HSV-1 from HSV-2 and should be used to detect asymptomatic individuals. 3
  • PCR is the gold standard for diagnosing active genital herpes in symptomatic patients, not serology. 3
  • Your test results should be interpreted in conjunction with clinical history; the performance of this assay has not been established for pediatric populations, neonatal screening, or immunocompromised individuals. 3

Summary of Required Actions

Immediate Actions

  1. Schedule hepatitis B vaccination series (0,1, and 6 months). 1, 2
  2. Measure anti-HBs 1–2 months after the third dose to confirm protective immunity (≥10 IU/mL). 1

No Action Required For

  • Hepatitis C (negative) 1
  • Syphilis (negative) 1
  • HSV-1 (past infection, asymptomatic) 3
  • HSV-2 (negative) 3

Common Pitfalls to Avoid

  • Do not assume you are immune to hepatitis B simply because you have no active infection—you are completely susceptible. 1, 5
  • Do not skip post-vaccination anti-HBs testing—approximately 5–15% of adults fail to respond to the primary vaccine series and require revaccination. 1
  • Do not administer hepatitis B vaccine in the buttock—this route results in lower immunogenicity. 1, 2
  • Do not interpret positive HSV-1 IgG as requiring treatment—this simply reflects past exposure and immunity. 3

References

Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Guideline

Hepatitis B Serology Interpretation

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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