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STDs (Expert Forum)
herpes test: accuracy of Western Blot at 9 weeks
Answered by
Edward W Hook, MD - HIV Prevention, stds
This forum does not cover AIDS/HIV issues. This forum is for questions and support regarding STD issues such as: Chlamydia, Crabs (pubic lice scabies), Gonorrhea, Hepatitis (viral), Herpes, HPV, Molluscum Contagiosum, PID, Rectal Infections, Syphilis, Trichomonas, Warts, Yeast Infection.
IMPORTANT
This forum is limited to questions about STDs other than HIV/AIDS. For questions about HIV prevention, or if you have general questions about safe sex (e.g., condoms, how to protect yourself from HIV and STDs), please visit the HIV Prevention and Safe Sex Forum
Some of the most common types of questions concern the risk of HIV or STD after a particular sexual exposure, and about symptoms that might or might not be due to HIV. If your question is along these lines, please visit the HIV Prevention and Safe Sex Forum.
This forum is limited to questions about STDs other than HIV/AIDS. For questions about HIV prevention, or if you have general questions about safe sex (e.g., condoms, how to protect yourself from HIV and STDs), please visit the HIV Prevention and Safe Sex Forum
Some of the most common types of questions concern the risk of HIV or STD after a particular sexual exposure, and about symptoms that might or might not be due to HIV. If your question is along these lines, please visit the HIV Prevention and Safe Sex Forum.
herpes test: accuracy of Western Blot at 9 weeks
by evenearlierWBtest, Jul 09, 2008 07:36AM
Three months ago, my penis had incidental contact with a nude woman's groin area. No penetration or sex. Three weeks after the contact, my doctor performed a type specific test. The HSV II score was 1.7 and he prescribed daily Valtrex which I have been taking.
Around week 6, I wanted the opinion of a specialist so I went to another doctor, one who focuses his practice on STDs. He performed another test, this time the HSV II score was equivocal -- 0.96. He advised to stop worrying.
Around week 8, a small pimple like spot (similar to a whitehead pimple) appeared on the shaft of my penis. For a week it would grow slightly, then shrink slightly. I was anxious, so nine weeks after contact I had the second doctor perform a Western Blot. He also visually examined the spot and stated it did not look like herpes to him ("more like eczema"). He also swabbed it. He explained that the swab would likely come back negative for two reasons: first, did not look like herpes, and second, if it was herpes it looked too "old" and inactive for a swab test. The spot disappeared a day or two later.
I put off getting the results. About 12 weeks after contact, the spot returned. Sometimes there are one or two smaller spots near it. Again, they seem to appear and fade during the day. Sometimes the spot is raised, sometimes it is merely a white discoloration. So three months after contact, I went to the doctor to get the results from the WB. The swab and the WB were both negative. The doctor re-examined the spot visually, and again told me that it did not look to him like herpes. At the time, only one spot was visible.
How reliable is the Western Blot score from 9 weeks after contact? (can it be quantified as, for example, 50% accurate at 9 weeks?) I know 9 weeks is early for a WB. Can I at least stop worrying about the spot, because it appeared before the WB test?
Around week 6, I wanted the opinion of a specialist so I went to another doctor, one who focuses his practice on STDs. He performed another test, this time the HSV II score was equivocal -- 0.96. He advised to stop worrying.
Around week 8, a small pimple like spot (similar to a whitehead pimple) appeared on the shaft of my penis. For a week it would grow slightly, then shrink slightly. I was anxious, so nine weeks after contact I had the second doctor perform a Western Blot. He also visually examined the spot and stated it did not look like herpes to him ("more like eczema"). He also swabbed it. He explained that the swab would likely come back negative for two reasons: first, did not look like herpes, and second, if it was herpes it looked too "old" and inactive for a swab test. The spot disappeared a day or two later.
I put off getting the results. About 12 weeks after contact, the spot returned. Sometimes there are one or two smaller spots near it. Again, they seem to appear and fade during the day. Sometimes the spot is raised, sometimes it is merely a white discoloration. So three months after contact, I went to the doctor to get the results from the WB. The swab and the WB were both negative. The doctor re-examined the spot visually, and again told me that it did not look to him like herpes. At the time, only one spot was visible.
How reliable is the Western Blot score from 9 weeks after contact? (can it be quantified as, for example, 50% accurate at 9 weeks?) I know 9 weeks is early for a WB. Can I at least stop worrying about the spot, because it appeared before the WB test?
Doctor's Answer
by Edward W Hook, MD, Jul 09, 2008 09:16AM
, Jul 09, 2008 09:16AM
I agree with your 2nd doctor (the STD specialist). In addition, I think that context is important for interpreting what is going on.
Focusing on the incidental contact you mention, please realize that the probability of your getting herpes through this exposure is low, EVEN if she had HSV. The friction involved with sex helps to facilitate transmission and it sounds as though there was less of this kind of contact involved in your exposure. Further, please realize that most exposures to herpes do not lead to transmission.
Now, about your symptoms. As STD specialist would be attuned to the varied manifestations of herpes, thus, while not perfect (no clinical exam, by anyone, is) his "educated guess" is better than most. Secondly, many dermatologic conditions other than herpes, including eczema, can come and go. Third the lesions do not sound like herpes. Fourth you have a negative swab test (culture or PCR?).
On to blood tests. You are correct that the Western Blot takes longer to come up than other tests like the HerpeSelect. For HerpeSelect 60-75% of tests that are going to be positive will be at 6 weeks, it would be higher as time progresses but your results add even more evidence that what you have experienced is not herpes. I also agree with your doctor's counsel to not worry about the low positive HerpeSelect result at 3 weeks, if it were HSV the results would go up, not down.
Taking together and considering the things that I've just mentioned to you, I find it most unlikely that your exposure mentioned lead to you getting herpes. If you want a repeat test, WB or HerpeSelect, I would do so at around 3 months and when the result comes back negative at that time, accept the result and move on. If the ash returns, see a dermatologist for a more definitve diagnosis and treatment plan. Hope this helps. EWH
Focusing on the incidental contact you mention, please realize that the probability of your getting herpes through this exposure is low, EVEN if she had HSV. The friction involved with sex helps to facilitate transmission and it sounds as though there was less of this kind of contact involved in your exposure. Further, please realize that most exposures to herpes do not lead to transmission.
Now, about your symptoms. As STD specialist would be attuned to the varied manifestations of herpes, thus, while not perfect (no clinical exam, by anyone, is) his "educated guess" is better than most. Secondly, many dermatologic conditions other than herpes, including eczema, can come and go. Third the lesions do not sound like herpes. Fourth you have a negative swab test (culture or PCR?).
On to blood tests. You are correct that the Western Blot takes longer to come up than other tests like the HerpeSelect. For HerpeSelect 60-75% of tests that are going to be positive will be at 6 weeks, it would be higher as time progresses but your results add even more evidence that what you have experienced is not herpes. I also agree with your doctor's counsel to not worry about the low positive HerpeSelect result at 3 weeks, if it were HSV the results would go up, not down.
Taking together and considering the things that I've just mentioned to you, I find it most unlikely that your exposure mentioned lead to you getting herpes. If you want a repeat test, WB or HerpeSelect, I would do so at around 3 months and when the result comes back negative at that time, accept the result and move on. If the ash returns, see a dermatologist for a more definitve diagnosis and treatment plan. Hope this helps. EWH
