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Possibly HSV positive but no antibodies?
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Possibly HSV positive but no antibodies?

Dear Doctor,

I have read many posts here but I am having a hard time trying to find the answer to my question.  Here is my situation and I will try to be brief.  

My last possible Herpes 2 (or any STD) exposure was over 6 years ago back in 2001.  Due to some genital symptoms (redness, irritation, a "pimple" in the public hair area) I was tested for herpes in 2006 and again in 2007 and 2008.  Here are my Herpeselect test results:

12/06:  HSV 1: .55 (negative),   HSV 2: .01 (negative)
12/07:  HSV 1: .98 (equivocal), HSV 2: .04 (negative)
2/08:    HSV 1: .70 (negative),   HSV 2: .03 (negative)

On the onset I know it looks like I am HSV 1 and 2 negative, but my sexual past would tell me otherwise.  I had a few partners and condoms were mostly NOT used.  This would leave me to believe that I was at high risk for contracting HSV 2.  Back in 2005 I was diagnosed with high-risk HPV.

I have read in past posts that about 5% of people with herpes do no produced antibodies.  My questions, thus, are:

1) Why?  What causes these people to not produce anitbodies to HSV (i.e. are there specific medical conditions that these people have?)  Would this be considered an immune problem?

2) If someone does not produce antibodies to the herpes virus and they have it, will they also not produce antibodies to other viruses?

3) My greatest fear is in regards to HIV.  I have been tested many times over the past 6 years and all have been negative, but what if I don't produce antibodies to HSV and HIV?  

4) Could something in my immune system cause me to not produce antibodies to HSV and possibly HIV?  Or is the ELISA for HIV more accurate than the ELISA for Herpes?

Again, I would like to stress that I was surprised when the nurse told me I was negative to both HSV 1 and 2.  I thought for sure I had one or both (given my past) even though I have not had any typical symptoms.

Thank you!!!
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In general, the HSV blood tests are more reliable than symptoms and/or sexual history in diagnosing herpes.  If your history for genital herpes were more typical -- a classical outbreak and/or a positive culture for HSV from a genital lesion -- then I would put more credence in that and conclude that you were one of the rare people who don't develop antibodies that can be detected by the blood test.  But your description of your genital symptoms 6 years ago really doesn't sound much like herpes.  And certainly your sexual history makes little difference.  Plenty of people have many more sex partners than you have and never catch HSV-2.  Whether or not someone has had HPV (either high risk or low risk) is irrelevant to all this.  Having HPV is not associated with high risk sexual lifestyle or with HSV, HIV, or any other STD.

Therefore, you can rely on the blood test results, especially since at least 2 tests gave the same results.  You are not infected with HSV-1 or HSV-2, and never have been.

1) The reasons some people don't develop HSV antibody are not known.  It doesn't denote a weak or abnormal immune system.  But this doesn't apply to you.  Almost certainly you don't have HSV.

2,3) No.  Other antibody tests done on people with false negative tests for one infection are not at higher risk for the same problem for other tests.  Your negative HIV test results are 100% reliable.

4) Yes, the HIV ELISA is more reliable than that for HSV.  With the tests currently in use, there is no such thing as false negative antibody test in a person with HIV.

Despite thinking "for sure" you had HSV, there was no justification for it.  You can rest assured; you don't have it.

I hope this helps.  Best wishes---  HHH, MD
4 Comments
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Thank you for your quick reply, Doctor.  I don't want to beat a dead horse to death or anything, but could that 5% who don't produce antibodies to HSV be caused by a Gg deficient HSV virus?  I have read that in other literature.  Also, is that 5% number correct?  That seems a bit high considering that is really 1 out of every 20 people who have HSV.

Within the past few months, I have also been tested for CMV and varicella.  I was negative for CMV antibodies and positive for varicella.  I just find it very strange that I am negative for HSV 1 and 2 and CMV; the first and latter both being diseases that most of the population have had.  

In addition, like I mentioned before, I wasn't very smart in protecting myself in the past and I have heard that some of the men I was with were rather loose themselves.  This just leads me to believe that I actually have these diseases (HSV 1 and 2) and I am just not producing the antibodies.  

Is there a possibility that my antibody levels just aren't high enough to be detected?  Afterall, I tested for herpes 5 years after my last possible exposure.

Thank you again for any information and insight you can provide.  It is very, very much appreciated.
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239123_tn?1267651214
You are reaching for highly improbable explanations.  Certainly I can accept the possibilty your symptoms were herpes, despite symptoms that really don't seem much like herpes.  And yes, up to 5% of HSV-2 infected people don't develop antibodies.  And yes, some people with genital HSV-2 don't have symptomatic recurrent outbreaks.  But what are the odds that someone with HSV-2 has all three of those things happen?

Most people with sexual lifestyles like yours do not catch herpes.  That you had lots of partners actually argues against your having HSV, not for it.  If you had HSV-2, the odds are good that at least one of your many partners would have caught it from you and you would have heard about it.

That "most of the population" has positive tests for those other viruses says nothing about the odds in a particular person.  A third of the poplulation do not have CMV.  Half the population do not have HSV-1.  Eighty percent do not have HSV-2.  There are millions and millions of people in the US who would have test results exactly like yours.  

Considering all these things, the odds are astronomically low that you have genital herpes or any HSV infection.

Presumably you came to the forum for reassurance.  I gave it.  Please accept it, and stop trying to talk me (and yourself) into believing you have HSV.  You do not.  Believe it and move on.
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Thank you for your help.
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