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Test Results -- What to believe?

Hi Grace,
My question is in regards to type-specific, IgG blood testing, such as Herpeselect. As I understand it, even the best tests miss about 10% of HSV-1 antibodies, and concerning HSV-2 antibodies, about 5-10% of people infected do not develop detectable antibodies. So my question is, assuming all testing bases are covered (i.e. enough time has passed after exposure, questionable symptoms are present, no issue w/ low positive due to having HSV-1), why would anyone consider blood test results legitimate given the likelihood of false test results due to the above statistics? It seems to me all blood testing is good for is typing or to determine a new or old infection when new symptoms present.

I'm asking because I've had...

* persistent (~4 years),
* frequently occurring (for the most part one-at-a-time, but several times throughout the month),
* atypical (painless, pus-filled pimples, abscesses, or cysts, never blisters, ulcers, or crusted over scabs, inside and on both sides of labia minora and majora, that resolve rather quickly [1-2 days] after manipulation)

...but nevertheless worrisome symptoms for at least, as best as I can recall, the past 4 years (since ~'08), which is roughly a year after my unprotected exposures (2x oral, 1x vaginal) with a supposed symptom-free/STD-free/obvious sore and lesion-free partner in '07. He says neither he nor his regular partner has ever shown symptoms of any kind, either oral or genital. FYI -- I have no history of cold sores either.

I tested via Herpeselect type-specific in 2011, with negative results for both HSV-1 & 2 (no record of results, but from what I recall, definitely under .90). I've not seen a dermatologist for this, nor ever had a culture done, but I did have one pimple present at my last annual appt., and although my dr. could barely tell it was there, she didn't seem particularly concerned and performed no testing other than the pap.

The longer these symptoms persist, the more I doubt my negative results and fear they were false (thanks to the statistics mentioned above). I know the advice here is that culture or PCR is the most definitive testing option, and believe me, if I could, I'd certainly go to a dermatologist every time and be seen to figure out what exactly is going on.

So I suppose what I'm ultimately asking is:

1. Does this even sound like herpes to you?
2. Given the probabilities of faulty test results, why would anyone believe or give credence to negative results, and should I?

This has been going on for what feels like forever (I was hoping if it was just a skin condition, it would've eventually run its course by now) and is really doing a number on me psychologically. I'll be honest, although I totally understand that herpes is not life-threatening and should, for the most part, be viewed as a minor inconvenience -- akin to chicken pox, really -- I'm terribly depressed and from time to time do have suicidal thoughts. I'm petrified to have normal sexual contact with my regular partner (who is STD-free) and have pretty much just been living life on pause for the last 4 years. All I can think is that I either have HSV-2 and am in the minority who doesn't produce antibodies or that I have HSV-1 and my test was one of the 10% missed. As my screen name suggests, I am having trouble letting this go.

Please help!

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Avatar universal
Update: I've finally convinced my partner from 2007 to get tested. His type specific IgG blood test came back positive for HSV1 and negative for HSV2. So at least I finally have some closure regarding HSV2 after all these years. While I am relieved, I do feel nervous about the possibility of GHSV1, however, Im pretty sure my longstanding, frequently ongoing symptoms are extremely atypical for HSV1 in particular, especially considering I'm over 7 years post exposure. I feel completely free of the notion that I have HSV2, and I'm so glad I can finally let that go. I'm afraid that now my sights are going to shift to GHSV1, so I know I'm going to have to do a lot of mental work to not go down that road. At least part of this nightmare is over. Just wanted to give an update to Fleetwood20, Bigtimeworried55, and GracefromHHP in particular, since you've all been very kind to comment on my posts for such a long time.
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Avatar universal
Thank you for your input and reassurances. I agree that multiple false negatives would be highly unlikely, however, they would only be false negative results if I produce antibodies and it was the test that missed the virus. In this case I would surely eventually get a positive result at some point with multiple tests, especially the WB. My concern is If I don't produce detectable antibodies, then no matter what I would never get a positive reading, so the test wouldn't necessarily be at fault. This is what has been my fear. It's not something that happens with much frequency, but it is possible, and since I have some type of symptoms for such a long time, although not typical or characteristic of HSV, I'm still left to wonder if it's HSV and not able to be diagnosed via blood. I come on this forum daily to read advice of moderators who very suredly say "you tested negative at the appropriate time, so you're negative," as well as my own exchanges with the experts. It makes me feel better, but only temporarily. I acknowledge that the only way I'm going to be able to get any definitive answer for my particular situation is to get swabs, which is something that will be incredibly complicated for me to do. I hate that because of this minuscule antibody development possibility, I can't trust the blood test. I suppose if I was lucky enough to not have any symptoms, then my blood test would be more believable. Thank you again for your thoughtful response, I appreciate you taking the time.
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Avatar universal
Your symptoms are quite likely psychosomatic.  They are very real physical signs caused by the stress you are putting yourself through.  The best advice I can give you is this, based on my experience.  I was quite the opposite.  I did test positive and was in denial.  I stressed and struggled over it.  I analyzed every little twitch or tingle, every little bump.  I kept my skin pretty inflamed and irritated from the constant inspection for any signs.  My test was a swab, which leaves little to no chance for error when positive.  I still did the bloodwork at exactly 16 weeks from exposure praying for a mistake.  Definitely positive with pretty high numbers.  The chances of you getting multiple false negatives, 7 YEARS later, and with WB test are about the same as me being really negative.  Not going to happen.  The obsession, however can cause you to produce psychosomatic signs and symptoms (think of the women who want to be pregnant so badly, they convince themselves they are pregnant and actually start showing, as if they were pregnant..)

Last but not least, I spent several weeks stressing over whether or not I really had herpes and have quickly learned, it's not a big deal.  My every day life is no different and I've actually been far more open talking about it to people I know as part of my accepting it.  I've got plenty of people still willing to be in a sexual relationship with me despite being told I have herpes.  However, I consider myself lucky to have caught HSV and not HIV and will be more selective in future partners, for MY health.  
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Avatar universal
Hi HowardH,
I just read one of your responses on another post saying you have 40 years experience in an STD clinic that sees about 15,000 patients a year. I wanted to ask you, during your experience, have you had any patients that tested negative via Western Blot but were actually positive? Is it something that's markedly more prevalent for HSV 1 or 2? Terri has told me that in 32 years, she's had 9 patients who this has happened to and that they all had obvious blisters, however I failed to ask for which virus type this occurred. I was just curious what kind of statistics you can recall, from your own experience. My understanding is that the WB is highly accurate, but can still miss some HSV 1 infections, and supposedly very little HSV 2 infections. However, this is all assuming there are even antibodies to begin with, which is my concern (that I don't produce them). Do people who don't produce antibodies have some other condition that causes this to happen (I.e. Immunocomprised in some way)? As much as I try to move on from this, and as much reassurance as I've gotten from top experts, I'm still having difficulty believing my test results as accurate, thanks to ongoing questionable symptoms. I appreciate your insight.
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Avatar universal
Just wanted to give a quick update. Seeking her exceptional expert opinion, as a last hope I sent a very extensive letter to top researcher Anna Wald that detailed my situation (probably even more information than I've shared here), including the advice and opinions I've received from both Terri Warren and Dr. Handsfield, themselves top experts as well. She very kindly took the time to respond, agreeing that because my symptoms do not appear to be consistent with herpes and because of my 3 negative blood tests, she also believes I don't have herpes. She offered no other input, no suggestion to seek further testing for what's going on, no guesses of what my symptoms could be due to, no advice to see a dr. I've felt better and more hopeful and optimistic since receiving her correspondence, although I know there will come a time when the doubt and worry will return.

I've been mentally working myself up to the possibility of going to a dermatologist if it comes to it. It's a shame the blood tests leave room for error and aren't always enough. And how unfortunate that there is a tiny possibility of not developing antibodies. Everything would be better if the blood tests offered as much certainty as the HIV tests and swabbing wasn't necessary. It's also disconcerting that the symptoms aren't more cut and dry. There's just so much room for doubt with HSV, I think that's why there is so much struggle and paranoia among us posters. I know that's why I have such difficulty.

After four years of this nightmare, I would just like to finally be free of this and live in peace and joy instead of fear and anxiety. All I can do is try to believe that my testing is accurate, despite whatever it is I have going on, and try with all my might to move on. Just wanted to give one last comment on my post and thank everyone for their input and advice. This forum has helped me a lot. I truly hope and pray for everyone on here that we can overcome the mental demons that come along with fear of this disease. Everyone please take care.
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Avatar universal
Hi HowardH,
I've been reading a lot of your posts. You seem really knowledgeable and helpful to fellow posters, and I'd appreciate your insight into my particular situation. In 2007 I had 2 incidents of unprotected oral (receiving) and a single episode of unprotected sex with a well-known acquaintance. No known STDs of any type for either of us at time of encounter. There were no visible symptoms on my partner that I could tell. I don't have HSV1 and have never had any cold sores, even in youth. I also do not recall having ever had a classic initial outbreak, although I know initial outbreaks aren't always as horrible in everyone. In 2009, maybe even in 2008, I started to get bumps in my genitals. They seemed to be more like pimples, though, as I've almost always been able to pop them and express pus from them. They've never really been superficial bumps, but to me have seemed more like under the skin. I started to get really concerned in 2010 because I was still getting them and thought if it had been some kind of skin condition that it would have eventually run its course. So I started to think this was herpes instead. Symptom-wise, they seem really atypical, as I get them several times a month, sometimes weekly, can express them, get them on both sides of the midline and both in the pubic area as well as inside the inner labia. Finally, they never blister and even after expressing them, they do not turn into open, weeping sores or burn. I've had 2 IgG type-specific tests, both negative for HSV 1 and 2, and recently took the western blot which also came up negative for both types. In the last couple of years, however, I've also started to develop what seem to me nerve issues, with dull aches in my rear, lower back, and back of thighs. I also sometimes experience tenderness in my genitals from time to time. I've corresponded with Terri Warren and Dr. Handsfield about my situation, as well as a few awesome community posters. I've even become a phone patient at Westover Heights and have talked to someone at the Univ of Wash about my WB test. Everyone has said my test results prove that I don't have herpes, but I know for a fact that there is a very very small population of people who have herpes but don't produce detectable antibodies. So this is where my head is regarding my symptoms. I just can't accept my blood test results as being accurate, knowing there is a possibility that I'm in that small group. I'd really like to hear your thoughts about my situation.

Thanks so much.
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Avatar universal
I find more and more people are in your situation, including myself. However, 4 years? My situation has been 8 months and I'm now starting to trust my blood results.

If you continue to believe you have herpes then act like you have herpes when considering your partner. You already convinced yourself you have it against all tests. I've done the same.

The difference is realizing when...when are you going to have enough and realize that you have taken a very reliable blood test outside of the respected timeframe to receive an accurate result and the test result is negative. Outside of a swab on fresh lesions, there is literally nothing you can do from a testing standpoint. I would know I have done everything including multiple swabs. My results all and have always been negative. Even with a single blister.

I've accepted my Western Blot as true when it says negative. It aligns with every other test I have taken to this point in conjunction. I'm living my life this way because you, along with I, have done the smart and respectful thing of trying to test regarding our status. Now, it's up to you to trust the results.

If not, counseling might be something which could be helpful. I've considered it myself at times. All the best.
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Avatar universal
Thank you, Fleetwood.
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Avatar universal
Yes you do know how to make it happen, you just need to act with boldness to realize it. A life lived in fear is only half lived.
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Avatar universal
Thanks, Fleetwood. I wish the blood tests were enough. Everything says definitive after 16 weeks, and that the WB is the gold standard, but there's still that tiny possibility... I don't want to have to swab, because for me, there are so many logistical issues I'd have to deal with in getting that done. But I'm also afraid, as you know, that my blood tests are wrong and in having a false belief that I'm negative, I'll pass it to my spouse (if I haven't already). I want so badly to believe my results. I read as much as I can that supports my hopes and reinforces my results being true, but it's these symptoms that take me back to square one. I've been in this nightmare for 4 years now. Paranoid, anxiety, worry, fear, self-examining, secretly testing. A solitary personal hell. I want this to be over, I just don't know if I can make that happen.
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Avatar universal
I also think you've read enough of my comments to know what I am going to say!

The question is what will make you believe you don't have herpes? If you've answered I will swab two times when sores appear and believe those results for good, then that's a great answer.

If that isn't your answer then there is nothing more that can be done to convince you. In that case you need to live your life on the basis that makes sense to you. If you want to believe you have genital herpes and live your life as such there's nothing to prevent that.
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Avatar universal
Hi Fleetwood. I would appreciate your insight on my situation. Two appropriately-timed negative type specific IgG tests, for both 1 and 2, and a negative Western Blot, also for 1 and 2. Can't rely on past partner to test. Near constant pimple-like genital symptoms (mostly pus filled, but not always), both sides, in both inner and outer area, not necessarily in hair-bearing area, with intermittent back/hamstring/rear ache. Believe to feel tingles as well. Never had a swab for HSV and was advised by Terri that she didn't feel I needed to given my blood results. Been told by both Terri and Dr. Handsfield that test results accurate, however, having extremely difficult time believing results given symptoms, in addition to a minute population of those who never test positive by blood test, as well as the minute percentage of missed cases via blood test. I'd be interested in your thoughts. Thanks.
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Avatar universal
Hi Tim,
Sorry, my story is very long and perhaps confusing. My questionable encounter was in 2007. I had type-specific testing in 2011 and 2013, and recently had the WB. All negative. This is the only exposure I'm worried about, as it was a one-time mistake outside of my marriage.
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Avatar universal
Have the bump swabbed.  

If it is a herpes lesion, you should know for sure with a swab of a new blister.  As I think you know.

As for your testing, what were the times at testing from last sexual encounter?
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Or Fleetwood, or Life360, or TiminBoston, any input from you all would be welcome as well.

Thanks.
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Grace, I've had 2 negative type-specific IgG tests and a negative western blot. Do you think, in light of my ongoing, recurrent symptoms, that this is sufficient evidence that I don't have herpes? I'm extremely concerned that I don't produce antibodies, and am considering getting PCR testing. My partner and I were intimate a couple of days ago, and afterwards I discovered a bump in my genitals, which of course is causing me to panic. Tonight he started to develop a cough and I'm freaking out that I finally transmitted it and this is the beginning of his symptoms. Please help me.
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Avatar universal
Why don't you see a doctor for this lesion versus seeking information or a diagnosis online? If I were you I would have already been in front of a dermatologist before even making a post.

What you describe doesn't sound herpetic at all, but I'm not a doctor. You suffer from the same paranoia as I do. The same. I'm slowly moving toward acceptance but it's very difficult. Your tests say you don't have herpes. The most sophisticated blood test for herpes says you're negative. You're negative.

Please see a proper doctor for that lesion. I highly doubt it's herpes. Seriously,
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Avatar universal
Yes, I took a Western Blot because like you I suffer from the same paranoia. It's been 6 months since my world flipped upside down with symptom identical to herpes minus the cluster like blisters. I have 3 swabs pending on pimple like lesions that formed on my genitals. I'm praying they are negative.

My Western Blot was negative for HSV1 and HSV2 at 22 weeks post exposure. Terri mentions this test being 99% accurate at this point. This concludes my chase for a diagnosis at this point. I have taken 10+ IGG HerpeSelect tests, 4 IGM tests, 1 Immunoblot, 1 LapCorp HerpeSelect HSV1 IGG, and now a Western Blot. All negative for both types. Never equivocal, never close to a false positive. I also have done 8 swabs, 6 of which have been negative and 2 pending.

After my swabs I plan on putting this to rest. Just accepting we might have a new strain or just can't produce detectable antibodies. I have had distinct symptoms, the difference is every lesion on my genitals that pops I rushed to get swabbed. I want to rest my head knowing that lesion was not herpetic. At this point there is nothing we both can do.

I have chosen to move on after my Western Blot thanks to Fleet, Timin, and Life. I won't let this ruin my life and I certainly won't extend this nightmare 4 years.

I suggest you seek counseling. I might to be honest because we are one and the same. Disturbing symptoms yet we continue to have negative results. Trust science at this point. Live your life. You have done everything medically available to find a diagnosis. Your paperwork clearly states you don't have herpes. Accept it and deal with that current fact.

I have not received an invoice for my WB test. It took 5 days from when I drew blood to get my results. I was highly impressed. Once I get an invoice I'll let you know.
Best wishes.
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Avatar universal
WB negative for both HSV 1 and 2. Cautiously hopeful that this is it. My exposure was in 2007, one time unprotected vaginal sex with someone who supposedly had no STDs and as far as I know to this day has never displayed symptoms. However I developed questionable, non-classic, frequent, ongoing symptoms (but can't remember when they started). 2 negative type-specific IgG tests, one in 2010, one in 2013. Advised by Grace, Dr. HHH, and Terri that most likely not HSV. Now waiting on Terri's insight regarding my latest results. This has been the worst 4 years of my life and I truly hope that this nightmare can be over once and for all. I will still have symptoms, but as long as they're not due to HSV, then I don't care about them. I just want all the paranoia, worry, and constant OCD need to examine myself to end. I want to believe all my test results and not wonder if I'm in that tiny percentage that really has herpes but never tests positive. It's funny, really, to think that this affliction isn't even life threatening, but the awful stigma behind it is so strong that it has the ability to cause people to self destruct. And how amazingly difficult it is to accept science-based facts when there's even a hint of possibility, no matter how minuscule, that it's all wrong. Crazy.
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Avatar universal
Hey bigtime,
I've been following you to see if you've gotten your WB results yet. I finally got the nerve to get the WB (got the draw today). It's going to be a long 3 weeks. Unfortunately, I wasn't able to pay cash at the testing site like I'd hoped, so now I'm going to be obsessively checking the mail for my invoice. I wanted to ask you if you had a similar experience and if you'd gotten your invoice yet. Can you confirm that the cost of the test is $150? I haven't been able to get a definite answer on cost. If you did get your invoice, about how long from when you tested did you get it?

Thanks for answering -- I sincerely hope you get a great relief-filled answer on your results very soon.
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Avatar universal
Thanks for the comments, Bigtime. It's hard to accept the thought though, as you suggest, especially because I have such longstanding genital symptoms. In all my research, I've found that there are instances of false negative HSV2 results (when testing time isn't a cause), although supposedly rare, and that is really what makes me most nervous. To answer your question, the exposure was 6.5 years ago, and I have had relations in that time since then, although begrudgingly, as I'm terrified to pass something on. My partner sometimes has instances that make me scared that it's already too late. I just don't know about believing these blood tests. I wish they were as trustworthy and reliable as the HIV blood test. I don't really have the resources to do swabs all the time. Although I've just been diagnosed with something, I can't imagine this is really what's been causing my problems. I believe this infection is relatively new, as I've been tested for infections in past years and this has never come up. This has been making my life horrible. So much fear and paranoia. And I hate myself. Thanks for listening.
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Avatar universal
Excuse me.. "You DONT have herpes." Please move on and continue with treatment prescribed by your doctor.
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Avatar universal
You don't have herpes and that's clear as day. My question to you is have you had sexual encounters since this sketchy exposure? I can guarantee you have not transmitted anything to a partner either. Why? Because you don't have herpes.

Herpes will do this to you. It did to me. Forcing me to keep testing because I was convinced my symptoms were the results of HSV. 16 weeks in, I'm still showing a strong negative with low antibody values. My point? Lots of other viruses, illnesses, infections can cause lesions and symptoms easily confused with herpes. Keep following up with your doctor but it sounds a diagnosis was made. Any lesion forms or presents itself why not just rush and get them swabbed and erase any doubt versus doing this to yourself all these years. Doesn't make sense to me.

Time to move on! You have herpes. Herpes doesn't act in the manner you describe. Stop Googling too. Your doctor is your best resource.
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Avatar universal
Ok, today I received a call that my lab work showed gardnerella vaginalis. Could that be what has been causing my symptoms? I haven't found anything online that says anything about pimples or cysts being caused by this. Is it possible to have had that for years? I've been prescribed metronidazole and just started taking it today.
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