Herpes Expert Forum
Ordering a Western Blot
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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.

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Ordering a Western Blot

Dear Terri,

Awhile back, you suggested that I get a Western Blot test for HSV-1 (medhelp.org/posts/Herpes/Boyfriend-has-G-HSV1--please-advise/show/1802921#post_8304417). To recap, my boyfriend was diagnosed (culture and blood) with G-HSV1. I developed strange symptoms but, my blood tests have consistently been negative.

Initially I decided not to bother spending money on the Western Blot since HSV1 is not a big deal and figured I'd just risk it. But that's proved harder than I thought - a year out, I'm still having anxiety which is starting to ruin our sex life. If there's some chance that I already have HSV1 and can stop worrying about catching it, I think the psychological relief would be worth the money. How much more accurate is the Western Blot for HSV1? You mentioned that you could order one for me - that would be amazingly helpful. What's the best way to proceed?

A lot of posts on this site suggest that genital-to-genital transmission rates of HSV1 are so low as to be basically negligible. That's comforting...but the stats say that there's shedding about 18 days a year. That doesn't seem totally negligible to me. I'm in love with my boyfriend, and if we can get past this sexual hurdle, I want to marry him. If I spend the rest of my life having sex with him, and he's contagious 18 days a year, aren't I basically bound to get it? (In case this is relevant, he's been on daily suppressive therapy for the last year, he's had one more minor outbreak, and unfortunately he did not notice a prodrome that would help him identify future outbreaks ahead of time.)

He caught this virus while we were broken up for a stretch of time. Before then, we used to have an amazing, free, uninhibited sex life. Now we rarely have sex, we use condoms and I can't enjoy it the way I used to because it gives me so much anxiety. I would give anything to get back what we had, because it's an otherwise perfect relationship.

Thanks so much in advance for your help.
55646_tn?1263664409
Yes, you can become a phone patient.  One of us will get some history about you and talk about your situation and then order the test.  

Where was your shingles outbreak?

The thing is, is you are negative and you get herpes, you will be able to start treating right away. Most people who have a really hard time don't have a clue what's going on when they first get infected, so they first treat for a UTI, then yeast, and finally, by the time the outbreak is significant and when they finally treat, the skin has to heal and all of that.  If you got symptoms and totally suspected herpes, you could begin treatment right away and get things under control quickly.

HSV 1 genitally rarely recurs often, so I wouldn't let that be a big deal for you.  Also, the doses of Valtrex to treat herpes are much lower than those used to treat shingle, so I would suspect you would do fine with the meds.  

Let's see what the western blot says.

Terri
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55646_tn?1263664409
The ELISA test  picks up about 90% of HSV 1 infections.  My opinion is that that figure, on the test kit, may be a little high.  The western blot does better, but I can't say statistically how much better.  My guess?  It probably picks up 95 or 96% or better, just don't know for sure.  But we certainly have patients in our clinic who test negative for HSV 1 by ELISA and are positive by western blot.  

The shedding rates that you quote are about right with the knowledge that we have using once a day swabbing.  And you are also correct that we don't see genital to genital transmission very often but sometimes it is difficult to know exactly how transmission occurs because often people both receive oral sex from and have intercourse with the same person.  Certainly, suppressive therapy will reduce the risk of infecting an uninfected partner, be it HSV 1 or HSV 2.  

You just need to call the clinic and set up an appointment to become a clinic patient and we will order the test for you if you choose to have it done.

So is your anxiety that you will acquire HSV 1 from him?  And is that the only anxiety?  Are you anxious about pain, stigma, what?  HSV 1 is usually a mild infection with infrequent recurrences.  It would help, I think, to identify what it is about the possibility of acquiring herpes bothers you.

Terri

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Thanks so much, Terri. I'll go ahead and call the clinic - can I become a patient without being able to come in person? (I'm on the east coast.)

My anxiety is about acquiring HSV1 - the pain, not so much the stigma, since I really do hope to marry this person. I'm a bit anxious about health in general, and I have this fear that I'll be one of the unlucky ones who has horrible outbreaks monthly or something. I had shingles once and it was not fun. I reacted badly to the Valtrex, so I fear getting HSV1 and then not being able to tolerate meds. All unlikely scenarios, I'm sure, just nagging "what if"s. To be honest, I'd love to forget the issue, accept the low risk and just have normal, unprotected oral and genital sex in the absence of symptoms - but I can't decide if that's crazy?

Ironically, my greatest hope is for the Western Blot to come back positive!
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55646_tn?1263664409
Yes, you can be a patient without coming in.

HSV 1 is infrequently recurring in the genital area, so if you did get it, you might never recur.  Also, if you got herpes symptoms, you could start treating immediately without having to wait and get a diagnosis and be seen and all of that.  

Where was your shingles?

Terri
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Hi Terri,

This is so helpful, thank you!

I had shingles on the right half of my torso, in a line starting under my right breast and wrapping around to my spine.

It's really comforting to know that the valtrex dosing would be much less should I need it. And I really appreciate the advice to not worry too much about the possibility of frequent recurrences. Sometimes it's hard to know how to temper my reaction to this whole situation - it ranges from no big deal to deal breaker in ten thoughts or less. The perspective is a huge help.

I'll call in to set up the Western blot this week.
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55646_tn?1263664409
Sounds good.  The shingles do sound like shingles.  Sometimes people get herpes simplex and shingles mixed up.

Terri
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55646_tn?1263664409
Terri Warren, RN, Adult Nurse Pr...Blank
Westover Heights Clinic
Portland, OR
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