Herpes Expert Forum
Been tested 5 times...many questions remain
About This Forum:

Welcome to the Herpes forum. This forum is for questions and support pertaining to herpes simplex virus infections (HSV-1 and 2) and herpes zoster (shingles) and the virus that causes it, varicella zoster virus. Questions about genital herpes are welcome both here and on the STD Forum.

Font Size:
A
A
A
Background:
Blank
Blank
Blank
This expert forum is not accepting new questions. Please post your question in one of our medical support communities.
Blank Blank

Been tested 5 times...many questions remain

Facts:
11/12/11 - My alleged giver has unprotected sex with a male
11/19/11 - I have unprotected sex with my alleged giver
11/21/11 - burning urination
11/22/11 - Tested for Chlamydia, Gonorhea, & Syphilis - & given Zithromax antibiotic as a precaution, assuming its chlamydia - All tests negative on 11/26
11/25/11 - Antibiotics = no relief.  Redness and skin cracking on glans (glands)  
11/26/11 - Call my giver to ask if she has anything. she started having symptoms on 11/25 (nothing before) and went to the clinic.  Gets positive swab for HSV 2.
11/27/11 - I'm in Mexico on vacation, so able to easily buy acyclovir and start taking it.  Burning urination gone in two days.  Now have flu like symptoms, muscles aches, swollen lymph nodes. Keep taking acyclovir until Christmas when I run out
12/08/11-(3 weeks post exposure) Herpeselect Igg antibody test (.07 - type 1 .48 for type 2)
12/13/11-(4 weeks) 2nd test through my primary doctor.  Test is run through Quest Diagnostics, so only get a range. less than .9 for type 1 and 2
12/28/11-(6 weeks) - 3rd test -  directly through Quest Diagnostics.  Less than .9 for type 1 & 2
01/09/12-(8 weeks) 4th test -Type 1- .04 Type 2 - .52
02/06/12-(11 weeks) 5th test -type 1 - .05 type 2 - .35

Other symptoms: Redness, burning on glans (glands), irritation, pimples on thighs

Below are my questions:
1) Do the antibody counts hold any weight at all?  They are all in the negative range and have even gone down slightly with my last test.  I have to believe that they do mean something.  I am clearly negative for type 1 with AB counts in the .04-.07 range.  The fact that my type 2 ranges from .35 to .52 is an indicator to me that I will eventually serconvert.  Are these antibody counts my acually antibodies or a comparison to a positive sample?

2) If I am experiencing a slow seroconversion, does this mean anything as far as how many recurrences to expect?

3) How long until a Herpeselect ELISA test can be relied on?

Related Discussions
55646_tn?1263664409
Normally, the index values that we see for negative tests are quite low, .01 maybe up to .20.  Sometimes we see them higher, like yours, and they stay negative always, but just at a slightly higher level. We don't know why this is, it just is.  Sometimes, that person is in the process of becoming positive, though with you, the timing seems less likely.  However, if you were my patient, I would stay off of herpes medicine at retest when four months have passed this the encounter.  You are still really close to the encounter date and I would say your tests are not yet reliably negative - you need to give it a bit more time.  

People are most infectious during the first six months of being infected.  Are you certain that your potential "giver" was infected just a week before having sex with you?

Terri
23 Comments
Blank
55646_tn?1263664409
The antibody tests do carry weight, yes.  The negatives for HSV 2 are a little higher than one normally sees and the fact that you've had a positive HSV 2 and some bothersome symptoms would prompt me, if I were your provider, to order a western blot antibody test from UW.  I wouldn't say your values are an indicator that you will eventually seroconvert, no.  The antibody results are an index value derived from comparison to a negative and positive sample.  

If you are slow to seroconvert, it has no impact on how many recurrences you might have.

I don't think the ELISA should be your final test, I think the western blot should be.

This can be ordered through Quest labs, the code is 34534.  I would wait 4 months from the time of your possible infection to be tested.

Terri
Blank
Avatar_f_tn
Can you elaborate on my antibody levels being a "little higher than one normally sees"?  I thought I would see my AB levels slowly increase toward a positive result, but this has not been the case.  Maybe I don't understand the testing well enough.  

I had been off anti virals since Dec. 25 when I took my Feb 6th test.  Shouldn't that be enough time off of AVs to not affect the test?

Since my giver contracted the virus exactly one week before my encounter, I was hoping she would not be contagious yet.  I know everyone has their story, but this has got to be one of the worst timing stories there is!  What is the normal incubation period before someone becomes contagious?
Blank
Avatar_f_tn
Yes, I am certain that my giver contracted type 2 the saturday before my encounter.  She has confirmed that the guy she got it from is positive.  She did not have her initial OB until 4 days after her encounter with me.  My inital painful urination actually started before her first OB! (two days post-encounter) The timing of everything just confuses me, but I guess it is possible.

I am cleary negative for type 1, so I thought I would seroconvert more quickly, and not be one of the "outliers" that didn't seroconvert for many months.  

I don't understand this comment by you "Sometimes, that person is in the process of becoming positive, though with you, the timing seems less likely."  Are you saying that a person with higher than .01 to .2 AB counts is sometimes in the process of becoming positive?  If so, how does my timing seem less likely?

Blank
55646_tn?1263664409
Yes, that's what I mean.  
So let me be very clear with my question - did your giver test negative for the type of antibody for the type of virus that was identified in her swab test that was positive?  That's the only way to know if someone actually has first infection.  

Again, your testing is all too early to be confident about the results yet.  If you plan on testing again, be certain not to take any antiviral medicine.

Terri
Blank
Avatar_f_tn
I did look at her results.  Unfortunately because she was having such a bad breakout, they did not give her a blood test for HSV.  Only a swab, that came back positive for type 2.  I understand we can't be CERTAIN this was a first infection, but it is very likely considering the severity of her breakout and the other symptoms associated with a primary infection (flu like symptoms, muscle aches, extreme difficulty with urination, bilateral breakout.) She has had a 2nd OB now, that she explained as only noticeable because she was looking for it.

The timing does seem odd to me, but I guess she can be infectious as early as a week post infection (pre first symptoms).  Have you ever seen a case like this?  I just can't get over the terrible timing.
Blank
Avatar_f_tn
Also, I have seen you mention many times to not take antivirals before testing again.  Is there solid scientific evidence that shows antivirals will truly affect the test results?  If so, can you point me in the direction of that paper.  I would love to read it.
Blank
Avatar_f_tn
Also, this is a direct quote from Dr. Hansfield from the STDs forum....

"Changes in numerical value, below the low-positive cut-off value of 0.9, mean nothing.  The very same specimen tested 10 times would give 10 different numbers, which could vary anywhere from 0.1 to 0.8."

I guess, it is safe to say that you disagree with Dr. Hansfield?
Blank
Avatar_m_tn
Here's the paper on antivirals, just to save Terri some time (bob12).

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC425069/pdf/jcinvest00131-0091.pdf
Blank
55646_tn?1263664409
In people who have not waited long enough from exposure to accurately test, I do have concerns about negative tests in the higher range, yes.  The reason is that you could be in the process of seroconverting, that is, moving from a very low negative through a higher negative set of values to a positive value.

Also, in my practice, I've seen some people, particularly with HSV 1 high negatives, be positive by western blot.  The ELISA test is not as good for HSV 1 as it is for HSV 2, so that may be a factor.

If you still have a higher negative when enough time has passed for accurate testing, then I would believe that, yes.  I don't think Hunter and I disagree on this discussion, I think he would agree that waiting long enough for an accurate result is important.

Terri
Blank
Avatar_f_tn
Dr. Warren,

This still doesn't quite clarify things for me.  My 3 AB counts in order are:

.48 at 3 weeks
.52 at 7 weeks
.35 at 11 weeks

If I were seroconverting, are you saying that my numbers would be slowly building toward a positive?  If I am reading your last post correctly, this is what you are saying.   Here is your quote: "The reason is that you could be in the process of seroconverting, that is, moving from a very low negative through a higher negative set of values to a positive value."

So, my 11 week test  should have been something higher than .52, not a drop to .35.

Either way, based on my past symptoms, I am sure I am positive, but just trying to understand the seroconversion process better.

And I  will ask this question one more time in closing (although I know the answer).  Would my giver be infectious one week after exposure even though she had not had her first outbreak or any symptoms at all?
Blank
55646_tn?1263664409
I do see that your numbers are varying quite a bit over time, yes.  The variation between these numbers is small, and I suspect that you will end up being negative and just be someone whose negatives are a little higher than others.  

People are most infectious in the first six months of being infected.  Whether your partner actually had first infection can only be determined by the combination of swab and blood antibody tests that I described earlier.  

I know you are anxious about this, but I think you will just have to wait a little longer to get that last test that will hopefully show that you don't have herpes.

Terri
Blank
Avatar_f_tn
Update...

At 13 weeks, my results are:
Type 1 - .09
Type 2 - .51

I know I need to wait until 16 weeks and get the western blot, which I will do, but I am considering this an experiment.  

Dr. Warren,

Is there any chance Lysine could be affecting my test results.  I have been taking 1,000mg diligently since early December?

Thanks.
Blank
55646_tn?1263664409
No, I don't believe that Lysine is impacting your test results at all.  I wouldn't worry about that at all.

Terri
Blank
Avatar_f_tn
Just to update this thread.....my 15 week test came back positive at 1.24.  The combination of my troublesome symptoms and this test have finally put some closure on my journey to find out if I have herpes.  Unfortunately, I do.  Not sure what to do next.
Blank
Avatar_n_tn
I'm having issues with pimples on my thighs, did you have blisters or were they pimples? Mine are near my knee, but some have been mid-thigh and I had on my stomach

Sorry to hear about your positive test, keep your head up
Blank
55646_tn?1263664409
A test value of 1.24 needs confirmation with a herpes western blot.  Even though it does appear that you are serconverting, I would certainly suggest that you do confirm.

Terri
Blank
Avatar_m_tn
You may also wanted to get tested for HIV as well for herpes isn't the only STD that shares the symptoms you described.
Blank
Avatar_f_tn
Dr. Warren,

I have a curiosity question regarding my most recent test.  You mentioned that "true negatives" usually fall between .01 and .2, which has been consistent with my Type 1 results (.07, .04, .05, .09).  However, my most recent test that came up positive for type 2 at 1.24 had a  result of .56 for type 1.  Would my type 2 results be causing my type 1 AB count to skew like this?  I have had no physical contact with anyone since November, so I don't think I picked up type 1 in the meantime.

Metagear3,
My HIV test at 13 weeks and 2 days was "non-reactive".  I think that is long enough post exposure to be relied on.  Thanks for scaring the heck out of me again though.  I thought I had at least put HIV to bed!

Blank
55646_tn?1263664409
Its difficult to know what is happening with your HSV 1 status. But the western blot will clear up this question also.  I would once again strongly encourage you to get this test done ASAP.  

Also, as I said before, we mostly see negative results between .01 and .2, but we also see truly negative values in ranges that are higher than that.

Terri
Blank
Avatar_m_tn
I've been watching this one closely.

I was under the, perhaps incorrect, understanding, that false negatives only happen when already positive with HSV1 due to the antibody cross-reactivity?

The increase in HSV1 number, although still negative, definitely seems plausible that it's HSV2 antibody raising those numbers.

When positive for HSV1, a false positive for HSV2 seems more likely than someone negative to each virus at the start.  Is that incorrect Terri?
Blank
55646_tn?1263664409
There are cases of HSV 2 strong positivity making the HSV 1 look positive when it isn't, yes.  Though less common than the reverse.  But that usually isn't an issue for people, frankly, since HSV 1 is so common.  

I just have no idea what to make of the values for the person in the post.

Terri
Blank
Avatar_m_tn
A related discussion, and???? was started.
Blank
Continue discussion Blank
This Forum's Experts
55646_tn?1263664409
Terri Warren, RN, Adult Nurse Pr...Blank
Westover Heights Clinic
Portland, OR
MedHelp Health Answers
Blank
Weight Tracker
Weight Tracker
Start Tracking Now
RSS Expert Activity
233488_tn?1310696703
Blank
New Cannabis Article from NORTH Mag...
Jul 20 by John C Hagan III, MD, FACS, FAAOBlank
242532_tn?1269553979
Blank
3 Reasons Why You are Still Binge E...
Jul 14 by Roger Gould, M.D.Blank
242532_tn?1269553979
Blank
Emotional Eating: What Your Closet ...
Jul 09 by Roger Gould, M.D.Blank