Negative HSV test due to a "local" infection?

[Lemten]

I've had Herpes-like symptoms recurring in my genital area for over 1,5 years after an sexual encounter. So i have had 3 blood tests done during this time: first after 8 weeks from possible exposure, second after 11 months from possible exposure, and last of them was done last month, 1,5 years ater possible exposure. The type on the test performed to my understading was ELISA that didn't differentiate between HSV1 and HSV2. And that didn't really matter because the result was negative everytime, meaning - due to the general guidance, that i am HSV-negative altogether. Right?

But: the infectious disease specialist i saw, said that if the infection is local, the body doesn't produce antibodies to be detected in a blood test. That is somewhat confusing, because i thought that most of the herpes infections are "local" and not systemic? If my doctor is right, that would mean that all the general info about herpes blood tests and their accuracy in diagnosing herpes, oral or genital, was wrong or at least very misleading.

So, is it really so? Of course i asked my doctor this : Isn't herpes almost always local and not systemic, meaning it presents itself as a sore or a blister on lips or genitals? And why are antibody tests then used and recommended fo diagnosing that type of HSV-infections if the body isn't really likely to produce antibodies to be detected?

Answer was that the body produces antibodies to be detected in blood mostly if there is, for example, mouth full of blisters - but not if there is, for example, one blister on a lip?

This goes against pretty much everything i've read about diagnosing herpes via blood tests and the reliability of them in doing so.

I understand that false positives and false negatives do happen but do they really happen that way? And if they do, wouldn't that mean that most of the negative blood tests for HSV (when there is a reason to believe in a possibility of being infected) were actually false negatives, if it really is that Unusual for the antibodies to be produced in a way that could be detected in a blood test if the infection (like most of the HSV-infections?) is local?

[william28]

Are you still have any symptoms ?

Thank you.

[gracefromHHP]

correct - they didn't have an adequate specimen sent to them to do the test.

I certainly wouldn't bother testing for zoster. shingles rarely reoccurs so no reason to think that shingles is the cause of your ongoing issues.

I wouldn't bother with any more herpes blood tests either at this point - lesion cultures only.  

Hopefully you get the dermatology consult soon and get better answers.   Unfortunately not too much more we can help you with at this point.  It certainly would be terrific to hear an update from the derm appointment but unless you get a + lesion culture, nothing we can help you with.  

best of luck!

[Lemten]

Yes, i'll let you know if something happens.

[Mistakeguy789]

Weird.  I don't know why not either. Please keep me in the loop though.  I am really curious to hear how things go.

[Lemten]

I'm sorry, i may not have been clear enough: I meant that the statement about not enough cells to give a reliable result WAS the result itself. So i think the test didn't even get performed due to the lack of cells.

I don't know why this test wasn't a PCR in the first place since i had a HPV PCR done also.

[Mistakeguy789]

Good info on the test.  Chances are this isn't herpes then.  Given you had it done under 48hrs that is really close to knowing its not herpes.  

The "fluid" from blisters doesn't need to be there to do culture with typing.  The best thing for you in your case would be to look into getting a PCR done on the rash when it comes back.  The PCR looks for the RNA/DNA of the virus itself.  It's far more accurate than the culture because it doesn't require the virus to be alive.  It just has to be there.  

It's hard to say that the cell-deficiency was the cause.  Most culture tests are grown and that is why the virus has to be alive on the swab for it to happen.  But I don't know much on this test so I can't argue for or against it.  Just to me it sounds like it isn't Herpes at all going on at this point.  I would be surprised if you got a positive test.