Herpes Simplex Virus II (HSV)-IgG

Bacterial/ Viral

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No Fasting Required

Details

Detects IgG antibodies specific to: HSV-2: Primarily causes genital herpes

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Herpes Simplex Virus II (HSV)-IgG Test Guide

Why is it done?
- Test Overview: This test detects IgG antibodies against Herpes Simplex Virus Type 2 (HSV-2) in the blood. IgG antibodies develop after initial HSV-2 infection and persist lifelong, indicating past or current infection.
- Primary Indications: Screening for HSV-2 infection in asymptomatic individuals, diagnosis of genital herpes, confirmation of clinical suspicion based on symptoms, sexual health screening, and assessment in immunocompromised patients.
- Typical Clinical Circumstances: During routine sexual health screening, evaluation of recurrent genital ulcers or vesicular lesions, prenatal screening (to assess risk of neonatal transmission), after potential exposure to HSV-2, evaluation of meningitis or encephalitis in certain populations, and monitoring in HIV-positive patients.
- Special Populations: Recommended in pregnant women to assess transmission risk, patients with multiple sexual partners, individuals with a history of sexually transmitted infections, and those with immunosuppression.
Normal Range
- Reference Values: Negative/Normal: < 0.90 index or negative by various assay methods Positive: ≥ 1.10 index or positive by assay Equivocal/Borderline: 0.90-1.10 index (requires repeat testing or alternative method)
- Units of Measurement: Results typically expressed as index values, antibody titers, or signal-to-cutoff ratios depending on the laboratory methodology used (ELISA, Western blot, or immunofluorescence assays).
- Result Interpretation: Negative result indicates no detectable HSV-2 IgG antibodies, suggesting either no prior infection or infection too recent to have developed detectable antibodies (early acute infection). Positive result indicates prior or current HSV-2 infection and immunity development. Borderline/equivocal results require clinical correlation and repeat testing.
- Clinical Significance: Normal (negative) results do not completely exclude active infection during window period or recent seroconversion. Positive results confirm HSV-2 exposure and persistent immunity but do not indicate timing of infection or current viral shedding status.
Interpretation
- Positive HSV-2 IgG Result: Indicates past HSV-2 infection and develops 1-2 weeks after initial infection. Antibodies persist for life, providing immunity but not preventing recurrent infection or viral transmission. Cannot differentiate between primary infection, recurrent infection, or latent infection. May indicate past infection even if patient is currently asymptomatic.
- Negative HSV-2 IgG Result: Suggests no previous HSV-2 infection, though may occur during acute infection before antibodies develop (window period). Very early acute infection (first 1-2 weeks) may test negative. Results should be interpreted in clinical context with symptom timeline.
- Equivocal/Borderline Result: Requires repeat testing after 2-4 weeks or use of alternative testing methodology such as Western blot for confirmation. May occur during early seroconversion or with certain test sensitivities.
- Factors Affecting Test Accuracy: Timing of test relative to infection onset (window period), immunocompromised status affecting antibody production, prior HSV-1 infection potentially causing cross-reactivity, laboratory methodology variations, and specimen handling quality.
- Positive Result Does Not Indicate: Active viral replication, current viral shedding, timing of infection, or symptomatic disease. Patient with positive IgG may be asymptomatic or have infrequent recurrences.
- HSV-1 vs HSV-2 Differentiation: This test specifically detects HSV-2 antibodies. Type-specific assays are necessary to differentiate between HSV-1 and HSV-2, as earlier non-specific tests may show cross-reactivity.
Associated Organs
- Primary Organ Systems Affected: Genitourinary system (primary site of HSV-2 infection), skin and mucous membranes, nervous system (establishing latency in dorsal root ganglia), and potentially systemic circulation during viremia.
- Conditions Associated with HSV-2 Infection: Genital herpes with recurrent vesicular lesions, herpetic proctitis, urethritis, cervicitis, meningitis (HSV-2 meningitis more common than HSV-1), encephalitis, disseminated infection in immunocompromised patients, and neonatal herpes simplex.
- Potential Complications: Secondary bacterial infection of lesions, post-herpetic neuralgia, psychological distress from chronic infection, transmission to sexual partners, neonatal transmission during vaginal delivery causing severe neonatal disease, and increased risk of other sexually transmitted infections.
- Risk in Specific Populations: HIV-positive patients with CD4 < 50 cells/μL at risk for severe disseminated disease, pregnant women risk for neonatal transmission (especially if primary infection near delivery), immunocompromised transplant recipients, and patients on immunosuppressive therapy.
- Associated Systemic Effects: Systemic symptoms during primary infection including fever, malaise, lymphadenopathy, and myalgias. Recurrent infections typically localized with minimal systemic involvement. Reactivation can occur with stress, immunosuppression, illness, or menstruation.
Follow-up Tests
- If Positive Result: HSV-2 IgM (if acute infection suspected), viral culture or PCR if active lesions present to confirm active viral replication, HSV-1 IgG to differentiate between HSV-1 and HSV-2 antibodies, and serologic testing for other sexually transmitted infections (syphilis, gonorrhea, chlamydia, hepatitis B/C, HIV).
- If Negative Result: Repeat testing 2-4 weeks later if acute infection suspected, PCR or viral culture if active lesions present (to detect HSV-1 or early HSV-2 infection before seroconversion), and consideration of HSV-2 IgM for acute infection confirmation.
- For Equivocal/Borderline Results: Repeat HSV-2 IgG testing after 2-4 weeks, Western blot confirmation testing, or alternative testing methodology (immunofluorescence or alternative ELISA platforms).
- Complementary Testing Recommendations: HIV screening, comprehensive STI panel (syphilis RPR/VDRL, gonorrhea/chlamydia nucleic acid testing), hepatitis B and C serology, complete blood count to assess for lymphocytosis in acute infection, and liver function tests if systemic involvement suspected.
- Special Considerations: Pregnant women with positive results should undergo obstetric counseling and delivery planning. HSV-2 IgM testing for distinguishing recent/primary infection from recurrent infection. PCR testing for CNS involvement if meningitis or encephalitis suspected.
- Monitoring Frequency: One-time screening typically sufficient for positive results (indicates lifetime immunity). Repeat testing recommended if prior negative result and possible exposure. Annual or biennial screening in high-risk populations recommended.
Fasting Required?
- Fasting Status: No - Fasting is NOT required for HSV-2 IgG testing.
- Dietary Considerations: Patient may eat and drink normally before blood draw. No dietary restrictions apply to this serologic test.
- Medications: No medications need be avoided or withheld. Antiviral therapy (acyclovir, valacyclovir, famciclovir) does not interfere with antibody detection. Continue all regular medications as prescribed.
- Pre-Test Instructions: Arrive for appointment well-hydrated to facilitate venipuncture. Inform phlebotomist of any recent blood transfusions (within 2 weeks) as this may affect test interpretation. Disclose recent vaccinations or immunizations if applicable.
- Specimen Collection: Standard venipuncture with serum collection tube (typically SST/gold top tube). No special handling or timing requirements. Specimen can be collected at any time of day.
- Timing Considerations: For suspected acute infection, wait at least 1-2 weeks from symptom onset to allow adequate antibody development. Earlier testing may yield false-negative results due to window period (time before detectable antibodies develop).
- Additional Preparation: No special skin preparation required. Avoid excessive heat or cold exposure immediately before collection. Sit calmly for 5-10 minutes before collection to minimize stress-related changes. Inform technician of easy bruising or bleeding disorders.

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