Jakarta. The South Jakarta District Court will rule today in the trial of five janitors accused of raping a 6-year-old boy at the Jakarta International School.
The allegations came to light based on the claim of the boy’s mother, who said her son got herpes after being sodomized in the school bathroom.
But serious doubts about the validity of her claims have arisen based on the laboratory and medical reports submitted to the court, in particular the tests for the herpes simplex virus type 2 (HSV-2). An HSV-2 test conducted by the SOS Medika clinic in Cipete, South Jakarta, came up negative when testing for the immunoglobulin G (IgG), but positive for immunoglobulin M (IgM).
Narain Punjabi, the first doctor who checked the boy, asked the mother to bring him back a week later for follow-up tests. She never returned, yet still went on to use the initial — and inconclusive — results as the basis for her criminal complaint.
One of the expert witnesses called to testify was John Kevin Baird, a professor at the Center for Tropical Medicine at the University of Oxford’s Nuffield Department of Medicine, who spoke to the Jakarta Globe about what the test results really showed.
Q: What is your view after analyzing the lab reports and testifying in court?
A: I was asked by the defense attorneys to review the clinical laboratory evidence in the dossier for prosecuting the JIS cleaners. They asked a simple question: “Is there evidence here proving
The prosecution pointed to a number of issues identified in the dossier that seemed to suggest a sexually transmitted infection. There was the laboratory report from SOS and a clinical report from RSPI [Pondok Indah Hospital]. The SOS report was a thorough battery of lab tests for sexually transmitted infections and all of those were negative except the IgM for HSV-2. It mentioned bacteria being cultured from the penis and anus, but none of these were pathogenic bacteria, they are bacteria found on all of us.
The positive IgM result was held by the victim’s mother and prosecutors as evidence that the boy got herpes. You say they are mistaken in that belief. Can you explain why?
The HSV-2 serological testing was negative for IgG and positive for IgM. The distinction between those types of antibodies in this test is extremely important. Neither test is for the virus HSV-2 itself, but for antibodies we form when exposed to the virus. It is more like finding the footprints of the virus, rather than virus itself. Sometimes footprints can deceive us with regard to who actually made them. This is true in all serological tests for infections, and with a great deal of variation in reliability between tests. Sometimes tests can “cross-react,” meaning infection A causes a test for infection B to be positive. In that instance, it is a “false positive,” meaning the test is not truly positive for infection B.
So the positive IgM result can’t be taken as proof that the boy was infected with herpes?
Yes, exactly. When we look up the technical specifications of the IgG and IgM test for HSV-2, what we discover is that the IgG is highly reliable and the IgM is highly unreliable. More specifically, the IgM test for HSV-2 is known to cross-react with a number of other infections that are quite common, including chicken pox, mononucleosis, Epstein-Barr virus and strep throat infection. In other words, any one of those infections could explain the positive HSV-2 IgM [in the boy]. This is why the US Centers for Disease Control and Prevention (CDC) says the IgM is not helpful for diagnosis of herpes. The CDC says, “False positive test results are relatively common with currently available IgM tests for herpes. Therefore, current assays are not helpful and should not be used.”
So the positive IgM result means nothing?
This is pretty clear advice from the CDC: “are not helpful and should not be used.” I explained the technical basis of that advice and, therefore, why I testified in court that the dossier contained no evidence proving [the boy] had a sexually transmitted infection. There is not any. That is a verifiable fact, not an opinion.
Is the lack of evidence of a herpes infection important in this case?
Very important. The male defendants in this case are identified in the case dossier as being positive for IgG HSV-2. That is very reliable evidence of that infection if the test is positive — and equally good evidence of absence of infection if the test is negative, assuming the test is properly done and reported. I made this point in court: If five men with genital herpes gang-raped a victim a total of 13 times over four months (a total of as many as 65 events of sodomy), it is impossible that victim would emerge from that kind of abuse and not be infected by genital herpes. And yet, the alleged victim was negative for IgG HSV-2 at the end of that long period of alleged abuse. That test result cannot be reconciled to the alleged offenses.
You think the test results do not support the accusations against the defendants?
I found no medical laboratory evidence in the dossier that [the boy] had a sexually transmitted infection, but there was evidence of all of the male defendants having at least one sexually transmitted infection: HSV-2. These facts — a victim without evidence of HSV-2 and alleged attackers all having HSV-2 — are incompatible with the allegations. Had those attacks occurred as detailed in the charges, the victim would certainly have been positive for IgG HSV-2 testing.
Assuming [the boy] is indeed negative for HSV-2 infection, it means only they could not have attacked him as charged without also infecting him. Another point I made in court was the fact that HSV-2 infection is quite common in Indonesia and most other modern nations. Studies show that the prevalence of IgG HSV-2 in the general population (not sex workers or other high-risk groups, but everybody) is about 10 percent to 25 percent, depending on the study.
In one particularly credible and well-done study (one of the authors is the late minister of health, Endang Sedyaningsih, who was a superb microbiologist and physician) shows 19 percent of women and 22 percent of men are positive. This is important because at least some of the suspects became suspects on the basis of being positive HSV-2 IgG. The fact that the defendants tested positive for genital herpes has no value whatsoever as incriminating evidence, even with a victim who may actually have acquired herpes in that attack. This is how I put it in court — imagine a child is struck down by a car and the driver speeds away; the police later arrest a man only on the basis of him owning a car. If he is the only car owner in town this is reasonable, but in a town where 25 percent of residents own cars, it is not. Same with genital herpes (car ownership) and allegations of sexual assault (hit and run). Herpes means almost nothing with respect to incriminating evidence because it is far too common.
How did the judges respond when you explained the IgM test does not prove there is an infection?
I gathered the impression that my testimony was perhaps the first time the judges understood in a technical sense what the IgM positive means or does not mean. I formed that impression on the basis of the follow-up questions from them — those questions were pointed at a clarity that seemed to have eluded them before then. It truly is a very technical matter for experts, and any layperson could easily have been confused and misled by the testing. These sorts of misunderstandings have indeed had tragic consequences in other settings as well.
Why did you agree to testify in this case?
When the defense attorneys approached me for technical advice, I agreed to review the clinical and laboratory evidence with no real understanding yet of its importance in this case. Only when it became clear that a clear technical understanding of the evidence actually mattered very much in this case did I agree to testify in court. I felt a moral obligation to do so, despite the risks. My view, based on the clinical laboratory findings, is that the defendants are almost certainly falsely accused. I could not have lived with myself had I declined to testify. That is the truth.