Seuroconversion

[directguy]

I'm having what I believe are frequent herpes outbreaks (genital, fingers and eye), but am at present negative at the four month mark for igg testing. So, three related questions:

1) Symptoms aside, does being negative at 4 months mean there's still a 10% I do have herpes? (I'm adding the 5% chance I'll seuroconvert in the last two months and the 5% chance that I'll never develope the antibodies)
2) What does it mean if I have herpes but never develop the igg antibodies? Will my body be less effective at containing the virus? Will the anti-viral suppression drugs be less effective?
3) If I do develope the antibodies in the final two months, does that mean my body might suddenly start containing the infection better?

Thank you for taking the time to answer these questions.

[H. Hunter Handsfield, M.D.]

I continue to conclude that you do not have an HSV infection of either type.  Obviously your dermatologist and I disagree about the interpretation of the IgM test.  As far as I am concerned, it is a useless test and we never use it in my STD clinic.  If your dermatologist remains convinced about it, you might suggest he search the medical literature -- and specifically to look up research by Dr. Rhoda Morrow on the topic.

Yes, it can take 6 months, and as you already know, a few people never seroconvert.  But please re-read my original reply:  the chance that a particular individual has two very unusual events (the atypical clinical picture plus failure to develop positive IgG tests on schedule) is too rare to be a realistic possibility.

[directguy]

Doctor Hunter, here's a quick update followed with a couple more questions. My dermatologist just tested me again at six months from potential exposure. Again, my igm came back positive (for like the 4th time), and both my Herpes Select igg's negative. I'll be hearing what my doctor has to say in a couple of weeks about this, but over the phone his assistant seemed to indicate that the doctor was still putting faith in the igm test, saying I have herpes although he don't know what kind yet. And yes, I've conveyed your extreme distrust of the igm test to him, but he still wanted to do the test.

1) Symptom wise, my eyes and hands feel better (maybe all in my head.) Also, I still feel light irriation on the bottom of my shaft, one side, but that's been constant for about five months. Nothing visible, although the skin there did appear rawer early on. Since you say symptoms aren't ongoing without break, I'm inclined to think this isn't herpes, but maybe a PCR swab is in order to be sure? What are your thoughts?

2) I saw in a post from Dr. Hook in April that he told someone that some people take six months or longer to test positive. I'd thought six months was the maximum for seroconversion (if it's going to happen), but if it's not, is there a definitive cut-off when you can be 100% confident that the igg result is what it's going to be, period?

Thanks for your continued assistance on this matter. (God knows getting a definitive answer is taking much longer than I anticipated.)

[H. Hunter Handsfield, M.D.]

I'll try to help.  But first of all, "what I believe are frequent herpes outbreaks" is not adequate to know you have herpes.  It would be extremely unusual to have simultaneous recurrent herpes outbreaks of the genitals, fingers, and eye.  And "frequent" raises a red flag as well.  The most frequent herpes outbreaks that ever occur are no more often than once a month or so, and in between those episodes, the skin appears and feels entirely normal.  You don't provide enough detail for me to be certain, but reading between the lines, your symptoms don't seem consistent with herpes.

Second, the negative blood test 4 months after onset is strong evidence against an HSV infection.

To your specific questions:

1) You can't judge the blood test results without also taking the symptoms into account.  People sometimes have atypical symptoms.  Other people can have delayed seroconversion on blood tests, as you obviously know.  But the odds of both those happening in the same person are almost too low to measure.   So as I suggested above, the overall story points to something other than HSV and the cause of your problem.

2) The small proportion of people with HSV infections who don't develop positive blood tests have no more frequent or serious health problems than anybody else with herpes.

3) Delayed seroconverters and normal seroconverters have no difference in any of this.  The antibody response doesn't measure the part of the immune system that keeps HSV infections in check.

You clearly need to see a provider to learn the correct diagnosis.  I very much doubt herpes.

Best wishes--  HHH, MD