HSV PCR- Blood or CSF

[poonam09]

Whether it is good to do PCR in blood rather than CSF? I think if we take blood sampleit  is good for monitoring the disease status as it is easy to take the blood sample at different time interval rather than CSF. I am simultaneously doing Blood ( buff coat) PCR for the patient for which CSF came as diagnostic sample. It is very encouraging that PCR amplicon band are appearing comparatively good in blood rather than CSF. Should i rely on Blood only for HSV PCR or i should accept CSF only. Please advise as i am a research scientist and new to clinical virology.
Thanx



This discussion is related to hsv pcr dna question.

[gracefromHHP]

pcr as a blood test isn't very worthwhile.  While there can be a systemic viremia ( sp ) with the initial infection, it's usually brief and not a good way to measure hsv infection.  Same with csf - you will only detect hsv in csf if the virus is currently active in the csf.  

I'm not sure if you are asking these questions just in general or if you are talking about using them to diagnose a patient as having herpes for general screening or for ruling out herpes as a cause of meningitis or just what - if you could add a few more details perhaps?

grace

[claire1234]

I read an article on line that states that HSV PCR using spinal fluid is a good way to detect HSV when you have suspicious symptoms but you get a neg on the IgG Elisa tests. It went on to say that antibodies do not stay in the blood for life so if you are asymptomatic and the other tests don't produce results to get the PCR done because the DNA for the virus stays in your body but not in the blood.

I was diag using a swab method 17 years ago. I don't have regular symptoms for herpes. Just the bump that they swabbed, one two years previously to the swab and one 8 years later. I have had two blood tests ran for the type specific IgG 1/2 and both came back negative for both strains. (Both tests within the last 2 weeks) Should I consider a PCR from spinal fluid or can I assume that I'm virus free?

It was suggested that I also try the Western Blot but I was told that:

"If the test that Labcorp ran was the Trinity ELISA (and I suspect it was), it is a very good test when compared with Western blot.  It is not quite as sensitive, however, as Western blot, especially for HSV-1 antibodies. Rarely, people with herpes (especially HSV-1) will test negative by Trinity or Focus ELISA but positive by Western blot."

Also, in the Dallas, Tx area the infectious disease physicians that I've asked (3 so far) do not do the Western Blot for herpes. Two referenced to the Elisa and one also mentioned the PCR.

If I was exposed to Herpes back in the 90's it was by oral sex and with the fact that I don't have regular or extreme outbreaks I thought that it would be HSV1.

This is what webmd states:

Polymerase chain reaction (PCR) test. A PCR test can be done on cells or fluid from a sore or on blood or on other fluid, such as spinal fluid. PCR finds the genetic material (DNA) of the HSV virus. This test can tell the difference between HSV-1 and HSV-2. The PCR test is not often done on skin sores, but it is best for testing spinal fluid, for those rare cases in which herpes may cause an infection in or around the brain.

ALSO see my post at: http://www.medhelp.org/posts/show/758189

Nobody has responded to it. I've tried to ask these questions of Dr Handsfield but my Visa won't go through the payment system that you use. I suspect that my card company has some kind of block against your payment system because it does work at Amazon.com.

[auntiejessi]

This question is much better suited for the herpes forum.  Bump up your question and tell Grace I said you should do it lol.

Aj

[claire1234]

I don't know how to "bump" my question and even so, no one in the herpes forum has answered my previous question so I don't suspect they will jump at this one. They seem content with answering the easy questions from the newbies. I guess I'll keep trying to find someone local who specializes in herpes enough to resolve this once and for all. Thanks anyways.

[MsMj]

i had some sort of out break in the past that was also cultured and tested postive for hsv2.. few months later blood test were done and they came out neg. it has been nine months & i havent had an outbreak since. the doctor told me that the culture must have given a false positive result and that sometimes these test get crossed referenced with other things, mumps, measles.. im also still very confused, & i have done some much research that i feel my head will explode any min.. the thing with hsv is that many MD really dont understand it and all have different opinions.. have u had any reoccurences?

[claire1234]

My orig test was 17 years ago and it didn't even type it out to HSV1 or 2. My last reoccurrence was maybe 6 years ago and that was 8 years after the one before that. The doctors that I've spoken to all want to do the Elisa type specific 1/2 blood test but I've had it done twice and it's always negative. No one wants to actually say the orig test must have been a false positive. I have a group of "supporters" that suggest the WB but I've contacted the lab that runs it and they said that it's unlikely that I'll get a poss on a WB with the neg that I've already had. Now I wonder about the PCR but posters here have said that you need to be at the very least actively shedding for it to work but another web site states that if you test spinal fluid it can confirm once and for all if you have HSV regardless of symptoms. That test starts at $400. so I want to know for sure before I pursue it. Everyone really preaches for the Elisa type specific serology but if you have a previous positive - few are willing to back the Elisa and discount the original test ran.  I find that frustrating to say the least. I've also been online for hours trying to work this out. I also have an appointment with a infectious disease specialist next week and I'm going to see how that works out. I also agree that a lot of MDs really don't understand all the testing possibilities and interpretations - or they just don't care. It's not like its a fatal diag either way so beyond the standard IgG serology tests that they love to offer they seem to be clueless.  

[auntiejessi]

Claire -

Find your old thread, and respond to it with "bump".  That brings it back up to the top.

Your other option, which might be the best one, is to post in our expert forum.  Click here - http://www.medhelp.org/forums/show/116

MsMj - the cultures don't cross-react.  If you had a false positive culture, it would be due to mix up in the lab.

There are a small number of people who will never test positive on the tests we currently use.  You are making antibodies, but a different kind than the ones the herpeselect use, which is why people are suggesting the WB to you.

As Grace already mentioned here, testing by PCR blood test and CSF has its limitations.  

AJ