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herpes serology tests questions
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herpes serology tests questions

Hello,

I'd like to begin this thread by stating that I am completely aware of the following: A.) That my questions are very specific and that I may be over-analyzing my status (I am worried and want the best possible information), B.) That the diagnosis of genital herpes is based on a number of factors including risk of exposure, physical symptoms/tests, and blood test results, C.) Herpes serology tests can take at least 3-4 months to be accurate, possibly longer, D.) No medical blood test is 100% accurate.

That being said, my questions focus on the herpes blood tests, especially in regards to the set number of people that consistently receive false negative results because they do not produce detectable amounts of the IgG antibodies most approved tests seek to detect.

1.) I've read differing opinions, but most informed posts on forums (including this website)  say that anywhere from 5-15% of people do not produce detectable amounts of the IgG antibodies said tests look for. This seems extremely high to me! Test companies report that the HerpeSelect is near 97% accurate. A clinician at the University of Washington's Virology Clinic also told me these numbers are inflated, and when everything is accounted for the Western Blot is close to 99.9% accurate. Now I don't know what to believe. Can you please confirm, deny, or clarify these percentages?

2.) Is there a separate test that can be taken to determine whether or not somebody lacks the IgG antibodies that herpes serology tests look for?

3.) Even though the Western Blot is an IgG-based test, will its search for an increased number of herpes-related amino acids (sixteen or whatever compared to HerpeSelect's two) reduce its number of false-negatives? If so, how significantly?

4.) Even though IgM blood tests are often times inaccurate and may produce false-positives, can this test be used to help IgG-deficient people determine their herpes status?

Thank you.
55646_tn?1263664409
1.) I've read differing opinions, but most informed posts on forums (including this website)  say that anywhere from 5-15% of people do not produce detectable amounts of the IgG antibodies said tests look for. This seems extremely high to me! Test companies report that the HerpeSelect is near 97% accurate. A clinician at the University of Washington's Virology Clinic also told me these numbers are inflated, and when everything is accounted for the Western Blot is close to 99.9% accurate. Now I don't know what to believe. Can you please confirm, deny, or clarify these percentages?

What we know about this is how many people who swab test positive for HSV 2 also test positive on the antibody test.  From my experience, with the ELISA, their numbers are pretty accurate - about 3% or so don't.  But with western blot, we pick up more people.  I would say that greater than 99.5% of people who swab test positive also test positive by western blot within 4-6 months (the vast majority by 4 months with very few outliers).  I believe that Anna and I agree on this, yes.  I have had 9 people in 31 years who test positive by swab test FROM A LESION and then test negative for that same type by western blot.  The key here, I think, is that they tested positive by swab test also.  



2.) Is there a separate test that can be taken to determine whether or not somebody lacks the IgG antibodies that herpes serology tests look for?

No

3.) Even though the Western Blot is an IgG-based test, will its search for an increased number of herpes-related amino acids (sixteen or whatever compared to HerpeSelect's two) reduce its number of false-negatives? If so, how significantly?

Yes, it looks for a large number of proteins on the outside of the herpes antibody, not just one like the ELISA looks for.

4.) Even though IgM blood tests are often times inaccurate and may produce false-positives, can this test be used to help IgG-deficient people determine their herpes status?

Not that I know of, no.  

Terri
23 Comments
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Avatar_m_tn
Wanted to clarify question 2....Is there a test that can determine whether or not a person lack's the mechanisms necessary to produce the IgG antibodies that serology tests look for?
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Avatar_m_tn
Hello My Friend,

I have experienced worry similar to yours... and the answer you will find is that the WB is accurate.

Here's the opinions of the Experts on this webpage, best I can tell.

Dr. Hook:  10-15% with HSV2 may not seroconvert
Dr. HHH:  5-10% with HSV2 may not seroconvert
Terri Warren:  >5% (probably a lot less) will not seroconvert

That is a big range, yes, but I think the context matters in their opinion.  Dr. Hook is probably the big worry trigger, but his advice is largely based on this study:

http://www.ncbi.nlm.nih.gov/pubmed/12671550

It gauged seroconversion times across a few different tests.  And most of the numbers match up with Dr. Hook.  The tricky part is, that a huge portion of the folks were tested VERY early (many earlier than 30 days from infection, and more still earlier than 60 days) and naturally not all the folks seroconverted because it was too early.  So it appears to me, Dr. Hook isn't wrong with his numbers, but he doesn't expound further, stating that the longer you wait, the more folks who were falsely negative will indeed seroconvert with the proper positive result.  So if you have waited long enough, (the max I've ever heard is 6 months) then you will get an accurate result.  

Terri Warren probably has the busiest herpes clinic outside of maybe UofW, and she's involved with a ton of studies, and she has stated multiple times that only 9 folks in her clinic have ever failed to seroconvert after having a positive swab, and she gets folks fly in to see her from other countries... that is how busy she is...

Also I've read Anna Wald's statements on the matter... I am pretty certain she is the nation's (world's?) leader in HSV research.  If you google search her, she is on a ton of herpes studies.  Best I can tell she is in agreement with Terri, that some folks take longer than others, but nearly everyone seroconverts eventually if they are truly infected.  If you've waited long enough, my friend, I think you can put it to bed.  

With the clinics saying the test is ultra accurate, with Terri Warren and Anna Wald stating it's super rare for someone to wait long enough and not get an accurate test, and with the only disagreement being from Dr. Hook who was merely referencing a broad scoped study and not necessarily actual UofW clinical specific data, I'd say the consensus is that you are in the clear.
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Avatar_m_tn
Hello and thank you for your responses,

JoeLog I appreciate your feedback and am glad to know that I'm not the only one that has worried over these tests. It's a shame the herpes blood tests can't be as conclusive as some of those offered for other STDs.

Terri, thank you for your input, but if you'd please indulge me, I just have two follow-up questions for clarification purposes...

1. There's a lot of data listed above and some of it seems to especially refer to HSV-II. Can you please summarize for me how accurate you honestly believe the HerpeSelect and WB are for HSV-I & HSV-II after 4 months, respectively?

2. This might be a stupid question, but I'm confused when you say this data regards people who have had a positive swab (and because some of my doctors have told me that without a swab the blood tests have little value)....If I have not had symptoms and/or have not presented the type of symptoms that can be swabbed, would the accuracy of the blood tests (or the likelihood of having or not having herpes) that you stated above be at least the same, possibly more accurate, or possibly less accurate? Logic would tell me that if I haven't had a lesion AND the blood tests show negative after 4-6 months, then the odds of being negative are even more in my favor. But after everything I've heard and read, I don't know what to think anymore. Please clarify!

Thanks again for all your support!
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55646_tn?1263664409
In the person who has a positive swab test, I think the ELISA picks up about 95-97% of those by four months.  This assumes no antiviral therapy of very short period of antiviral therapy in the patient.  I think the western blot picks up about 99% at four months, assuming the same.

Having a lesion and having a positive swab test have nothing to do with each other.  You can have a positive antibody test with no lesions ever.  The reason I quote that as part of the statistic is because that's the population the research is done one.  I don't believe that a study has been done on a person who has a sexual encounter, has a baseline antibody test  and then four months later does another one.  That kind of study is loaded with issues, as you might imagine, primarily, other sexual contacts in between.  

Is that clearer?

Terri
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Avatar_m_tn
A bit. So by 4 months post-encounter, with or without a lesion/swab, the tests are 95 to 99 percent accurate for HSV II and HSV I?

So assuming its been 6 months for me, I have yet to have an identifiable lesion, and I test negative for both HSV I and II, can I be certain I'm in the clear?
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55646_tn?1263664409
No, that's not quite accurate.  
The study about the sensitivity of this test was based on people who had a positive swab test from a lesion.  The number I quoted was for HSV 2.  The test is far less sensitive for HSV 1.  

I would say if you test negative for HSV 2 6 months later, you can stop worrying about HSV 2 infection.  You have done what you can do identify possible infection.

Terri
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Avatar_m_tn
This is troubling considering that many genital herpes inflections are from HSV 1!!!

Do you happen to know how accurate the tests are for HSV 1?
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Avatar_m_tn
Sorry to interrupt the thread, but I was hoping Terri could clarify the statement:

"Having a lesion and having a positive swab test have nothing to do with each other."  

Did you mean to say, "Having a lesion and having a positive ANTIBODY test have nothing to do with each other."   That was the impression I got from the context of your reply...
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Avatar_m_tn
This really makes me worry...i am tested negative for HSV 2 at 11 week post-encounter...that means this result is not conclusive yet and i have to wait up to 6 months post-encounter to get a conclusive result...really stress
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Avatar_f_tn
10 years ago I was Dx HSV 2 by some type of swab or culture. Not sure as to what test exactly.  They never gave me a copy of my results just a verbal.  Since then i never asked nor was I ever offered by any Dr. to be retested I just assumed I was very lucky and just didnt get OB.  I recently went to see A very well respected Dr in the area of STD because I had many questions on reducing risks of trasmitting the virus to my new partner.  The Dr. said he wanted to retest me and make sure I was infact + since test werent as accurate 10 yrs ago.  I was very clear that I had also started acyclovir just 3wks earlier.  The Dr. even asked to see my bottle of meds, which I did show him.  He went ahead and tested me with the Biokit.  My results were Negative.  He told me there was nothing wrong with me and there was no need for me to continue taking meds.  But I have now come accross with conflicting info. re: antivirals and test result.  Does it infact make a difference.  This Dr. is very well respected in the Area and was even a proffesor at one our large universities in Calif.  If antivirals make a diff. why would he not ask me to stop them for some time before retesting me.  I am very confused and need some clarity.
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55646_tn?1263664409
Yes, that's what I meant to say.  Sorry, and good for you for being so observant!  Actually, we also often get positive swabs from areas with no lesions as well in our studies where we do daily home swabbing studies.
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55646_tn?1263664409
According to the package insert, the Herpeselect picks up 91 out of 100 cases of HSV 1.  My impression is that's close to correct, according to our experience as well.  The western blot is most definitely better at picking up HSV 1 than the herpeselect.  

Terri
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Avatar_m_tn
Terri,

Thank you much for the info.

Last questions, I promise...

1. How can I set myself up to perform a series of home swabbing for additional testing on non-obvious lesion areas?

2. Aside from blood tests and home swabbing, are there any other tests for herpes available for asymptomatic people?

Thanks so much.
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Avatar_m_tn
One last addition (this thread is very interesting!) If I'm reading this right, extremelyworried01 was concerned about rare gG-deficient infections not showing up on an Igg test...   I believe the Western Blot can pick these up, can't it, because it tests for multiple proteins?
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55646_tn?1263664409
That is likely, yes

Terri
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55646_tn?1263664409
1.  Yes, you can do daily home swabbing
2.  No

Terri
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Avatar_m_tn
Hi Terri,

Does the PCR Blood Test offer any value in diagnosis?

I've read on that forum that it does not because herpes is not a blood borne virus, but the testing site I'm considering using reads the following:

"This test is used to aid in the diagnosis of Herpes Simples Virus infections.  PCR testing screens for viral genetic material or DNA in a blood sample.  This test is highly sensitive and can detect even small amounts of viral DNA.  The Herpes 1&2 DNA PCR can detect both type 1 and type 2 Herpes infections.  Results for this test are qualitative and come back with either a positive or negative result."

What are your thoughts?
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55646_tn?1263664409
No, no value.  Only with first episode infection MIGHT we see herpes in the blood.

Terri
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Avatar_m_tn
Thank you, Terri.

I also posted this question on the regular forum (because I didn't want to take up anymore of your time), but grace suggested that I ask it here...

Hello,

I was hoping to obtain more information about the daily PCR swabbing tests offered at the Westover Heights Clinic. I've currently received negative results on all my blood tests, but want to reinforce my results and reassure myself by performing a series of these swabs (regardless of the odds or costs involved). Has anyone ever done this? If so, I was hoping you could share your experience, and answer some specific questions I have:

1.) Is there a chance of receiving false-positives?

2.) How long does one need to perform daily swabs in order to reach maximum accuracy and be as sure as possible that they are not infected with HSV 1 or 2?

3.) Is performing the tests pretty easy to administer, process & handle?

Thanks.
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55646_tn?1263664409
There is always a tiny chance of a false positive yes.  Tiny.  We ask that people swab for two months if people start to swab.   It is easy to administer, but you need to become a patient of the clinic on the phone so we can explain this completely.

Terri
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Avatar_m_tn
Ok. Thank you!
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55646_tn?1263664409
You're welcome
This thread is closed now.

Terri
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