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'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