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Long term Herpes, but negative serology tests
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Long term Herpes, but negative serology tests

I was clinically diagnosed with genital HSV-2 by a dermitologist approximately 17 years ago.  She did a culture test on the lesions but it came back negative for HSV-2.  She was still convinced that it was probably HSV-2 and prescribed acyclovir suppression therapy.  I have been taking acyclovir ever since.  Other than this condition, I am in very good health.

Over the years my flare-ups have been much less severe.  I still occasionally have some prodrome symptoms & mild out-breaks and just up my acyclovir dosage as needed to control (no full blown outbreaks).  During a recent physical exam, I mentioned to my doctor that I had never had a positive culture or serology test for HSV-2 so we decided to do one.  Surprisingly, the results for HSV-2 (and HSV-1) were negative.

HSV Type 1 - Specific Ab, IgG  Result was <0.91 (negative)
HSV Type 2 - Specific Ab, IgG  Result was <0.91 (negative)

My doctor recommended I discontinue my medication and wait and see if active lesions appear so a culture can be done.  I am extremely hesitant to do this as I have not had to endure a full blown outbreak for several years - not to mention that cultures are often inconclusive anyway.  I got my doctor to agree to have a Western Blot Test done.  The WB test came back negative also.  So here I am, wondering what the heck is going on.  I am still taking daily acyclovir while I decide how to proceed next.

Is there any reason to belive that HSV-2 antibodies would diminish to an undetectable level over a period of 17 years?
Could the daily usage of acyclovir for suppression have affected my HSV-2 antibody levels?

Any answers / other recommendations would be greatly appreciated - Thanks
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Dr Wald I believe it is has been following patients for 20+ years who still yearly test + for hsv2 on the WB.  There is some info out there on seroreversion but from what we know, it's not something that is an issue for a very large group of people. Some info that suppressive therapy will lower your igg result too but only by 10% if I"m recalling properly - not enough to turn a clear positive into a clear negative by no means.

I totally agree with your provider - stop your acyclovir and the next time you get symptoms, go be seen within 24-48 hours of the appearance of symptoms for a lesion culture and typing.  Even in the best providers who see herpes all the time, one study showed that 1/3 of the time they were wrong with their visual diagnosis. Would be a darn shame if all this time you thought you had herpes, spent your hard earned money on treating it as well as worried about transmission needlessly. It's time to confirm this for once and for all!

grace
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101028_tn?1419606604
Another reason to stop therapy and wait for an ob is because if this is hsv1 genitally, even the best blood tests we have still don't always pick up on that and it sheds less often and isn't as likely to be transmitted to a partner. The only accurate way to confirm it is thru a lesion culture of active symptoms.  If you have hsv1 genitally, you can still contract hsv2 so knowing your type is important.

grace
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Thanks grace.
I'll follow up with my doctor on the acyclovir discontinuation.
I really appreciate your quick response.
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What are the chances of testing negative on a Herpeselect test but positive on a WB test 6 months after an encounter?
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I don't have actual stats but it would be rather low. The herpeselect is really good at picking up on hsv2 infections - 98% of them in fact.

grace
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