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Confused by Western Blot Test Results
I went through a divorce in Fall of 2011 and had learned that my spouse was quite sexually active outside the marriage. I wanted to get verification of my sexual health status before beginning to date, so I ordered the full battery of STD tests, including blood work for herpes simplex - though I never presented with any symptoms.  I was originally diagnosed with HSV1 by means of an IGG test (+2.90) in Dec., 2011.  Retested positive again with an IGG blood test (+2.70) in April, 2012.  Started dating someone with both HSV1 & 2 and had some oral symptoms, so my doctor ran blood tests again - this time using Western Blot through Quest Labs.  Results for both HSV 1 & 2 came back negative.  Can I now infer that I do not have / do not carry the virus(es)?  Should I test again? Very confused and unsure of my status right now. Input is greatly appreciated. Thank-you.  
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101028 tn?1419606604
even the best blood tests, which is the herpes WB, still misses 1 out of every 10 hsv1 infections.  no easy way at this point to know if indeed you really do have hsv1 or not.  

grace
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...what about accuracy of HSV2 Western Blot results? My physician just call to say that I am clear.  Is this accurate? Can diagnosis be trusted? Feel like I'm shaking the magic 8 ball on some old-timers desk..."the future is not clear,"  "as later." Any insight? Direction from this point?  What do I believe, follow, tell future mate, etc?  I would like to be able to understand and define my current status.  Truly thank-you for your incite and input.
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101028 tn?1419606604
yes I would trust the negative hsv2 results.  

unfortunately there isn't a clear answer for future partners. It's low risk that you have hsv1 but you can't confirm it 100% unfortunately.  I'd just be honest about that when discussing herpes with future partners - it's not likely you have it but even with confirmatory testing, you couldn't get clear answers for hsv1. It's a good way to bring up the topic with a partner to see if they've even ever been tested for herpes and what their status is when you talk about the testing you've been through.  

we have a magic 8 ball at my house. we still sometimes just shake it and ask when we get frustrated...lol.  It has yet to tell me that "without a doubt" my knight in shining armour is on his way to rescue me...sigh.
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Two more questions:
(1) I'm a little unclear when you say I "couldn't get clear answers for HSV1."  I did get conflicting test results (positive, low-value IgG results and negative Western Blot sero results), but why then do I.M Specialists and Serologists even use the phrase, 'false positives'? Can't I assume that the low value positive IgG results were false, and that the negative values of the far more accurate Western Blot test are accurate?  

(2) Even when using safe sex practices, what is the risk of HSV2 transmission (my partner is HSV2 positive) between us through viral shedding? I am curious, especially as my partner cannot tolerate daily suppressive drugs (Valacyclovir, etc).  

Thanks again for your help...

I've always taken STD transmission very seriously and been sexually responsible all my life. I only had unprotected sex with my now ex-wife, and have only dated HSV-positive women since being initially diagnosed during the period of my divorce.  In light of my most personal experiences during the past 18 months, I would never shun a person with an STD.  But as I once remarked to the diagnosing physician who flippantly told me that having HSV 1 & 2 is no big deal, I replied, "That's great to know! How soon can I give it to YOU then?!" Crickets.  

I still find it AMAZING that when a physician orders full battery of STD tests, they automatically check for everything under the sun BUT HSV1 & 2.  This is standard operating procedure, even after it has been established through the medical community that HSV1 and 2 are steadily on the rise and that most carriers are ASYMPTOMATIC. And so by this professional practice we only can expect the numbers of cases to grow. This is not to say that HSV is the end of the world by any means, however I'd be lying if I didn't say positive STD results are a real life-changer.
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You stated that herpes WB, still misses 1 out of every 10 hsv1 infections.  What about for hsv2? Same "miss" ratio?
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101028 tn?1419606604
thankfully it is about 99% accurate at detecting hsv2. It has about a 91% accuracy for hsv1. That is why we rely on it heavily for hsv2 confirmation and hope for the best with hsv1 confirmation. ( hope this makes sense, i just woke up and might not be as clear to others as I am in my own head )

as I said, it's likely you don't have hsv1 but bc the Wb isn't as good at hsv1 detection, you don't have 100% confirmation you don't have it.

if you are a male with a female who is hsv2+ as a partner. if you did nothing but avoid sex anytime she has anything going on genitally, you are 96% likely each year NOT to contract hsv2. If she takes daily suppressive therapy and you use condoms in addition, it's a 99% likelihood that you wouldn't contract hsv2 on average from her each year.

out of curiosity, why doesn't your partner tolerate suppressive therapy?
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My partner cannot tolerate suppressive therapy because it causes her photo/light sensitivity &  tachycardia.  She also said when she just used Valacyclovir for suppressive therapy only when her prodromal symptoms presented, outbreaks would come back much more aggressively when going back off the meds.  I don't want her to be put at risk for far more serious health risks in the name of our sex life, nor would I ask that of her.

HUGE "fat finger" mistake I made in my 1st entry here in this string of correspondence ... meant to say I was originally diagnosed with HSV2 by means of an IgG test (+2.90) in Dec., 2011.  Retested positive again with an IgG blood test (+2.70) in April, 2012 & have never presented with any symptoms. I never came up positive for HSV1 in either the of my IgG sero tests or Western Blot sero test.  Still finding it really hard to believe after all this that I could really be HSV2 neg. Further, I just had a doc call me and say, "the neg Western Blot don't really mean anything, because you had two previous positive IgG blood test outcomes."  I feel more confused than ever - would like to believe I am truly HSV2 negative at this time, but all I have is conflicting info...time to shake the eight ball again (and learn how to check my typing, too)?
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101028 tn?1419606604
she could try acyclovir instead suppressively and see how she tolerates that if you are interested in her being on suppressive therapy.   since you get less active acyclovir in the body with acyclovir than you do valtrex, sometimes folks tolerate it better.   also recurrences always seem worse once you get used to not having them and/or having really mild recurrences on suppressive therapy.  they aren't any "worse".  I usually cuss quite a bit through ob's when not on suppressive therapy ;)

your provider is wrong about the WB confirming that you had low false positive igg results previously . it's why we recommend the WB for the low positives.  The low positive false positive issue is well known with herpes testing and your provider should better familiarize himself about it.
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Grace:
Thanks for further input on other suppressive therapy with acyclovir for my partner.  I don't know if she has ever considered / tried it before, but I think she'd be willing to try it.  I can also see your point about "believing that outbreaks are worse after coming off of suppressive meds, because the symptoms while on the meds were....well, suppressed.  I've got to talk to her about this a little more.

I am still unclear about about what you meant in the final paragraph of your last response..  Again, I had earlier positive HSV2 IgG results, and just recently recieved negative HSV1 & 2 Western Blot blood test results.  Based on negative HSV 1 & 2 Western Blot blood test results, should I consider myself HSV 1 & 2 free at this time?
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101028 tn?1419606604
yes you should consider yourself herpes negative at this point.  the WB trumps all other blood tests.
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Grace - Thanks very much for all the information & dialogue you provided to me in the past few days.  Best regards.
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