Have you heard of this test

[ntrouble]

I went to a infectious disease specialist after my elisa test for HSV1 came up 4.99 and HSV2 test came up 1.09 (equivocal) for followup. He agreed that my general practicitioners diagonosis of positive for HSV2 was unwarranted at this time and agreed to retest me. I asked for a Western Bloc at 16 weeks which he said he would try to do. He came back and advised me the Western Bloc was not commercially available and wrote me a prescription for a "Polymcrase Chain Reaction Test" for HSV (hard to read his writing, I apologize if its the wrong spelling). He told me this test was very specific and was better than the Western Bloc. As you can imagine, since my original diagnosis of positive for HSV2, I have done alot of research on HSV and have never heard anyone mention anything about this test. Have you heard of it, and if you have, is it really a good determiner of having the HSV?

[H. Hunter Handsfield, M.D.]

I'm tailoring my response partly for your ID specialist.  Feel free to print this out and show it to him.

First, I agree it is very unlikely you have HSV-2.  If you're not having symptoms typical of genital herpes, you really don't need further testing.

Second, you could have a repeat commercial blood test using a different test method.  Most likely your original test was the Focus HerpeSelect test, the most commonly used (and your numerical results are consistent with that test).  You could be tested with the Captia HSV-2 test, produced by Trinity Biotech; or with the BiokitUSA test.  Although neither of these is officially a confirmatory assay, research shows that using a test with a different test technology usually works well as a tie-breaker.

Third, I don't agree with PCR testing.  (The first word is polymerase.)  PCR tests for the virus itself, which is only present intermittently even in people with frequent recurrences of genital herpes.  A positive result would confirm you have HSV-2, but it is never possible to conclude that someone is not infected, even with several negative PCR tests.  

Finally, the Western blot test is available.  Although not commercially marketed, it is offered routinely by a few labs.  Most such testing is done at the University of Washington clinical laboroatories, where the HSV Western blot was was developed and most studied.  Your local lab will know how to refer a specimen for outside testing by a reference lab like US.  The HSV WB is expensive, probably around $200 including your local lab's handling fee, and maybe not covered by insurance.  If that's not an issue, you could have the WB instead of repeat testing with Captia or BiokitUSA.

I hope this helps. Best wishes--  HHH, MD

[H. Hunter Handsfield, M.D.]

There is a typo above:  "Your local lab will know how to refer a specimen for outside testing by a reference lab like UW [not US]."  The UW lab is in Seattle.  

[ntrouble]

Can I just go to one of these labs for the test or do I need a prescription or referrel from the doctor to get it?

[ntrouble]

I just called a local lab who says they do refer specimans for the WB test. I contacted my specialist and they said they will have a prescription/referrel for the test waiting for me at the office. Thank you for the information, I really want to get this over and know once and for all......I hope your optimism pays off, this has been a terrible ordeal and I really want to get this behind me, hopefully with no infection

[girl1986]

Good afternoon I just have a quick question:
I know this has been said and asked over and over and over again but it seems like everytime I read about it or hear about it, its a different answer.
Above you state "First, I agree it is very unlikely you have HSV-2.  If you're not having symptoms typical of genital herpes, you really don't need further testing"
I really dont understand this. It contradicts almost everything we hear and read about genital herpes. I have read many times that up to 90% of people who have an initial herpes infection do NOT have any symptoms, but you are saying that if you don't have symptoms then you most likely do not have herpes??? I have also been told by doctors that if you had herpes you WOULD know it. Now, 90% seems like a ridiculously high number, saying that only 10% of people who have herpes will get symptoms. So, since -ntrouble- does not have any symptoms why is it so highly unlikely that she does NOT have herpes? You have also stated in another post that these "supposed" asymptomatic herpes infections, indeed do have symptoms but are so mild they go unnoticed. Another post you stated that the majority of people who have an initial infection do NOT get ANY symptoms at all. So are there symptoms always or not? So if 100 people all got herpes at the same time how many people would actually get lesions?
Sorry for the long post I would appreiciate if you could clarify a few things! Thank you!

[H. Hunter Handsfield, M.D.]

People need to read every answer on this forum strictly in the context of the question asked, the symptoms described by the questioner, and so on.  You cannot sum all those replies and assume that they all apply equally to all situations or to all other questions asked on this forum.  Most people in the circumstance you describe have had exposures that have almost no chance of transmitting HSV.  Further, most asymptomatic infections probably occur in people who don't know or care that they might have been exposed.  Among people frightened enough to post a question, most probably would notice symptoms if they acquired HSV.

For example, someone like you--who apparently has spend a large amount of time compulsively looking at multiple threads (and perhaps other websites) to sort out herpes symptoms--most likely would in fact have typical (if mild) herpes symtpoms if s/he actually were infected.

This is a thread jump, so no ongoing discussion here.

[ntrouble]

I just got my Western Blot test results back today and they were positive for HSV1 ( not a surprise ) but negative for HSV2. At 15 1/2 weeks I developed a painful pimple at the base of my penis around the area where my pubic hair was growing in ( I used to shave the area ). It had no head and did not develop with puss etc. About a 10 days later it was gone without progressing. At this point with my equivocal result, my diagnosis as positive for HSV2 by my general practitioner based on my high equivocal IGG result and this painful pimple, I kinda resigned to the fact that I had HSV2. Now I get my result its hard to shift my mind back to that I dont have it after convincing myself I did. My questions are 1) I took the test at 15 1/2 weeks from exposure, is this definitive for the time I waited 2) The western blot results notes that this test is not approved by U.S. FDA ( Not trying to be insulting), are you confident on the reliability of the WB? This is great news and maybe I'm being too pesamistic.Thank you

[H. Hunter Handsfield, M.D.]

1.  The combination of test results proves you don't have HSV-2, regardless of the timing of the WB result.

2. WB is the gold standard test.  A test cannot be approved by FDA unless it is submitted to FDA for that purpose, an expensive and time-consuming process only pursued by companies with commercial interests.  WB is not a commercial assay.  The same thing applies to many other excellent diagnostic tests and, for that matter, to a number of standard but non-FDA-approved treatments.

Bottom line:  The news is all good and you are not being too pessimistic.  Congratulations.