I am 25 y/o female and 1 yr ago was diagnosed with herpes via a non typespecific culture from my gyno. At this time, my IGG came back negative for both HSV 1&2. I had my bf get the IGG too and he had a very high positive for HSV-1, and negative for HSV-2. Thus, I assumed for several months that I had newly contracted HSV-1. Even though I believed I had HSV-1, I took valtrex continuously over the last few months since my 1st OB, besides for a couple weeks without here and there.
9 months after my first outbreak, I had a negative IGG and I have since taken it 4 more times, and ALL have come back negative (by the way, I believe I have been taking the ELISA because they base my negative score on >0.9). My last negative IGG was in December, a full 11 months after my 1st OB. Also of note, in the last 2 months I have had 2 instances where I believe I had an outbreak, but didn't get a culture.
Having had 2 more outbreaks, I am starting to obsess whether I actually have HSV-2. I know that recurrences are far less common in HSV-1, so the fact that I may have now had 3 outbreaks in 1 year while on drugs makes me think maybe it's hsv2.
1) What do you suggest I do in terms of further testing - worth it to try the Biokit or Immunoblot (chance of different results than the ELISA)? I have read a lot of this Western Blot, but I'm wondering whether it would be advisable for me to take it in my situation... if the IGG is giving me false-negatives, what are the odds that the Western Blot would be able to detect something different?
2) Do people NEVER seroconvert, and therefore never test positive via any type of blood test? If so, what percent?
3) Do you think it's more likely that I have HSV-1, given my boyfriend's oral HSV-1 status and also given the fact that I continue to have false-negative IGGs (I have read that about 10% of people will get false-negatives for HSV-1 with the IGG, but a much lower rate of false-positives for HSV-2).
If you take Valtrex regularly, you can impact antibody development. We have seen it delayed by 9 months in one patient.
Another factor is that the ELISA is notoriously poor at detecting HSV 1 infection. It misses at least 1 out of 10 infections, as you note, and the likelihood is greater that you have HSV 1 since that's all your boyfriend has, right?
Even the western blot misses a few HSV 1 and 2 infection, more HSV 1. I would suggest that you ask your doctor for a swab kit to take home and you gather a swab the next time you get what you think is an outbreak. And then ask that it be run by PCR, not culture. PCR is far more sensitive.
If you had a sore and it tested positive by culture, I would trust that you do have herpes.
I will ask my doctor for a swab kit, but then would I bring it back to my doctor or have to find a lab on my own who would run that? I know neither my gyno or primary care do PCR...just not really sure how this all works, and none of the doctors or spoken to seem to know anything about it.
And I guess my real question is do you think western blot could detect my infection if the IGG is not detecting it? Or does the western blot teste the same way as an IGG, so wouldn't be worth taking. I really want o get a western blot if there's a chance it may tell me what kind of HSV I have. Also, you mentioned the ELISA is notorious for missing hsv1, so what do you think about getting an immunoblot and biokit- are these known to detect antibodies that the ELISA does not? How often does the ELISA miss hsv2 infections?
I really appreciate all your insight!! Thank you!!
Oops, looks like I didn't address my last comment to you. You can disregard that, as I have discovered that I was previously misinformed with my results, which changes things quite a bit!
I went to see my PCP and had them pull up my results from my last test. Turns out they did an HSV Type-specific Immunoblot and the results read as follows: "HSV Type Specific Immunoblot - negative; HSV-1 IgG antibody positive, HSV-2 IgG antibody -negative" -- I'm confused as to why it says the test is negative, but then goes on to say positive for HSV-1? I am taking this to mean though that I have Hsv-1.
That same day, they also did an "HSV Type-2 Specific Ab, IgG, Immunoglobulin M, Qn, Serum", which came out as negative, <0.91.
(Keep in mind, these tests were done about 11 months after my 1st outbreak.)
My 2 new questions are:
1) given these results, do you think I can say with confidence that I have HSV-1 genital? Or would you advise further testing to confirm with western blot and maybe even try the ELISA again to confirm that I have HSV-1, and not HSV-2? I am about to lose my health insurance, so want to cover my bases while I still am covered.
2) Can I even trust the results of my Immunoblot? what are your thoughts on its accuracy? Why would an immunoblot catch an infection, while the ELISA would not? Trying to wrap my head around this...
I guess now I'm weary of blood tests and confused as to how the ELISA missed my HSV-1 just 1 month prior, while the Immunoblot showed that I have it. I'm still concerned that there's a possibility that I do have HSV-2, and the immunoblot just revealed old infection (not the one I believe to have contracted 1 year ago).
I can't stop thinking about these things, so again, any insight you have would be so helpful.. thank you!
Hadn't heard back from you and still just wondering if you have any insight as to how the Immunoblot detected my HSV-1 infection, but the ELISA did not. What is the difference of these two tests? Do you believe I can trust the results of my Immunoblot and disregard the results of ELISA? Do you advise further testing to confirm: i.e. a western blot?
I don't doubt that I have genital herpes (the culture was positive), but I would really like to know what kind I have. Also, I have now spoken to 3 doctors regarding a PCR and none of them know what that is, so I'm not sure how to go about getting one done if I do have another outbreak.
Yes, I think a western blot would clear this up. However, I think since the culture was positive, you probably have HSV 1 genitally. I believe this because your boyfriend has HSV 1 and because you appear, by immunoblot, to have converted from HSV 1 and 2 negative to HSV 1 positive (at least by immunoblot)..
You can also become a patient our clinic and we can send you PCR swabs to gather if and when you have another outbreak. Even with HSV 1, sometimes you can have more outbreaks in the first year of infection.
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