DNA PCR HSV test by blood sample

[hawkfan1234]

A little under 4 months ago I engaged in unprotected heterosexual intercourse with a girl I didn't know at college. Two weeks later I noticed a linear fissure about an inch long on the creases of each thigh where it meets the groin. These symptoms healed in about 5 days. I went to a doctor while the symptoms were still prevalent and he said it looked like dry skin/psoriasis. This symptom appeared again on my left thigh at 14 weeks and I was given a similar diagnosis by a different doctor. I never noticed red bumps or blisters before the linear fissures appeared in my thigh crease and I was searching for them diligently. At 11 weeks after this encounter I had a herpes ELISA type specific blood test performed. The results at 11 weeks were IgG 1 - negative, IgG 2 - negative, IgM 1/2 - positive. The nurse who read the results to me told me that this meant that I had recently acquired either HSV 1 or HSV 2. Having read up on the IgM test I began to doubt his diagnosis and I decided to get retested at 15 weeks. Unbeknownst to me, they ordered a HSV DNA PCR blood test instead of an ELISA antibody test. I wasn't even aware such a test existed until they gave me my results today. I was negative for both HSV1 and HSV 2. However, I found the following disclaimer on labcorps website:

This test is intended for use as an aid in the diagnosis of herpes simplex virus (HSV) infections; it also differentiates HSV-1 from HSV-2. PCR testing of blood, serum, or plasma samples is clinically useful only in potential cases of disseminated HSV infection (neonates, immunosuppressed individuals) and not as an aid in the diagnosis of either mucosal or CNS disease.

Is the HSV DNA PCR test reliable as a blood test?  For instance, what is the serology window, and what is the sensitivity of this test? Also, how should I interpret the positive IgM at 11 weeks? Finally, do my physical symptoms sound like they could be herpes? and should I consider retesting?

[hawkfan1234]

Hi Terri,

I got my anti-body results back today. The herpes select IGG 1 - was .07, IGG 2 was also .07 and the IGM was not detected. My only question, is it strange that both igg 1 and 2 came back at the same value of .07? does that suggest a faulty test or non reactive form of the virus, or am I just way over analyzing this, and it is simply a coincidence that the values are the same. Thanks

[Terri Warren, RN, Adult Nurse Practitioner]

They pick up about 96-97% of culture proven HSV 2 positive patients (that is how the study was structured to look at this question).  The number of glycoprotein g deficient strains is significantly overstated, as of my read of the literature.

Terri

[hawkfan1234]

Also, could you tell me how sensitive the type specific igg blood tests are, specifically the igg2 test? I have seen sensitivity percentages anywhere from 85% to 96%. I'm hoping that the disclaimer that as many as 1 in 10 cases of hsv are glycoprotein g deficient is over stated?

[Terri Warren, RN, Adult Nurse Practitioner]

aaaah, that is a big help in understanding your situation.  
Yes, if your IgG test comes back negative, that is the one you want to pay attention to, not the IgM.  And enough time has gone by for accuracy.
I've not seen herpes present as a fissure at the groin fold, but I've seen many fungal infection present in that way, for sure!  

Terri

[hawkfan1234]

The Igm test was a blood tested performed at 11 weeks after potential exposure along with a blood type specific igg test. The igg type 1&2 tests were both negative but the Igm type 1/2 was positive. The nurse said that this means that I had a recent exposure. Then I was retested at 15 weeks to double check and that is when a different dr office ordered the blood pcr test. I called that office on Wednesday  and asked them to rerun my blood sample as an igg elisa. I should have the results in 1 to 3 days.

Have you ever seen a case of hsv that causes a linear fissure at the groin fold but no apparent blisters or red bumps?

Assuming my igg antibody test comes back negative I would like to be able to stop worrying if that symptom which has recurred once since I first noticed it, is a cause for concern or not. My goal is to be able to accurately and reliably move on from this one way or the other. Thanks for your help.

[Terri Warren, RN, Adult Nurse Practitioner]

No, it is not reliable at all!  The made an error in ordering this test.  You aren't going to have herpes virus in your blood, you might have it from a sore, but not in the blood.  PCR testing for herpes should be done from lesions, not blood.  Blood testing should be for antibody, not virus.  

The IgM test, was that done from blood also?  It is notorious for false positives, and the fact that it was positive from blood just confirms all of that.  

What you need is type specific antibody testing.  
I'm so sorry you went through all of this, what a mess.

Terri