herpes or yeast- can't find a similar question

[beansiegator]

Having had some major hsv anxiety recently for other reasons (actually made an unrelated post that got resolved), i have been reading through other posts and am now really concerned i might have overlooked previous atypical outbreaks and want advice on whether i should get a blood test. Prior to symptoms, i had sex was w/ condom 4/22/12- somewhere between 5/1 and 5/4 i began to have what i thought was symptoms of a skin yeast infection on my left labia- a red itchy patch of skin (not raw or broken). I applied topical miconazole and it stopped itching so much, but then after a few days it seemed to return so i did the monistat insert, and i got full relief within 7 days of that. On 7/21 or a little before, the redness and itching returned in the same spot. This time i went to the doctor; i also had a red yeast infection under my breasts and she felt both were external skin yeast and prescribed diflucan and nystatin cream (She looked at my discharge and found no yeast but felt it was external only). Both areas improved but still had some redness 7 days later, more so on my labia but somewhat under my breasts as well. On 8/1 i went to a different doctor and showed her the redness on my labia (smaller but still present) and she insisted that it was not herpes- by 8/7 i was at my gynecologist and there was still an extremely faint pinkness but no itching. As for the red patch: it would typically get much redder if i itched it, and calm way down if i left it alone. The borders were irregular (e.g. it wasn’t round or oval). the biggest it got was probably 1/3", and the smallest about 1/8" I was satisfied at the time that it was skin yeast but now realizing herpes always recurs in the same spot, im scared these clinicians missed the diagnosis? If its worth anything i am very prone to fungal infections- i have non itchy ones that always recur in the same locations (e.g. abdomen, back).

[beansiegator]

Thanks, this is fascinating!

[Edward W Hook, MD]

You misunderstand the science involved here.  The nature of these tests is such that some sort of "background" value in uninfected persons is the norm and is to be expected due to low grade cross reactivity with other, non-HSV antibodies.  These negative values can "bounce" around within the negative range, even when the same specimen is retested but a value of 0.00 is a potential sentinel event deserving further scrutiny.  If your subsequent test values move around in the negative range that would not be a cause for concern.  I'd be surprised however if you had another negative (0.00) value.

Sorry, this thread will need to end at this time.  Take care.  EWH

[beansiegator]

This is interesting! If there are 90 negative values (0-89), each one stastically have something like 1.1111% represented. So because it shows up less than that, you feel it's a sort of suspicious value? I personally plan to retest in 4 months to rule out any window-period exposures. If i got a 0.00 again, I wonder if that would bear repeating given my test history (if my blood is just highly non-reactive, or if I just got two low values coincidentally previously). If it jumped up to .85, would that mean I should retest again? I understand if this thread is over but I'm curious from a scientific standpoint and also am curious that I got another quite low value- if I must continue to expect very low values to consider myself negative. Again, if the thread's over I understand but this is a very interesting, confusing and stressful topic. haha.

[Edward W Hook, MD]

Thaks for the infiormation.  I checked with our lab which does thousands of HSV serologies.  Less than 1% of serologies have 0.00 values.  Typically antibody negative serological tests have some numerical value detected.  While I'm sorry it frustrated you, if I were asked the same question, I would answer it in the same way.  A value of 0.00 MAY reflect the absence of antibodies but it could also indicate problems in the lab and bears repeating.  EWH

[beansiegator]

Hi,

For the sake of posterity/others who have received that score, i tested again and it was negative:

HSV-1 IGG                     <0.90 ISR                    0.23                  
HSV-1 INTERP                                               Negative
              
HSV-2 IGG                     <0.90 ISR                    0.04                  
HSV-2 INTERP                                               Negative    

So it seems like 0.00 really is a valid score? there was no explanation for why, she just said ANY value under .90 is valid. these message boards indicate otherwise but maybe that was born out the need to reassure folks that values liek .5 or .75 weren't "sort of positive". or maybe my first test did fail and i am just coincidentally negative. just wanted to close the loop.    

also, I do appreciate your input, even though I was frustrated with the inconsistencies I perceived in the answers. I'm curious, does this change your perception of a 0.00?

Thank you for all the advice.

[Edward W Hook, MD]

No, it does not change my opinioon or advice.  Your level of anxiety warrants further explanation.  EWH

[beansiegator]

so it does not change your opinion that i found other folks said with those results on this forum?

i also found this table in a trinity biotech document about their test and if i am reading it correctly, it cites 0.00 as a sample score. i do not know that this is the manufacturer of my test though but hope it relates. i cannot paste the table here but this is the pdf and it is Table 8 on page 4.

http://www.trinitybiotech.com/Product%20Documents/2346600-29%20EN.pdf

i do not believe my lab will speak to me directly and my doctor has already said she does not believe there is cause to retest so i feel my options are limited.

[Edward W Hook, MD]

Sorry you feel this way.  My response reflects my analysis of your situation.  Fair or not, you asked for my opinion and have it.  EWH

[beansiegator]

to be honest, i am also frustrated with these answers, which don't seem consistent. i combed through this forum and found ~25 - 30 users who reported igg scores of 0.00, about 15-20 for type 2 and 5-10 for type 1. numerous of them were given the "congrats you're negative" by the STD Experts MDs. I just don't understand this at all. i have no idea how many negative reported scores there are on this forum, i'd imagine thousands, but there are also 90 possible negative scores on the igg. i tried to get Dr. Handsfield's opinion on the matter since he answered my previous question but he refused because you were now handling this question. At this point I feel this isn't fair to me.

[Edward W Hook, MD]

I understand the frustration.  A level o 0.00 is quite unusual and, at the very least, is worth a call to the lab.  I think testing again is reasonable as well, if only for your peace of mind (which IS VERY important).  

[beansiegator]

OK, I am not trying to be obsessive but I am reading through these forums and you explained the way the tests were read to someone else as "The chemistry of the HerpeSelect is such that there are always background signals which are read in the assay.  If your result had been zero I would have grave concerns about whether or not the assay was done correctly."

I asked my doctor and she just said 0.00 was normal and I am negative.

This is so frustrating!! I feel liek I faced up to a big fear and now I'm still unsettled. I want to test again but I know she will think it's unnecessary.

[Edward W Hook, MD]

Personally I do not see the need.  I would not.  EWH

[beansiegator]

Thanks...should I get a second blood test to be sure?

[Edward W Hook, MD]

Welcome back, Your test results indicate that you do not have antibodies for HSV-1 or HSV-2.  Thus you can be confident that your recurring lesions were not herpes.  I do agree that the 0.00 result is quite low but I would tend to believe the result.  The lab would not have reported out a result if they did not feel the test perfromed properly.  EWH

[beansiegator]

HSV-1 IGG 0.21 <0.90 ISR   HSV-1 INTERP Negative    Comments:   No IgG antibodies specific to HSV1 detected.  Patient ispresumed to not have had a previous exposure to HSV1 throughinfection.  Such individuals are presumed to be uninfectedwith HSV1 and to be susceptible to primary infection. ------------------------------------------------------------------------------  


HSV-2 IGG 0.00 <0.90 ISR   HSV-2 INTERP Negative    Comments:   No IgG antibodies specific to HSV2 detected.  Patient ispresumed to not have had a previous exposure to HSV2 throughinfection.  Such individuals are presumed to be uninfectedwith HSV2 and to be susceptible to primary infection.

those are my results...im sort of shocked? does the 0.00 seem suspicious, liek the test failed? or am i jsut looking to be infected? ha.....

[Edward W Hook, MD]

Good question.  Some health care providers are less sophisticated about such test than their patients (and, in their defense, they have much to keep up with). It might be best to say HerpeSelect.  EWH

[beansiegator]

Is just specifying herpes igg type 1 and 2 good enough when i request the test? or does my doctor need to say herpeselect elisa?

[Edward W Hook, MD]

Welcome back to the Forum.  I'll try to provide some guidance but what is rally needed for you is testing to help sort this out.  The problem of course is that HSV can certainly mimic fungal infections and your recurring vulvar lesions could be either.  As a starting point, and I emphasize, this may be a starting point, I would suggest that you get a type-specific gG based IgG test for HSV.  If the test is negative or positive only for HSV-1, then it is most unlikely that your genital symptoms and lesions are not due to HSV.  On the other hand, if the test is positive for antibodies for HSV-2, the. It becomes POSSIBLE that your genital symptoms could be due to HSV.  At that time, I would work to arrange PCR evaluation of your lesions if and when they recur.  Having a positive blood test however does not necessarily mean your symptoms are due to HSV.

I hope these comments are helpful.  I'll be happy to comment on your test results, should you choose to test.  EWH