std test - false negative?

[pbk22]

About 9 months ago, I was first diagnosed with genital herpes type 1.  I had 1 lesion on the head of my penis, and I went to the doctor, who cultured it.  Came back positive for type 1, negative for type 2.  That was my very first outbreak ever, I was sick of something else at the same time, and I have not had another outbreak either orally or genitally before then or since that time.  I am entering into a new relationship, and wanted to confirm 100% that I do not have anything else, any other type of STD, for my future partner's sake (I have only had heterosexual sex).  So 2 weeks ago, I went to get tested at a Planned Parenthood.  Negative for HIV, though it was one of those "rapid" blood tests which comes back very quickly, don't know how much reliability I can put on that.  Though I have been tested (non-"rapid" tests) for HIV at 5 weeks, 4 months, 6 months, and 9 months, just to be sure.  I also had them do a blood test for herpes on me, because again for the sake of my future partner, I wanted to be certain that I only had type 1 and not also type 2.  After 2 weeks, I called the clinic for my results.  They said that the herpes blood test came back NEGATIVE for type 1 AND type 2.  What does this mean?  Was this blood test a false negative?  Shouldn't it have been positive, as I've possibly had herpes simplex in my body for at least 9 months time?  Could the culture have been a false positive?  What am I to think of these results?  If you need to know what type of blood test they conducted at the clinic, I can find that out for you.  Thank you for any information.

[Edward W Hook, MD]

Grace's comments are correct.  Don't overthink this.  EWH

[gracefromHHP]

It's not that you aren' t producing antibodies to hsv1 - it's that the tests we have currently aren't picking up on them. The tests we use for herpes still miss 1 out of every 10 hsv1 infections.  They seem to be better at picking up on hsv2.

Don't let yourself get caught up in questioning all this. You know you have hsv1 genitally by the lesion culture.  No reason to suspect that your other tests aren't accurate.  

grace

[pbk22]

Just to clarify, Doctor:
1) You said that you "would be (word missing here) that [I] do not have HIV or other STDs."  You're right that I generally sound like a low-risk individual, but the last person I dated/slept with for a few months, unbeknown to me at the time, had an extremely promiscuous past and I fear made all of the bad decisions in life for the most part I had avoided until we dated.

2) Is there cause for concern/is it unusual or alarming, medically speaking, for my body not to have produced antibodies to HSV-1, which genital culture was positive 9 months ago?  Should I get retested for HIV at 12 months for the same reason, perhaps I have it but haven't produced antibodies?

3) Is it likely that I could also have HSV-2 either orally or genitally, not know it, and similar to the "false negative" HSV-1 test just have produced no antibodies?  Thank you so much for your time, Doctor.

[Edward W Hook, MD]

Thanks for the information on the type of test. The good news is that this is a good, reliable test (not all are).  The bad news, as we've said above is that some people (possibly you) do not develop positive tests.

As for your original question- no test is perfect, thus the is simply no way to be absolutely sure that you do not have an STD.  At the same time, the tests are very good and, as you describe yourself, your risks are low.  I would be that you do not have HIV or other STDs.   I think you are being overly cautious.  EWH

[pbk22]

Yes, your responses were more than helpful, thank you.  This forum is a wonderful place for laymen to get good, solid answers.  Thank you, again.  FYI, I found out from the clinic that the type of test they conducted was an HSV 1/2 IGG Herpes-Select Type-Specific AB test, via blood-draw.  That may not change your conclusion.  I will rely on the culture and presume that I have genital HSV-1, and will be forthcoming and cautious with my future partner.

Back to my original question (i.e., me wanting to know 100% for sure that I do not have any other STD's for future partner's sake), I wanted to make sure through the testing that I did not have HSV-2 as well, either orally or genitally.  But with the blood test being a "false negative" for HSV-1, something we know I have, can I not rule out anymore that I don't also have HSV-2?  Also, is there anything that could be wrong with me healthwise, my body not producing antibodies to the HSV-1 which we know I have?  You mentioned 6 months, but my culture was taken 9 months ago.  Could it also be probable that I do have HIV despite my negative tests, as my body may just not be producing antibodies to that either?

I have not had any form of sexual contact whatsoever in almost 5 months.  Would I have had noticeable symptoms by now if I had ANY OTHER type of STD, is there any more tests that you recommend I have before becoming involved in a new relationship?  How about HPV, is it possible to test for that in men so that I can be similarly cautious with my new female partner?  Thank you.

[H. Hunter Handsfield, M.D.]

Usually Dr. Hook and I pay attention to the flag that says the other has started to answer a question.  I missed it this time, and was constructing this reply as he was writing his.  Sorry for the duplicaiton, but the good part is you get two for the price of one.  As you will see, we agree with each other -- I just take more words to get there.

The culture test is the gold standard. You definitely had genital herpes due to HSV-1.  Some people never develop positive blood tests, and in others it just takes longer than usual.  Most likely your HSV-1 blood test will become positive someday in the future, but not necessarily.  But ithere really is no reason to re-test.  Whether positive or negative in the future, it will not change the diagnosis.  (The "rapid" blood test is only for HSV-2, so that result doesn't mean anything either.)

Except for the negative blood test for HSV-1, your story so far is highly typical for genital herpes due to HSV-1.  Recurrent outbreaks are uncommon; 40% have none at all, most of the rest have 1 or 2 additional outbreaks over the next 1-2 years, then none after that, very different than HSV-2.  Also, asymptomatic viral shedding -- that is, periods when the virus can be transmitted without an obvious outbreak -- is less common than for HSV-2, and genital-to-genital sexual transmission of genital HSV-1 appears to be uncommon.

You should be careful to avoid sex with your new partner if or when you have symptoms to suggest another outbreak in the future, and it would be kind to tell her of your past infection.  And she might be immune anyway.  Half the population has positive HSV-1 blood tests, usually due to childhood infection, often with no recollection of it.  If your partner has had it before, she is immune -- or at least highly resistant -- to catching HSV-1 again, anywhere on her body.

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

[Edward W Hook, MD]

Believe the culture. The only way to have a false positive culture is for the specimen to get mixed up and this is terribly unusual.  As for why you do not have antibodies, in a small percentage of persons, it can take quite a while (>6 months) for antibodies to develop.  As to just how common this is, that is difficult to say because the studies do not go out that far.  My advice would be to believe the culture- your history and test results are consistent and the consequences of assuming that you don't have infection could be problematic (although, in general, genital HSV-1 is far, far less contagious for partners than HSV-2.  

As for other STDs. The rapid tests for HIV are very good- you don't have HIV.

Hope this helps.  EWH