help test nightmare

[jemhokie99]

I am 53 yeaer old male. Had intercOurse w hsv2 confirmed female 11 months ago. Had sex 6 times, s of which used condom. He had a bump mear her labia. 7wks latr I developed a groin bump and went to I'd clinic. Culture neg, igg elisa neg. Ask me come back at 10 wks post exposue for reeval. Another igg neg. I went to dermatologist 2 wks ago, 11 months no sex and after remove cyst did igg. It was 1.99. I read this is likely neg. I've had no ob's, etc. Can I infer I had a .2 chance of not converting at 10wks times ..4 pct chance this test rite to assess probability have hsv2 of 8pct? Do I retest or wait to see if I blister, etc. No insurance and spending too much mny.

[H. Hunter Handsfield, M.D.]

I believe that most likely you don't have herpes.  Does it really matter whether that judgment is 75% versus 90% certain?  I think not. There is no point in speculating when the answer is going to come soon from the blood test result.

You don't need to know how EcelGuy's deleted comment fits with all this.  He provided one comment that agreed with what I already said, plus another that was inaccurate and potentially confusing.

Please don't post anything else until the test result is available.

[jemhokie99]

Dr. Handsfield, still no results as of Friday.  I will check back in tomorrow.  I see all this follow up commentary since I was on here last.  What does the statement back to ExcelGuy09 have to do with my question?  

Also, I see where you have responded to "1DayDown."  I was thinking based upon having read before you said I had less than a 10% chance of hsv2 and you were 75% confident this were the case.  Is that what you meant or you mean somewhere between less than 10 and 25% or maybe if I were to do an average of the two say 12 to 15 %?

Thanks... this extra comments confuse me and I don't see how the ExcelGuy ties in with this.  Can you help me here?

[H. Hunter Handsfield, M.D.]

Thanks for your comment, but I deleted it (and one on another thread) for two reasons.  First, your second paragraph in this thread was wrong; herpes lesions are pretty much equally frequent all over the penis, except for the base.  Second, on this and the HIV forum, we generally limit advice to that from the moderators, partly to prevent exactly the sort of error just referred to.  (There are exceptions, but it has to be an especially important point.)  The community forums are available for advice from general MedHelp users.  Thanks for your understanding.

[H. Hunter Handsfield, M.D.]

Good point.  My guess on 2/1 was a 10% chance he has HSV-2 and yesterday it was 25%.  It's somewhere in that range.  Just shows how imprecise this business is.

[1daydown]

Doctor, if you predict there's a less than 10% chance than he is truly positive, wouldn't you be 90% sure that his WB would be negative (not 75%)?  I apologize; not intending to be disrespectful.  Just trying to understand your calculations, sir.

[H. Hunter Handsfield, M.D.]

Most predictions for persons on this and the HIV forum concern people with almost no chance of having the infection that concerns them -- in which cases my track record has been 100%.  With your test record to date, I guess I'm around 75% confident your WB will be negative.

I imagine the WB will be done on your specimen within a few work days of arrival in Seattle.  The rest will be time for specimen management, shipment, and communication of results, which can be highly variable from one lab to the next.  Some labs may intentionally inflate the expected turnaround -- better to have the result early than to say 1 week and not have it for 3 weeks.

[jemhokie99]

I will let you know the results of the WB.  My doctor knew very little about it and I dug around on here and found the code for it.  I was told it will take as much as 3 weeks for a result.  Does this sound right?

Also, as a side note (you bet it will be negative).  Just for grins and giggles, as well as some potential comfort for me, what type of record do you have on your bets/predictions?

Thanks again for your support.

[H. Hunter Handsfield, M.D.]

Although many websites and other educational resources list genital "tingling" or "burning" as a herpes symptom, this doesn't mean that tingling or burning by itself is a herpes symptom.  Herpes sores may tingle or burn, and these feelings may appear for 1-2 days before herpes sores appear.  But by itself this symptom does not suggest herpes.

Let me know the WB result, but I really can't help further until then.  I'm betting it will be negative.

[jemhokie99]

Doctor H, I hope you are ok.

I plan on the WB Monday.  I am having some "Ben Gay" type burning on my penis near where it meets my scrotum.  It also appears to have this same type of sensation on the foreskin.

Can HSV 1 or 2 cause this?

Thank you.  I will update on the WB.

[jemhokie99]

Thanks.  I like you and your straight-on reply.  I am going to think it all over.  I have really over-tested and drove myself crazy the last year.  I've got to get my head straight and I mean it.  If there is so much imprecision on the blood testing, the manufacturer should be forced to pull their product until it is made right...

I've learned alot about medicine throughout all of this.  I thought it much more of a science than it appears.  It appears to be as much art as science...

Thanks again, I've got some thinking to do.  You're a good guy...

[H. Hunter Handsfield, M.D.]

Hey, come on!  Read what I already wrote!  My first reply says "I would say there is less than a 10% chance you have HSV-2...."  If you need more certainty than that, the only way is to have the Western blot.

[jemhokie99]

Dr. One more question - in the total evaluation of my case, no penile blister, neg at 10wks, no blisters in 10 months, etc. Would you put more weight on this than a 1 time 2igg?

[H. Hunter Handsfield, M.D.]

The reasons for false positive results on the HSV blood tests are not known.  And yes, if you had herpes, you likely would have noticed symptoms like you described. But as I said, I believe it is unlikely you have genital herpes.

Let me know if you have teh Western blot test.  But until and unless you do that, there isn't much more I can say.

[jemhokie99]

Doctor, what causes the IGG values to go up and down like this?  Also, shouldn't I have had a penis blister/bump within the 2 week timeframe that I so often read about on here?

I've had nothing but a groing bump and a sebaceous cyst.

If the ELISA tests are that variable then why aren't the ranges recalibrated on them?

Thanks.

[H. Hunter Handsfield, M.D.]

Welcome to the forum.

Many technically positive HSV-2 IgG antibody are false, if the ELISA ratio value is under 3.5 and especially under 2.0.  You should have stopped when you were ahead:  the negative result at 10 weeks was very strong evidence you were not infected with HSV-2.  Assuming you have not been exposed to a new sex partner since then, most likely the latest result is simply false positive.  However, to be certain, I recommend you have an HSV Western blot test.  WB is the ultimate gold standard in HSV blood testing.  The test is done at the University of Washington clinical laboratory in Seattle; your doctor's office or the local lab will know how to forward your blood specimen to the UW lab.

As to a percentage estimate, should you not have the WB test, I would say there is less than a 10% chance you have HSV-2, but I can't be more predcise than that.

Finally, whether or not you have the WB, I agree that if or when you develop any genital blisters, sores etc, of course see a doctor or clinic immediately (within 2 days) for direct examination and testing.  But I doubt that will happen.

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