Herpes Blood Tests

[t1234]

I understand Dr. Wald's study of 27 females is the basis for determining asymtomatic shedding.  However, in her study
62% of the females were determined to be symtomatic after being educated in what the symtoms looked like although
they orginally thought there were sero positive but non
symtomatic.

Has there been any studies with statictically significant numbers of people who are sero positive to HSV2 but are asymtomatic as determined by appropriate interviews after education in the symtoms and confirmed to be such by periodic
physical examinations during the study to determine if in
fact sero positive people who do not have or never have had
any symtoms do in face shed the virus?

If not, it seems clinics should not be diagnosing people with
HSV2 on a sero positive test along?

THX

[Alan Rockoff, MD]

I don't know of any studies with precisely the data you're asking about.  I advise consulting www.herpesdiagnosis.com.  Given the subtlety of symptoms in some people, it seems the newer herpes serology tests are indeed pretty reliable.

Best.

Dr. Rockoff

[t1234]

Thanks,  I assume then that anyone who tests positive for hsv2
in a realiable test such as Herpes Select has Genital Herpes
and can transmit it via viral shedding???

Also--what about blood transfusions--does this mean
than anyone receiving contaminated blood will show up
positive or get HSV2?

Thanks again

[Terri Warren, RN, Adult Nurse Practitioner]

There have been several studies now looking at asymptomatic shedding besides Anna's original study looking at the 30+ women.  We have a study published together in the JAMA and we now also have the transmission study substudy in 89 patients, published in New England Journal last week on which I am also an author.  The original question is missing the point a bit, I think.  The thing about herpes is that almost 100% of people who test positive also shed virus during days when they have no symptoms.  This is true for both people who know they are infected and recognize outbreaks and those who simply test positive, and try as they may, cannot recognize outbreaks.  It is true that once people are taught to recognize outbreaks, many can who previously could not.  But what we know about shedding is that people who test positive but have no recognized outbreaks shed at about the same rate as those who have anywhere from 1-12 outbreaks per year.  Those who have more than 12 outbreaks per year shed more often.  The advantage of being tested is that once someone is identified as being HSV 2 positive, they can do things to prevent transmission like 1) using condoms more often when having sex 2) notifying partners that there is a risk of transmission so people can make choices about taking risks 3) taking antiviral therapy daily which reduces transmission by half 4) being careful not to infect a pregnant woman by abstaining from intercourse in the last trimester or abstain from giving oral sex in the last trimester if the mother is HSV 1 and 2 negative and the partner is infected with HSV 1 only,and 5) developing the ability to recognize outbreaks.  These measures would be used to reduce transmission, but there is are benefits to the person with herpes as well.  1) Infecting someone you care about can be very painful emotionally, especially if you could have prevented that by knowing you were infected 2) daily therapy can greatly reduce outbreaks, which can be unpleasant 3) studies have shown that people with herpes do better psychologically when they are not having outbreaks.  So there are benefits both the infected person and the uninfected person with testing.  Yes, it can be very upsetting to find out that you have herpes by getting a positive blood test.  But which is better - finding out you are infected through a blood test or by infecting a sex partner?  And yes, there are a few false positives on the blood test and a few false negatives.  No lab test is perfect.  But the good thing about the HerpeSelect tests is that they can be confirmed and/or not confirmed by HSV western blot, if necessary.    Hope this helps to answer your questions.  
Terri Warren

[t1234]

Terri, I understand you are a Nurse who answers questions on WebMD and are not either a doctor or a Dermatologist?????

I am personally sero negative, so I don't have a "dog in this
fight" from this prespective.  However,  I have had friends who
have taken STD profiles and have been diagnosed as having
herpes and being contagious.  This has been to the havic of
their personal relationships.

Doctors seem to disagree on the the meaning of Seropositive to
IGC.  Certainly noone would disagree that a person who has
herpes outbreaks will not asymtomatic shed the virus.  However, exposure to the virus along is the question.

From a lay persons look at the studies it appears they were done
to support feasibility of vacines or economics thereof.  In some
cases the effects of antivirals.  Interestingly, I saw one study that showed some people  have natural immunity.

Surprisingly, I didn't see a study at first glance on the obvious question of whether the thousands of people who are
being diagnosed as "herpes contagious" at various STD clinics in some cases by lab techs who are looking at test result are
really such.  

[t1234]

Hopefully, there is such a study out there somewhere, otherwise a lot of people are being done a great injustice.

[Terri Warren, RN, Adult Nurse Practitioner]

I would suggest that you review an article in JAMA, 2000, by Anna Wald and myself that looks at the issue of testing positive without symptoms and shedding virus.  There is a new study now out of UW that found that 68 or 69 people who tested positive by serology, but had no symptoms, tested positive by swab test, genitally.  

Yes, I'm a nurse practitioner, not a dermatologist or a physician.   I have been the investigator or subinvestigator on over 80 clinical trials, most of them related to herpes. I have articles in the New England Journal, Journal of the American Medical Association, the Journal of Infectious Disease and The Female Patient, and soon, in the Journal of Clinical Infectious Disease.  I'm also an author on the transmission paper that came out Jan. 1 in New England Journal of Medicine.  So I think I have reasonable credentials to talk about herpes.  I have no vaccine to promote, nor any particular treatment, just 23 years of running an STD clinic and doing herpes research.  

People who test positive by serology HAVE herpes and are infectious to other people.  Current studies indicate that 98.9 percent of them shed virus from the genitalia when multiple studies now have been done, using daily home swabbing.  

[Terri Warren, RN, Adult Nurse Practitioner]

Whoops, that should have read 68 OF 69 people shed from the genital area, not OR.  Sorry about the typo.