HSV 2 test decisive

[Slimright112]

I have read thru the forum extensively.  Recently, I see there has been quite a bit of interest in the debate over HSV 2 blood test accuracy with an individual with HSV 1.  I am curious to find a definitive answer.

This study I found referenced by multiple users:
http://www.medhelp.org/posts/STDs/HERPES-2/show/463636

Dr. Hook and Nurse Warren seem to me, to imply that indeed HSV1 prior infection may delay seroconversion for HSV 2.  Dr. Handsfield disagrees.  Is there a consensus on this issue?
Also, if the study posted above is indeed a small study that has an error rate of +/-20%, then why use such a study a reference to begin with?  If many individuals misidentify lesions or are asymptomatic  I imagine the accuracy of a blood test is valuable.  Is a four month blood test TRULY 90-95% accurate for HSV 1 individuals based on years of study, or is the number not known?

[Edward W Hook, MD]

To all concerned.  Dr. Handsfield, Terri and I have all been in contact with each other and with others regarding this issue.  Here is my assessment of where we stand.  All three of us agree that the data that we base our comments on are from rather small studies and that it is unlikely that there will be larger more comprehensive studies to address the issue of how pre-existing HSV-1 might influence (i.e. slightly delay) development of antibodies to HSV-2, should a person become infected with HSV-2.  The data, as well as our own discussions among ourselves and other experts indicate that while the presence of HSV-1 infection MAY delay development of antibodies to recently acquired HSV-2 infection, however most patients will still develop antibodies by 3 months and only a small number (and saying how small that number is just not possible, certainly less than 10%) of those who had HSV-1 first will have modest delays in antibody response.  Virtually all persons will have accurate results at 6 months.  

Having said this, you each need to also understand the each of us responds to your questions based not on the result of a single test but on our carefully integration of all the information we have given you.  To be focused on a single test result is a formula for misunderstanding.  

Let's not let this conversation go further.  I will let Dr. Handsfield and Ms. Warren know of my response and they will respond as they see appropriate but we are not going to get into a lot of "what ifs" and "could this be" interactions over this.  EWH

[Alexis_22]

I really have to comment on this thread as my question was addressed (http://www.medhelp.org/posts/STDs/HSV-II-at-3-months/show/1259514).

I, too, have noticed the discrepancy in Dr. Handsfield's statements that HSV I does not delay the production of detectable antibody levels (I am not questioning his expertise, simply needing clarification on his different view on the matter).  I was advised to retest past 3 months by Nurse Warren because I have HSV I and advised by Dr. Handsfield not to.  I am so confused and growing increasingly anxious.

Dr. Hook, please advise on the matter?  I am not intending to start a debate; however, I am still worried about my status and wondering if I truly do need to retest and if so, perhaps a different route?  Biokit or another igG?

Thank you so much.  

[Edward W Hook, MD]

But you are arguing and  I think you are over reading Dr. Handsfield's comments.

Ulitmately at at time approaching 6 months, we believe that type specific tests for HSV-2 such as the HerpeSelct are 90-95% sensitive. That does not mean that some results do not need further information or testing but that is an accurate generatization.  EWH

[Slimright112]

Also, I should believe that the general reliability of the HSV 2 blood test is indeed close to 83% with an individual already having HSV 1, or the 90-95% cited other places is more realistic?

[Slimright112]

Thank you for the rapid response Dr. Hook.  It is by no means my direction to argue.  But in this recent post Dr. HHH seems to disagree.  Maybe I am misreading?

http://www.medhelp.org/posts/STDs/HSV-II-at-3-months/show/1259514

[Edward W Hook, MD]

I think you are mis-interpreting some of Dr. Handsfield's past statements.  The studies which describe the time course of development for positive HerpeSelect tests were performed at Dr. Handsfield's institution.

You are correct that he study that Terri and I quote is rather small but it provides the best data we have.  Here on the Forum we do our best to provide clients with the most scientifically  sound data available. While we often wish there were more studies and data smaller margins of error, the data are difficult to come by and expensive to generate so we use what is available.  I would add however that our personal experience serves to validate and support the published data.  Furthermore, as all three of us (Dr. Handsfield, Terri and me) have said before, the manifestations of HSV are modified when the person under consideration has a pre-existing, related HSV infection. Thus we are confident that persons who have pre-existing HSV-1 have some (modest) additional resistance to getting HSV-2 over those who do not have HSV-1, and that pre-existing HSV antibody will modestly slow the development of a positive HSV 2 antibody test.  We stick by or earlier statements.  EWH