Negative Results Despite (Somewhat Atypical) Symptoms

[help_me880]

Hi Terri,

I posted a while back, and have good news.  My 16 weeks (Captiva from Labcorp) test came back negative for both types.  I also took a 17 weeks + 1 day test (Herpeselect from Quest) and am awaiting results.  Symptoms have been atypical and not painful (hemmoroid, pimple on the thighs which was negative by culture).  No blisters or typical symptoms.  However, I remain very worried as I was non-consentually assaulted (some skin-to-skin contact) by someone who I have reason to believe might have diseases.

I am still having some concerns, and was wondering:
**What is the longest you've ever seen for a patient to seroconvert, assuming no use of antivirals and negative for both types?
**After a certain point, would you assume if someone has not yet developed positive IGG antibodies as measured by Captiva or Herpeselect, then they probably never will?  (Again no anti-virals and negative for both types.)
**Is this test similar to the Western Blot in terms of providing confirmation: http://requestatest.com/herpes-12-igg-immunoblot-testing  The "Request a Test" company said it is more sensitive than the Captiva test.  (The cost is not an issue if indeed this is a worthwhile test.)

[Terri Warren, RN, Adult Nurse Practitioner]

Both the Captia and Herpeselect tests have about the same sensitivity - I don't prefer one over the other.  The immunoblot is definitely NOT a confirmatory test for the two other tests.  We used to use it in our clinic and switched to the Herpeselect for greater accuracy.  

With no antiviral therapy, I've not seen anyone take longer than four months to seroconvert.  However, I have heard of people taking longer, just haven't seen that in my herpes specialty practice of 31 years.

Terri

[Terri Warren, RN, Adult Nurse Practitioner]

I think four months is enough.  Rarely, though it happens, does someone become positive between four and six months unless they have taken antiviral therapy, in my experience.  

Terri

[help_me880]

Thanks Terri.  I retested again at 23 weeks (as I was too anxious to wait until the 6 months) and was still negative for both types.  I am planning to test again after 6 months for additional reassurance.

I have since had a blister on my finger (wasn't painful, lasted less than 2 days so I wasn't able to get to the doctor to have it swabbed) and a sore above my lip (hard to tell if it was a cold sore or simply a pimple).  The blister occurred after a weekend of hiking/camping, so I'm really hoping it could somehow have been a reaction to poison ivy or bug spray or something.  Would you expect the 6-month test to be conclusive in telling me if either the finger or mouth issue was type 2 herpes, or would it require more than 6 months due to being on the finger/face?  

[Terri Warren, RN, Adult Nurse Practitioner]

No idea why the test took longer, but stuff happens.  I would put this behind you now.  

This is my last post on this thread.
terri

[help_me880]

Hi Terri-  I took another test at 19 weeks which was negative for both types.  However, the previous tests I've taken (at Quest, ordered through internet testing service) came back in 2 days while this test took a week to come back.  After several days the internet testing service contacted Quest to ask why it was not back, and Quest confirmed that my sample was "still testing" and that testing can take anywhere from 24-74 hours from the time Quest receives it, but could not explain why it was taking so much longer than previous times.  I was wondering if the fact that it took much longer this time indicates that there was something suspicious (ie it was originally equivocal or borderline or on the way to becoming positive that would have required additional tests)?  Or does it just sometimes take longer if the lab gets backed up?

Also I have not noticed anymore genital symptoms to swab, but did notice a bump on my mouth.  If I had herpes 2 on my mouth, would the time to seroconversion be longer than genitally since it is not the site of preference?

Thanks

[Terri Warren, RN, Adult Nurse Practitioner]

Not sure what happened there, but I really don't anything else to say here.

Terri

[help_me880]

Terri, did your last response get cut-off?  It says "I don"

Thanks

[Terri Warren, RN, Adult Nurse Practitioner]

From the encounter.

I don

[Terri Warren, RN, Adult Nurse Practitioner]

That's by western blot, by the way.

Terri

[JoeLog]

Hey there,

read this very recent thread, it's all about testing concerns similar to yours:

http://www.medhelp.org/posts/Herpes/herpes-serology-tests-questions/show/1956263


That study you are reading has a lot of variables.  The biggest misleading portion of it, is that the subjects who were blood tested for HSV were tested at different time intervals.  Some of them tested at 60 days and never tested again, so their seroconversion at 4 months was never recorded because no test was ever performed.  Also I believe some folks were DID seroconvert at 6 months may have skipped prior tests at 60 days or at 4 months, and thus their seroconversion was recorded much later than it could have been.  Also Terri mentions that out of the 100's of hsv patients she sees, she's only had 9 folks ever not seroconvert... thats a pretty tiny number.

[help_me880]

Thank you Terri.  I was wondering when experts say that the Herpeselect is 95-99% accurate at detecting positive results for HSV 2 at 6 months (assuming no antivirals), whether the 1-5% who get a false negative at 6 months will eventually test positive after 6 months, or most people with a false negative at 6 months would remain false negative and not go on to test positive?  I can pay again if I have reached the maximum number of questions included in my payment.  Thanks.

[Terri Warren, RN, Adult Nurse Practitioner]

It definitely could be due to antiviral medicine, I don't know those details of subjects right now, will have to recheck.  
As I said, there are a few people who serconvert after a long while, but they are definitely not common.
You are looking for certainty and I can't give it to you.
If I were you and I was worrying this much about bumps that appear on my body, I would ask my doctor to give me some PCR swabs to take home and I would swab every bump that comes up and get the PCR swab to the lab so you could eliminate each individual symptom as they show themselves.

This is my final post on this thread.

[help_me880]

Also I am looking at http://journals.lww.com/stdjournal/Fulltext/2003/04000/Raising_the_Consciousness_for_Identifying_and.7.aspx and it seems like some people took longer to test positive.  Is that due to use of antivirals or other reasons?  Thank you

[help_me880]

Thank you Terri.  I am planning to test again in 1-2 weeks, and then again at the 6-month mark.  I also saw report online of someone seroconverting only at 44 weeks, so it is hard to put aside worries.  Do people sometimes convert *after* 6 months?

Given my symptoms: hemmoroid (which I don't normally get) 2 weeks after encounter (cultured negative), red bump on thigh approx 1 month after encounter, red bump on abdomen approx 3 months after encounter- is it really possible these symptoms could be just a coincidence or caused by anything else?  

[Terri Warren, RN, Adult Nurse Practitioner]

well, by now, I would expect a positive if you were infected, not a high negative.

As far as we know, seroconversion time is not related to severity of the outbreak.  

I think if you are negative at 17 weeks, that's about as good as you are going to get.  If you feel you need to retest at 6 months, do it.  I doubt it will change the picture, though.

Terri

[help_me880]

Thank you again.

The reason I was looking for an IGG with exact number was because I read on other posts on this forum, that you might be on the way to seroconverting if you go from a low negative to higher negative.  So I wanted to see if I was still at a low negative.  Or is that not a correct way of thinking?  Would test results gradually go from low negative to higher negative to positive, or would it jump?

Do you recommend more testing for me, and if so, when?  I have seen some websites say 16 weeks is mostly conclusive and 6-months is fully conclusive?  Do you think seroconversion can occur later for mild symptoms, or that it would be similar?  

[Terri Warren, RN, Adult Nurse Practitioner]

I do not believe that MANY people seroconvert late.  I think it happens rarely.  What we do see from time to time is that someone may test repeatedly negative, then keep testing and eventually get a positive result that is just over the cutoff for positive and then deem themselves positive when they actually probably have a false positive.  Unfortunately, they don't do a confirmatory test to find out that it is a false positive.  So they decide that they did actually seroconvert late.  This is very frustrating for me.  

Antibodies are made in response to infection, not necessarily an outbreak.

Terri

[help_me880]

Thank you, Terri.  

Do you recommend that I take additional tests at this point?  If so, when?  I am not worried about type 1, only about type 2.  

Also is the production of antibodies a response to an outbreak, and if so would the fact that the symptoms were mild and non-painful cause production of antibodies to be delayed/not detected on test?  Had I not been concerned about stds and inspecting my body due to having been assaulted, the symptoms are so mild that I would not have noticed them.

I want to be happy with negative tests and put this behind me, but since I read about many people on the internet seroconverting after very long amounts of time or the tests being inaccurate, I don't know how I can ever get peace of mind knowing my status.

Thank you very much for your help, Terri.

[apple2002]

Terri...

I took a test at 5 months (igg) that returned negative (general negative no exact number <.91). Based on the above thread, is this still an accurate reading based on time to test?  I assume based on what I've read and your comments that it's important to wait a minimum amount of time and not test too early.

[Terri Warren, RN, Adult Nurse Practitioner]

From the encounter.
You don't need the exact negative number.

Terri

[help_me880]

Thank you very much, Terri.

My results from 17 weeks & 1 day test (exactly 4 months) are negative.  When you said you have not seen anyone after 4 months, did you mean from encounter or from symptoms?  I am not sure if I should take another test in a few weeks/how long to continue the tests?

Also this Quest facility (Horsham, PA) does not provide numerical results, only negative <.90.  I was wondering if you know how I can get a test from a Quest facility that will provide an exact number?

I am very happy these results are negative, but I am not 100% convinced I am out of worry yet.

[Terri Warren, RN, Adult Nurse Practitioner]

Yes, that primarily happens with HSV 1, not HSV 2.  

Terri

[help_me880]

Also I was wondering if the Biokit or Western Blot sometimes find that people who are negative on Herpeselect are really positive?  I see the Biokit and Western Blot mentioned to confirm low positives are truly positive, but haven't seen the opposite (confirm negatives are really negative).  

[help_me880]

Thank you Terri.  When I took the first Herpeselect test at Quest at 5 weeks, they sent it to a Quest lab that reports # results for negatives.  When I took followup tests (at the same Quest service center and online testing company), Quest just reported <.90 negative (no specific #s).  The online testing service said they cannot control what lab Quest sends it to or how Quest reports the results.  Do you know if there is any way I can get it sent to the lab that gives # results so I can see if I increased to higher negative?

Also did you mean 4 months from symptoms or 4 months from encounter?  And what is the longest documented seroconversion you are aware of outside your practice?

Thank you very much for your expertise.