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Human Immunodeficiency Virus 1 (HIV-1) with Western Blot Confirmation
Human immunodeficiency virus (HIV), the etiologic agent of the acquired immunodeficiency syndrome (AIDS) is a cytopathic retrovirus. This test uses a viral lysate as the antigen source and detects antibodies by specific immune binding and subsequent color development (enzyme immunoassay (EIA) technology). Sensitivity and specificity of this assay are 100% and 99.7% respectively. Sera which are repeatedly reactive in two out of three tests are subject to confirmatory testing by the Western blot method. Some individuals may be initially reactive by the preliminary test and negative or indeterminate by Western blot. This may be caused by other viral antibodies or autoantibodies which cross reacts with the viral antigens although this is extremely rare. http://www.labcorp.com
Human Immunodeficiency Virus 2 (HIV-2) with Western Blot Confirmation
In 1986, a second type of HIV, called HIV-2, was isolated from AIDS patients in West Africa. Studies of the natural history of HIV-2 are limited, but comparisons with HIV-1 show some similarities while suggesting differences. Both HIV-1 and HIV-2 have the same modes of transmission and are associated with similar opportunistic infections and AIDS. Patients infected with HIV-2 may have a negative or indeterminate result by standard HIV-1 serology. The development of antibodies is similar in HIV-1 and HIV-2. Antibodies generally become detectable within 3 months of infection. Testing for combined HIV-1 and HIV-2 is available.
Human Immunodeficiency Virus (HIV-1), Proviral, DNA by PCR Amplification
Polymerase chain reaction (PCR) amplification and detection by DNA hybridization http://www.labcorp.com
HSV 1/2 IGG, HerpeSelect Type Specific AB
Herpes Simplex Virus (HSV) is responsible for several clinically significant human viral diseases, with severity ranging from inapparent to fatal. Clinical manifestations include genital tract infections, neo natal herpes, meningonencephalitis, keratoconjuncitvitis and gingivostomatitis. There are two HSV serotypes that are closely related antigenically. HSV type 2 is more commonly associated with genital tract and neonatal infections, while HSV type 1 is more commonly associated with infections of non-genital sites. Specific typing is not usually required for diagnosis or treatment. The mean time to seroconversion using the type specific assay is 25 days. The performance of this assay has not been established for use in a pediatric population, for neonatal screening, or for testing of immunocompromised patients. (Quest 2005 Directory of Services.)
HSV IGM Antibody W/REFL Titer
Herpes Simplex Virus (HSV) is responsible for several clinically significant human viral diseases, with severity ranging from inapparent to fatal. Clinical manifestations include genital tract infections, neo natal herpes, meningonencephalitis, keratoconjuncitvitis and gingivostomatitis. There are two HSV serotypes that are closely related antigenically. HSV type 2 is more commonly associated with genital tract and neonatal infections, while HSV type 1 is more commonly associated with infections of non-genital sites. IGM HSV antibodies in infants may be helpful in the diagnosis of neonatal infection. IGM antibody usually appears within the first 4 weeks of life in infected infants and persists for many months. IGM suggest a recent HSV exposure but does not differentiate between primary infection or reactivation. (Quest 2005 Directory of Services.)
Chlamydia/Gonococcus by Nucleic Acid Amplification

Chlamydia trachomatis and Neisseria gonorrhea are the most common sexually transmitted diseases. In 2002, the Centers for Disease Control and Prevention published guidelines for laboratory testing that emphasized the use of Nucleic acid amplification tests for screening for Chlamydia trachomatis and also for Neisseria gonorrhea when conditions of transport could compromise viability of the organism. Other guidelines have recommended Chlamydia screening for all women 15 to 25 for Chlamydia as well as testing pregnant women during their first trimester for both Chlamydia and Neisseria. In some settings, the fact that both Neisseria and Chlamydia testing can be performed on the same specimen, testing for both can be an effective strategy.

Because nucleic acid amplification (NAA) tests are more sensitive than conventional culture methods and nonculture tests, the CDC recommendations stressed the potential for false-positives and the impact of low incidence on the positive predictive value of a test. For this reason, they recommend that all non-culture methods should be considered as 'presumptively' positive. In those cases where a positive result is thought to be incorrect, they suggested that treatment should be offered while awaiting the results of additional testing. Only another NAA test was recommended as follow up testing after an initial suspect positive test and a test with an alternate target was the first choice of additional testing. Culture continued to be the method recommended for all medicolegal cases. Testing of children was actively discouraged because of the potentially low positive predictive value of the tests in low incidence populations.

Chlamydia trachomatis is recognized as the leading agent of sexually transmitted disease worldwide. Although only 30% of states designate Chlamydia a reportable disease, in the United States more than four million new cases of Chlamydia infection are reported annually. The asymptomatic nature of a large proportion of chlamydial infections leads to under-diagnosis of chlamydial infection and consequent health problems. Approximately 75% of infections in the female and approximately 50% of male infections are asymptomatic. Women are most severely affected due to the correlation between untreated Chlamydia infection and entopic pregnancy and infertility. Rapid detection and diagnosis of chlamydial infection is critical in controlling not only the spread of disease but also the devastating sequel. Partner evaluation to prevent reinfection is also an important aspect of controlling the spread of the disease.

The diagnosis of Chlamydia trachomatis infections has traditionally relied on culture technology; however, the time-consuming nature of culture techniques catalyzed the development of direct antigen and nucleic acid detection methods. Conventional techniques such as culture and fluorescent antibody staining have demonstrated limited sensitivity. The development of targeted nucleic acid amplification techniques provide the means by which direct detection methodologies could achieve requisite sensitivity while maintaining excellent specificity. Clinical studies have shown that amplified methods detect about 15% more chlamydial infections than other non-culture with a specificity >99%. In addition, the test is able to utilize specimens, including bloody specimens and male urine, that are not compatible with culture. A variety of transport devices have been validated for use with the nucleic acid amplification test for Chlamydia, including TriPath SurePath liquid cytology medium.

Gonorrhea manifests as acute urethritis in males and as cervicitis in females. N. gonorrhea can be detected from asymptomatic females. Detection and treatment of these individuals is critical because if it is left untreated, gonorrhea can result in serious complications, including pelvic inflammatory disease, sterility, and ectopic pregnancy. It is very important to control the spread of this disease between sexual partners; thus, the use of a quick reliable test system is essential.

The current definitive method of detection for N. gonorrhea is the culture of the microorganism; however, this organism is especially fastidious. It can be difficult to grow in culture. Negative cultures due to overgrowth of contaminating microorganisms occur or due to the organism rendered nonviable during transport due to the incorrect transport being used or the correct transport used incorrectly. At least one study has demonstrated that a significant proportion of negative cultures received in a public health lab had evidence of N. gonorrhea by nucleic acid testing but were negative by culture. The nucleic acid amplification test for the presence of N. gonorrhea provides the sensitivity and a specificity equal to traditional methods of organism isolation and identification. The major disadvantage at the present time is that antibiotic sensitivity testing cannot be done on these specimens. Guidelines for antibiotic susceptibility testing of N. gonorrhea have been published; however, this microorganism is not routinely tested for antibiotic sensitivities. http://www.labcorp.com

Hepatitis B Surface Antigen

Hepatitis B virus (HBV) is a DNA virus with a protein coat, the surface antigen (HBsAg) and a nucleic acid core, the core antigen (HBcAg). There are eight different serotypes. Early in infection, HBsAg, HBV DNA, and DNA polymerase can all be detected in serum.

HBsAg can be detected one to seven weeks before liver enzyme elevation or the appearance of clinical symptoms. Three weeks after the onset of acute hepatitis about 50% of the patients will still be positive for HBsAg, while at 17 weeks only 10% are positive. The best available markers for infectivity are HBsAg and HBeAg. The presence of anti-HBs is frequently associated with non-infectivity. The chronic carrier state is indicated by the persistence of HBsAg and/or HBeAg over long periods (six months to years) without seroconversion to the corresponding antibodies. Such a condition has the potential to lead to serious liver damage, but may be an isolated asymptomatic serologic phenomenon. http://www.labcorp.com

Hepatitis C Virus (HCV) Antibody

Following the development of sensitive and specific testing for hepatitis B, 90% of post-transfusion hepatitis is now hepatitis C. A gene product (c100) of hepatitis C virus (HCV) was isolated and an assay for anti-HCV developed. The assay detects antibody to a presumptive togavirus or flavivirus which may be an etiologic agent of non-A, non-B hepatitis (which may not be a unitary disease entity).

For blood donors, hepatitis C serology correlates with surrogate tests for non-A, non-B hepatitis (ALT and anti-HBc). Since hepatitis C serology identifies a broader group of infected individuals than surrogate testing, it reduces risk of HCV during transfusion. Studies in hemophiliacs indicate that antibody to HCV is a reliable marker of HCV. http://www.labcorp.com

RPR (Monitor) W/Reflex Titer
This is a non-treponemal screening test for syphilis. False positive results may occur due to systemic lupus erythematosus, malaria, mononucleosis, infectious hepatitis, leprosy, brucellosis, atypical pneumonia, typhus, yaws, pinta, or pregnancy. Positive results should be confirmed with a more specific treponema pallidum antibody test (FTA-ABS). Monitoring of RPR is helpful in assessing effectiveness of therapy. (Quest 2005 Directory of Services.)
Lipid Panel

Includes tests most commonly used to evaluate the cardiovascular system and measures the different types of lipids or fats in your blood. There are many kinds of lipids, most of which are included in your total cholesterol level. Understanding the differences between these lipids will help you understand why you need to know more than your total cholesterol level.

Questions for a Lipid Panel

  1. Is there a history of heart disease or stroke in your family?
  2. Do you have high blood pressure or a family history of high blood pressure?
  3. Do you smoke?
  4. Are you diabetic?
  5. Are you within normal weight for your height?

Total Cholesterol - It is an essential body fat. It facilitates absorption and transport of fatty acids, synthesis of vitamin D at the surface of the skin, as well as synthesis of substances such as hormones and bile.
Indications - A high level of cholesterol in the blood is a risk factor for cardiovascular disease, which can lead to heart attack and stroke.
Reference Range -- < 200 mg/dL

HDL cholesterol - Sometimes thought of as the "good cholesterol". A plasma protein made in the liver. It is involved in the transport of cholesterol and other lipids from the body.
Indications - High level is desirable because it can aid in the removal of excess cholesterol in the body tissues, preventing accumulation of LDL Cholesterol in the arteries.
Reference Range -- > 34 mg/dL

LDL Cholesterol - A plasma protein derived in part if not completely from intravascular breakdown of the very low density lipoprotein. Delivers lipids to the body tissues. It is generally referred to as the "bad cholesterol"
Indications - Lower levels are desirable because LDL can accumulate in the inner walls of the arteries, narrowing them and reducing blood flow.
Reference range -- 130 mg/dL

Total Cholesterol/HDL - C Ratio -- Calculation is obtained by dividing the Total Cholesterol level by the HDL Cholesterol level.
Indications - The higher the number, the greater the risk of coronary heart disease
Reference Range -- < 4.98 calculated

Triglycerides - Principle lipids in the blood, where they circulate bound to a protein forming HDL and LDL cholesterol. They can show how well the body is processing fat in your diet.
*****This is not considered an independent factor for heart disease*****
Indications - Lower levels are desirable. Higher levels seem to reflect a lower activity level of enzymes that break down fats in blood. This results in higher levels of LDL and lower levels of HDL which are linked with heart attack.
Reference Range -- < 200 mg/dL

PSA Test
This test is intended for use as an aid in the management of patients following surgical or medical treatment for prostate cancer. The use of PSA as an aid in the management of prostate cancer patients after treatment has been well documented. The frequency of cancer recurrence correlates with the degree of cancer progression at the time of treatment. It has been estimated that cancer relapse following radical prostatectomy occurs in 3% to 11% of patients where the tumor is confined to the prostate. Fifteen percent to 40% of patients with tumors extending beyond the prostatic capsule will have cancer recurrence and to 30% to 66% for patients with positive surgical margins or invasion of seminal vesicles will experience relapse. Biochemical recurrence, defined as increasing PSA levels after treatment, can be observed much earlier than clinical signs of tumor recurrence. Persistent elevation of PSA following treatment or an increase in a post-treatment PSA level has been found to be indicative of recurrent or residual disease. The lead time for the detection of cancer may be increased by months, or even years, through the use of ultrasensitive PSA. The ultrasensitive PSA test has a functional sensitivity of 0.01 ng/mL, which is an order of magnitude greater than that of other conventional assays (0.1 ng/mL). http://www.labcorp.com