Please correct info on herpes blood testing

[Terri Warren, RN, Adult Nurse Practitioner]

I have just spent $19 to respectfully request that you update your information on herpes blood testing to the public who reads your posts.  Dr. Rhoda Ashley Morrow, who is considered the nation's top expert on HSV serologic testing, has written many articles on the significance of an HSV positive serology - that is, that when people test positive on one of the new type specific IgG serologic tests, that they have the infection and can transmit to others. The Centers for Disease Control have found these tests to be in the 98% range for both sensitivity and specificity.   You, in previous posts, have stated: "Positive blood tests don't mean much--only that your body was exposed to the virus, not that you have the condition." I would strongly suggest that you review the literature, and, based on that review, change your statements about this.  As a dermatologist representing a prestigious institution like Tufts, I am certain that you want to be posting accurate information.  I refer you to the following journals that have articles written by Dr. Ashley-Morrow:  Herpes, July, 2002, Sexually Transmitted Infections, Aug, 2001, Clinical Mirco Review, Jan, 1999, Dermatology Clin, 1998, Sexually Transmitted Disease, April, 2003.  You may also want to visit herpesdiagnosis.com,a website developed by Dr. Ashley-Morrow and Gray Davis, another herpes expert, for up to date information on the technical aspects of these serologic tests.  

I am the person who answers all the herpes questions for WebMD, and think it is important that information available to the public on the internet be consistent and accurate,  particularly between professionals.  
Sincerely, Terri Warren, RN, ANP, MS, MEd

[Alan Rockoff, MD]

I thank you for correcting me on this point.  I was not aware of the availability and specificity of herpes 2 IgG serology.  Getting a negative IgG (at least after enough time has passed) will help reassure those who are fearful of herpes but turn out not to have it.  I will recommend this from now on, and refer people to Dr. Ashley-Morrow's website.

Dr. Asley-Morrow writes as a virologist, whereas I write as a clinician who deals not just with herpes but with the (arguably) more common herpes-phobia.  (Please see the note on this forum "A little wordy but fit to be tied," posted yesterday.)  The facts are what they are, but the clinical perspective differs somewhat.

I've put some questions of relevance to this matter in an e-mail to Dr. Ashley-Morrow, and will add her comments and my own to threads on your query.

Thanks again.

Dr. Rockoff

[syrme]

Hi all - My personal experience shows that herpes can indeed be spread from anywhere in the "boxer shorts area"
more to the  point - and this is NOT proven - but only a hypothesis on my part - I believe that it will only be spread from areas where you commonly GET sores. I myself have never had one on my penis itself - Mine started on my scrotum and moved around there to finally encompass six different areas - and have now moved mostly to my anus. My sister has it on her lower buttocks almost her thigh. Please consider just how much help a condom would be in either of our cases? I managed to get this thing from a hooker while I was wearing a condom. In my mind this is PROOF that condoms are only of any use if the sores commomly appear on the penis itself and the condome COVERS that area. My girlfriend of three years still hasn't got herpes although we have unprotected sex MOST of the time. We are not really careless though - if I have any sort of prodromes we abstain or I wear boxer shorts AND a condom - cover up everything - this is a small price to pay to keep my girlfriend disease free.I have had this a loooong time and have studied it carefully - It is true however that it winds down as time goes by and is also affected by your mental state. Anxiety will definately bring it on !!
thanks
Syrme

[CRAZY BRAIN]

The study was sponsored by GlaxoSmithKline, a WebMD sponsor.


Do you know who GLAXOSMITHKLINE is?

[glw]

these are both excerpts from webmd articles.... reliable info I'd say....



According to the American Social Health Association, about 50% to 80% of adults in the U.S. have oral herpes and about one in five has genital herpes, but as many as 90% are unaware that they have the virus. As with all viruses, there is no cure.


Herpes is different from other common viral infections because once it is introduced it lives in the body over a lifetime, often without symptoms or with periodic symptoms.




Herpes Common in Middle, Upper Classes

1 in 4 Test Positive for Herpes in Suburban Areas

By  Cherie Berkley, MS
WebMD Medical News  


July 29, 2003 -- A new study shows that genital herpes is an equal opportunity virus. As many as 25% of people tested in relatively affluent suburbs had the STD, but only 4% of them reported a history of having it.


Researchers presented the findings at the 15th Biennial Congress of the International Society for Sexually Transmitted Diseases Research.


"Knowing that herpes is highly prevalent among affluent and educated people living in the suburbs should help to erase some of the stigma so commonly associated with the disease," says leading sex therapist Ruth Westheimer, aka "Dr. Ruth," in a news release.


To drive the point home, researchers randomly chose six primary care physician offices in affluent areas in six major U.S. cities. They tested blood samples for herpes simplex virus 2 (HSV-2) antibodies in almost 5,500 people ages 18-59, 5,430 of whom completed a questionnaire. The volunteers were 75% white, 14% black, and 4% Hispanic. Seventy-four percent had some college or higher education and 45% had a household income of at least $60,000.


The results showed that higher levels of education, income, and marital status didn't curb the chances of getting HSV-2. In fact, one in four volunteers tested positive for the disease but only 4% of them knew they had it. Volunteers ages 40 to 49 had the highest rate of infection (31.2%). More women than men were infected.


Many People With Herpes Unaware of Infection


"One of the reasons herpes continues to spread is because very few people with the virus know they have it. In order to help manage the spread of the disease, both doctors and patients need to be aware that everyone who is sexually active is at risk for getting herpes," says Douglas Fleming, MD of the Robert Wood Johnson School of Medicine in Piscataway, N.J.


Researchers stress that high economic status should not automatically mean someone has a low risk.


Genital herpes is a contagious viral infection primarily caused by HSV-2. It spreads through physical skin-to-skin contact in the genital area. Spread can even occur through contact with a person who has no symptoms. It can affect men and women, causing periodic outbreaks with symptoms such as painful or itchy clusters of blisters, bumps, and rashes in the genital area, thighs, or buttocks. Herpes is not life threatening and there is no cure, but patients can take prescription medications to suppress outbreaks.


The study was sponsored by GlaxoSmithKline, a WebMD sponsor.

[CRAZY BRAIN]

Exactly Worry Wort..also they can't TEST you for Genital Warts and you could have that too?

[worrywort44]

Im not a medical professional or anything, just kinda worrisome about some of my sexual experiences in the past.  I just wanted to point out that I believe many of these websites stating that 1 in 4 people are infected with herpes simplex 2... nearly everyone has hpv (genital warts)... are full of it.  HOW, if a patinet never reports any symptoms of these viruses can they be sure of this.  Testing is shady and not done extensivly in herpes and there really isnt a test for hpv in men so where do they get off on putting fear in all these anxious people who probably have NOTHING. I paraphrase and quote Terri Warren on Web MD "3-4% of men will contract genital herpes if they have UNPROTECTED sex with an infected woman for a YEAR," not one occurance. Sounds to me like its pretty tough to catch when in dormant stage, doesnt it you?  I know many people are asymptomatic or dont realize their symptoms are related to herpes but given how difficult it seems to be to transmit; Doesnt their claim of 20-25% of the adult population seem a little shocking?  I thought so too!

[Alan Rockoff, MD]

You're welcome.  I have corresponded with Dr. Morrow, and spoken as well with ID experts who confirm what she says.  Basically, the news is good: having reliable tests that tell people what they need to know one way or another will reduce anxiety along with making it easier to reduce herpes transmission.

Thank you very much for bringing this information to my attention.  I will do my best to disseminate it.

Alan Rockoff

[Terri Warren, RN, Adult Nurse Practitioner]

Dear Dr. Rockoff,
Thanks so much for responding, and responding so openly and graciously.  You will enjoy interacting with Rhoda, she's great - very smart, funny, open to discussion.  She get a ton of email, so I'm going to give her a heads up that you are writing to her.  

I completely agree with you about the herpes phobia.  That's one reason I like the serology so much, that we can reassure many folks that they are most likely not infected.

Thanks for what you do here.
Terri Warren

[yoshi2me]

Terri,

Thank you for posting accurate information about herpes.
It's frustrating to see people asking valid questions and getting nowhere on this forum. Hopefully folks will do their homework and become a part of the solution for their patients instead of trying to sweep herpes under the rug. There are so many people out there that have it and don't know it because they've never been tested for it. I'm hoping they will make screening for herpes routine in the future because right now it's not part of the std screening process.  

THANKS!

Angela

www.yoshi2me.com

[CRAZY BRAIN]

Terri,

You don't need to know about me I am not into showing my credentials publicly.

Regarding babies of course this is a concern don't be silly but you make it sound like a epidemic, it is more like a West Nile outbreak. So for you I take from your own website "Less than 0.1 percent of babies contract genital herpes."

I did say what you say I think you misread it is all, honest mistake.  I said if you are a man you can transmit it 10% of the time to a woman and Women %4 of the time to a man. Please tell people the facts on condom effectivness that basically condoms are 98% effective for both sexes when used between outbreaks and correctly. Why not post that too? Why?

"They cannot tell you 100% if in fact you can transmit this on to someone else, just that it is possible 10% of the time if you are a man, %4 of the time if you are woman roughly." You've got those numbers slightly mixed up. We know that 98% of people who are antibody positive shed virus, so conceptually, they are all infectious and can transmit. Actual transmission occurs in about 10% of women per year who are exposed to an HSV 2 partner and they are negative themselves and in about 4% of men who are negative and having sex with women who are HSV 2 positive.

Lets cite some articles for you since you like them.

Psychosocial impact of serological diagnosis of herpes simplex virus type 2: a qualitative assessment.

Melville J, Sniffen S, Crosby R, Salazar L, Whittington W, Dithmer-Schreck D, DiClemente R, Wald A.


CONCLUSIONS: Individuals exhibit strong emotional and psychosocial responses to a serological diagnosis of HSV-2 infection. Many of the negative responses may be time limited and influenced by factors that are potentially amenable to counselling.


Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA 98195-6460, USA.


Debate: the argument against. Should every STD clinic patient be considered for type-specific serological screening for HSV?
Terri,
UMM you got me mixed u that is what I said. Men transmit to a women %10 of the time women to men %4.

"You've got those numbers slightly mixed up. We know that 98% of people who are antibody positive shed virus, so conceptually, they are all infectious and can transmit. Actual transmission occurs in about 10% of women per year who are exposed to an HSV 2 partner and they are negative themselves and in about 4% of men who are negative and having sex with women who are HSV 2 positive."

HSV 2 is trasmitted in less than %1 of babies born

Mindel A, Taylor J.

These include the lack of a cost-effective and sufficiently specific and sensitive screening test, the absence of an intervention that benefits the health of the individual or reduces the risk of onward transmission and, not least, the psychological, social and sexual sequelae of an unexpectedly positive result.


What people have the highest rate of STD's generally Borderline Personality Disorder, Anti-Socials, people that share needles etc. These are Serious Mental Illnesses. People with SMI's have a higher rate per capita of HIV Infection also. "Variables significantly associated with one or more HIV risk behaviors in bivariate analyses included being female, any limitation in instrumental functioning, not having a bipolar disorder, more psychotic mental health symptoms, problem drinking, and not receiving HIV counseling"


"Do you not look for breast cancer with a mammogram because of the chances of a missed cancer or a test that says there is a mass when there is none? Do you not look for prostate cancer because the test may tell you you have elevated PSA levels, when they mean nothing? Or do you take the test info and confirm if needed, or retest with another test to clarify?"

This is a silly argument. Those are LIFE THREATENING condtions that can actually be detected with other tests besides a blood test. I am saying that just a HSV 2 blood test is NO WAY to simply diagnose someone with HSV 2 that is not fair to the patient and it is irresponsible Medical care.


"First of all, the test is about $100, which is very competitive with the ELISA HerpeSelect in most settings. And if they use some of the money to support a herpes research setting at the Univeristy of Washington, (not the University of Seattle

[pandora9049]

herpes sucks:(

[Terri Warren, RN, Adult Nurse Practitioner]

I am putting your words into quotes so I am getting the absolute statement that you wrote, rather than just summarizing, here.

"You have HSV 2 antibodies in your blood, but they do not know for SURE if you have the virus, just you probably do". - Yes, that you probably do, with a 98% likelihood.  In our New England Journal article of March 2000, we found that only 1 of 53 people who simply tested positive for HSV 2 antibody, but had no symptoms of  herpes ever, did not shed virus from the genitalia during a 94 day period of self swabbing.  That means 98% did shed HSV 2 from the genitals during that time period.  Previous and subsequent studies have shown that you continue to add more people to the group of shedders, the longer you swab.
  
"They do not know if you will ever get symptoms or have had them even though 2/3 of people that have been exposed actually are symptomatic."  Yes, we believe that probably 80% of those who test positive, actually do have symptoms, but are not recognizing them as being related to herpes.  There are felt to be some people who do not have symptoms that they can recognize.  However, symptoms are not the only key to transmission, so though they are of interest, they are not our only interest.

"You can have HSV 2 on your foot or your mouth and vice a versa with HSV 1."   Well, technically, I suppose that is true.  But if 98% of those who tested positive for HSV 2 by antibody test shed virus from the genitals during a 94 day period, who likely is it that an HSV 2 infection is coming from something that happened to your foot?

"They cannot tell you 100% if in fact you can transmit this on to someone else, just that it is possible 10% of the time if you are a man, %4 of the time if you are woman roughly."  You've got those numbers slightly mixed up.  We know that 98% of people who are antibody positive shed virus, so conceptually, they are all infectious and can transmit.  Actual transmission occurs in about 10% of women per year who are exposed to an HSV 2 partner and they are negative themselves and  in about 4% of men who are negative and having sex with women who are HSV 2 positive.

"There is also false + and false - that occur with these tests so you could worry for no reason."  Yes, there are both false positives and false negatives on the type specific antibody tests, but they account for about 2-3% of the test results. Many of the false negatives occur from testing too soon after exposure, and can be resolved by testing later after exposure.  Some of the false positives that occur on the ELISA HerpeSelect occur at very low numbers, and can be resolved by doing a follow-up western blot.  There are false positives and false negatives on almost every test out there.  Do you not look for breast cancer with a mammogram because of the chances of a missed cancer or a test that says there is a mass when there is none?  Do you not look for prostate cancer because the test may tell you  you have elevated PSA levels, when they mean nothing?  Or do you take the test info and confirm if needed, or retest with another test to clarify?  I think the later.  To not test would miss 98% of those for whom the result would be accurate.

"The Western Blot is expensive and is used to help fund research at the Remington Clinic at Washington University in Seattle."  First of all, the test is about $100, which is very competitive with the ELISA HerpeSelect in most settings.  And if they use some of the money to support a herpes research setting at the Univeristy of Washington, (not the University of Seattle

[CRAZY BRAIN]

Ok people reading this site.

This is what this lady and a few others are saying.

Go get a HSV type specific blood test this is what you will find out if you come up +.
You have HSV 2 antibodies in your blood, but they do not know for SURE if you have the virus, just you probably do.
They do not know if you will ever get symptoms or have had them even though 2/3 of people that have been exposed actually are symptomatic.
You can have HSV 2 on your foot or your mouth and vice a versa with HSV 1.
They cannot tell you 100% if in fact you can transmit this on to someone else, just that it is possible 10% of the time if you are a man, %4 of the time if you are woman roughly.
There is also false + and false - that occur with these tests so you could worry for no reason.
The Western Blot is expensive and is used to help fund research at the Remington Clinic at Washington University in Seattle.
Also if you have HSV 1 antibodies they reduce the risk of symptoms and reduce the risk of transmission possibly.
So armed with these facts that come from their own sites and researchers what do you think.
Is it worth knowing that you MIGHT have symptoms and might have an illness if you have never had a problem?
What mental health risk does this pose.
Please all of you remember that this is a highly controversial subject.
These tests are relatively new and they just know a little about what they mean at the early stage of these type specific tests.