A note about this article: I'm Melissa King, LMHC, a psychotherapist with special expertise in helping people navigate the emotional and relational impact of a genital herpes diagnosis. I provide in-person therapy in Manhattan and virtual therapy throughout New York State, California, and Florida. I also offer an in-person therapy group in NYC for women with genital herpes.
**Articles here are not intended as medical advice or treatment of mental health concerns. Please speak with your healthcare provider to make decisions about your medical and mental health.
**Please note that this article was written a few years ago and is still relevant for individuals who received an IgG based test with a value attached to it as described. There is a new test offered at Labcorp (the Roche Elecsys) that is more accurate than the test described in this article. The Roche does not provide a value (just positive or negative) and I believe Labcorp is the only one offering it at this time. The Western Blot is still the gold standard. You can read updated information about herpes testing at the website of Terri Warren, NP’s and in her forum.
Over the years, many people with no history of herpes symptoms have called me to begin counseling or group therapy after receiving a herpes diagnosis from a blood test screening alone. Some of these individuals later learned they didn’t have herpes. It is true that you can have herpes and not be aware of symptoms. In fact, it is thought that most people who have herpes don’t know they have it. However, if someone tells me they have never recognized any symptoms, I think it’s worth exploring a little further. I do this because I don’t want to have a client enter counseling for a genital herpes diagnosis if they don’t actually have herpes. They may need counseling for other things, but I’d rather then focus on those other things.
I suggest that they obtain a copy of their results and look at whether they had an IgG or IgM based test (the CDC says IgM based tests should not be used to diagnose herpes). Once they confirm that it was an IgG based test, I ask them to look for the index value of their result. About 50% of people who test positive for HSV-2 on an IgG based test with an index value between 1.1 and 3.5 do not have herpes (the lower the value, the higher chance of a false positive, the higher the value the more likely it’s an accurate result). The CDC recommends that anyone who tests positive on an IgG based test with an index value that falls between a 1.1 and 3.0 should get confirmatory testing (experts say the Western Blot is the best confirmatory test). Research shows that there can even be false positives above this range in some people.
(**A positive swab test of a lesion in someone with symptoms can be a confirmation. Blood tests are helpful when a swab test can’t be obtained or to help sort out other matters.)
Getting Help with Confirmatory Testing
I've found that an important part of mental health for patients with herpes is to feel a sense of understanding and agency around their diagnosis and test results and to learn information that can help them make a decision about whether they want to pursue confirmatory testing or not. I often refer patients with low positive results to consult with a medical expert if they have additional questions. The healthcare provider I trust the most with these types of questions is Terri Warren, NP, who has been an excellent resource for many of my patients. There may be other healthcare providers who can navigate appropriate confirmatory testing, but many providers have not learned how to do this. If you are questioning your diagnosis and want to learn more about confirmatory testing, you can do so here. If you need help coping with the diagnosis or with awaiting results, therapy or a support group can often help.
Low Positive Result with Symptoms
On rare occasion, I have seen people with symptoms that are assumed to be herpes, even recurring symptoms, who have not obtained a positive culture and who have a negative or low positive result on the IgG, even after an adequate amount of time has passed to have a higher value. Other conditions can cause rashes on genitals, such as eczema and even Lyme disease (yes, I have actually seen this happen). While a case like this can certainly be a true positive for herpes, if something is just not adding up in your mind, it may make sense to explore it further with your healthcare provider or perhaps seek confirmatory testing (either via a swab or Western Blot for instance).
A Little Something About HSV-1
HSV-1 can also have low index values that are false positive. If there is no history of symptoms and it is a true positive, it is impossible to know if an HSV-1 infection is oral or genital (unless the individual has never had contact that could expose the genital area). More than 50% of adults in the U.S. will test positive for HSV-1.
Take that number in…
Most HSV-1 infections are oral and plenty of people don’t recall ever having a cold sore or symptoms that would explain their HSV-1 diagnosis. That said, there are also many people who contract it genitally, often from someone who has the infection orally and performs oral sex (with or without active symptoms).
Coping with Results
Finding out that your result is not a false positive, or simply having to wait for confirmatory testing, can be really difficult. If your result is a true positive, adjusting to the diagnosis may take time. Concerns about dating, disclosure, sex, relationships, and how you feel about yourself are all things that can be explored in therapy.
I have been working with men and women with herpes for over 20 years and have special expertise in helping people navigate the emotional and relational impact of genital herpes. I offer individual therapy in person in Manhattan and virtually throughout New York State, California, and Florida. I also offer an in-person therapy group in NYC for women with genital herpes.
**This information is not intended to replace medical advice or psychotherapy and is not intended to address all the caveats of a diagnosis. I am not a medical provider and simply provide this information as a resource for learning.
More Posts About Herpes
I hope the resources in this blog can further assist you. Read other posts about herpes here.
**Information on this site is not intended to replace medical advice and does not constitute a psychotherapeutic relationship with the reader.