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Accuracy of herpes serology tests?
Hi, I have a couple questions over the accuracy, namely the sensitivity, of the herpes elisa IgG blood test. I had a herpes blood test performed a month ago. The test was taken at 11 weeks after an unprotected heterosexual encounter in college. I have no idea if she had an std or not, I just want to make sure that I did not acquire an std from that encounter. The test results I received from the test at 11 weeks were IgG type 1 and 2 - Negative, IgM type 1 and/or 2 - positive. (The reason why I was tested in the first place is that I have “noticed” some abnormalities that made me question if they weren’t herpes symptoms?) I should admit that I have been very paranoid with all of this, and I have undoubtedly over analyzed my "symptoms" but I just want an answer for the sake of my peace of mind.

When analyzing my test results online, I went to the labs website where the following disclaimer was listed for the IgG blood test: 5-10% of infections may occur with glycoprotein G-deficient virus.  Detection of antibody presence in these cases may only be possible using a non type-specific screening test.”

I understand that the IgM test is unreliable, but is the disclaimer listed above accurate? 5-10% of infections that aren’t detectable by IgG is a pretty significant percentage. If its true, how would someone infected with the virus, but not exhibiting symptoms, know that they were infected? Are there any blood tests that are type specific that can detect the glycoprotein G-deficient virus, for instance the WB test or the Biokit test? Also, does anyone have different numerical information regarding the prevalence of the glycoprotein g-deficient virus?

In summary along with the questions mentioned above, if I were to get retested at 15-16 weeks after potential exposure and receive negative results, how much confidence can I place in that result? Might it be necessary to rely on the IgM result if a person had the g-deficient form of the virus? My ultimate goal is to get tested and get a definitive answer either in the affirmative or negative, can that be done with an elisa blood test or does a person need to use the "golden standard" WB test to be certain?

Thanks for your time and I would very much appreciate any input.
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101028 tn?1419606604
it's really helpful when you just keep adding to your original post instead of making new ones like we ask in our read before posting post on the forum. thank you for your future cooperation with this.

really no reason for more testing. should you get a recurrence of your genital symptoms, be seen for a proper exam and if they suspect herpes, they can do a lesion culture.

the WB still is an igg based test.

grace
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101028 tn?1419606604
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Hi Grace, I apologize for the mistake, I appreciate your informing me. Is it accurate then that the igg test can miss up to 5-10% of infected individuals, even after a sufficient amount of time has passed?
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1174003 tn?1308164419
The test can miss some peoples infections.  If you feel thats a large number that is far less then how many people will test inaccurately with the IgM testing.  
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Mistakeguy789, I agree with your above post, the IgM testing can be very misleading. I am simply curious as to how often the IgG test misses hsv positive people due to a glycoprotein g deficient form of the virus? I was hoping someone might have information dispelling the 5-10% disclaimer listed by some labs.
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1174003 tn?1308164419
The test can miss 1 out of 10 infections.  So while about 5-10% of people may have that there is at least the 90% chance you will show up if positive.  
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Thanks for the information. I have one last question. Does herpes ever present itself as a linear fissure (about an inch long), particularly in the groin fold area? I experienced these fissures twice in the last 4 months. Once two weeks after unprotected sex, and once last week. I saw a doctor and she said she thought it was dermatitis and not herpes. I was happy with this diagnosis but having this same symptom appear 3 months after I had the first experience made me wonder if it wasn't a recurrence? I never noticed any red bumps or fluid filled blisters before the fissures occurred. Also on both occasions they healed very rapidly, within a number of days. Do these symptoms sound like herpes? Thanks so much for your help guys it has helped me a lot.
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1174003 tn?1308164419
Doesn't sound like herpes but herpes has many different looks.  Chances are this wasn't anything really and your doctor didn't feel as so either.  Typically herpes takes at least 5-10 days to heal.  Chances are this isn't herpes.  
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1174003 tn?1308164419
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Hello,

I recently was retested just to make I had allowed enough time for hsv serconversion. Unbeknownst to me, they order a PCR DNA serum test instead of an elisa antibody test. The results from the hsv 1 and 2 pcr serum test were negative. I have been unable to find hardly any information regarding serum pcr hsv tests. I have found a lot of information on pcr spinal fluid tests being accurate but very little on the accuracy of serum based tests. Is the pcr test a more accurate one than the elisa? That is what the doctor told me after he called quest when I asked him about it. Or should I consider taking an ELISA test to double check? Thanks so much.
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101028 tn?1419606604
of course a pcr blood test is going to be negative - herpes is not a blood borne infection. It's inappropriate for a pcr blood test on adults outside of research.

call the clinic and ask them to please credit you because they ordered the wrong test and to order the right test for you.  

grace
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101028 tn?1419606604
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Thanks, I will do that. In your opinion then is there any value to these results whatsoever or should they be completely disregarded. If so, there are a number of testing websites that are spreading disinformation as they are touting the blood version of the pcr test as being extremely sensitive and accurate. Thanks, you provide an excellent service with the donation of your time.
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101028 tn?1419606604
absolutely no value at all to a pcr blood test for herpes on you.
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101028 tn?1419606604
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Hi Grace,

I went to the provider who performed the pcr blood test on me. I told him that I wanted an elisa test as the pcr test was not proven reliable. The clinic called the lab and the lab said that they could use the specimen that was sent to them on Feb 17 and that I did not need to have blood drawn again. I accepted this but can blood specimens be accurately analyzed when the blood was drawn 6 days ago? Thanks.
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101028 tn?1419606604
yes it can.
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Hi Grace I got my IGG results back and they were as follows. IGG 1 - .07; IGG 2 - .07. The test was a herpeselect test. Is there any significance to both igg type 1 and 2 returning a value of .07. Might that result be indicative of a faulty test or something of the sort, or is this simply a coincidence? Thanks so much.
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101028 tn?1419606604
I don't think Terri had answered this the last time you posted to her about it so I will answer it for you - no, it's coincidence only and not of any significance.

glad you finally got answers :)
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101028 tn?1419606604
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Hi Grace thanks so much!!!
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Hi, I know this is kind of late but I just wanted to clarify something.  Grace stated that the western blot is an IgG based test but that is not entirely true.  It detects IgG but it also detects a bunch of other antibody components.  This is useful for that 5-10% of people with gG deficient HSV that you mentioned.  I know this for a fact because I am one of these people.  I have had HSV-1 for over 2 years, and to this day my Herpes Select test comes out negative.  But I got the western blot done and it was positive.  My gynecologist explained that this is most probably because I have a gG deficient strain, so I do not produce the IgG antibodies.  If in doubt, western blot is always the way to go because it is the most accurate.  Yes, it is more complicated and more expensive but at least if will give you a clear answer.

And by the way, I have noticed that the doctors and experts on these websites always dismiss symptoms as being unrelated to HSV unless they are classical symptoms or you have a definitive culture.  Please do not listen to them.  SO MANY people (up to 80%) with HSV have mild or no symptoms at all!  For instance, I never get sores--just papercut-type lesions, along with itching and vaginal discharge.  I'm sure Grace and Dr. H would immediately say this is not herpes, but in fact it is. And it is because of doctors dismissing these symptoms that people think they are fine and continue to spread the virus!
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