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Indeterminate Western Blot Test
Hello H. Hunter Handsfield, M.D.,
I have been in a committed relationship
for 3 years before that I was in 4 year relationship. With no reason to believe
my past or present relationships had HVS 1 or 2.
In the past once in a routine Gyno appointment asked to be tested for all STD'S but I
do not know if they tested for HVS 1 or 2 since everything I read tells me that is not
included in a STD screening. I went to a new Gynecologist I am in Seattle as
as I felt I had a yeast infection. I tried the over the counter Monistat
but it didn't seem to help. She also thought it was a yeast infection took a culture
but said it was hard to read because there was still the monistat in there. Gave
me a prescription which did clear it up - a little better each day, took about a week
still had some redness than cleared. it did itch but no rash no sores, no pain, no tingling.
She did a routine STD screening - asked if I wanted to be tested also for herpes .
All test came back clear except when she called me with the results (the nurse - this was
at the polyclinic) she said HVS 1 & 2 were positive but it was so low I might just have
HVS 1 most likely but definitely one - I should retest in 6 weeks. She didn't give me the actual
numbers & when I asked what test she didn't know......that she would have the doctor call me back.
Missed the call & the doctor leaves me a message that if I have any questions to make an appointment
with her - or we will be playing phone tag. It all seemed so unprofessional to me for the nurse to not even know
what type of test it was.
I decided to take the Western Blot test at HarborView STD Clinic, Seattle. it
was indeterminate for both HVS 1 & 2 the lab fella said it was very odd
to get these results so he called the lab and they said to retest in 12 weeks.
I had chicken poxs as a child & I test positive for thyroglobulin antibodies common in someone who has had Graves Disease. Could that have anything to do with?
MEDICAL PROFESSIONAL
Most likely you spoke with the medical director himself. His bar code analogy is excellent; in the future I will use it myself. I agree that most likely you do not have HSV-2. That will be reinforced if the original test numbers are very low. In any case, I don't see much cause for continued confusion. I agree that repeating the standard test, with reflex to WB if positive, is a good way to sort this out.
It would be best if you got your advice from a single source. Since in-person care is always preferable to online advice, that should be at the Harborview STD clinic, either in person or by telephone, not here. As I said, I'll comment one last time when you report the original test numbers, but that will be as far as we can go here. In the meantime, don't lose a lot of sleep over this. Most likely you don't have HSV-2.
It would be best if you got your advice from a single source. Since in-person care is always preferable to online advice, that should be at the Harborview STD clinic, either in person or by telephone, not here. As I said, I'll comment one last time when you report the original test numbers, but that will be as far as we can go here. In the meantime, don't lose a lot of sleep over this. Most likely you don't have HSV-2.
Thank for your answer. I have called the Polyclinic today to ask what test it was and what were the numbers. I spoke to the nurse and she told me I have to wait for the doctor to come in tomorrow she doesn't know. STRANGE. I will call again tomorrw and also ask that they mail me my copy of the results or if I may pick it up I know its my right. I don't understand why the nurse can not tell me.
I also spoke to the DR. at Harbor View. He told me that the test reads like a bar code and if there is even one antibody in it it will show one bar.Giving it an indeterminate result.
I than asked if people have low numbers in blood test and show a low
antibody in WB they still have the antibody how can they possibly not have it. He responded with it could be autoimmune antibodies. I told him
that I have had graves disease which is autoimmune. He said that is possible. I asked if he has the biokit test there - he told me I can
wait a bit take the regular blood test(not sure which one that is) if it comes back low they will atomatically do the WB again. He told me most likely I do not have it...... I am so confused.
When I get the numbers from my first test I will let you know what they are.
With Warmth and Thanks!
Ellen
I also spoke to the DR. at Harbor View. He told me that the test reads like a bar code and if there is even one antibody in it it will show one bar.Giving it an indeterminate result.
I than asked if people have low numbers in blood test and show a low
antibody in WB they still have the antibody how can they possibly not have it. He responded with it could be autoimmune antibodies. I told him
that I have had graves disease which is autoimmune. He said that is possible. I asked if he has the biokit test there - he told me I can
wait a bit take the regular blood test(not sure which one that is) if it comes back low they will atomatically do the WB again. He told me most likely I do not have it...... I am so confused.
When I get the numbers from my first test I will let you know what they are.
With Warmth and Thanks!
Ellen
MEDICAL PROFESSIONAL
Welcome to the STD forum. I would love to help but I don't think it will very much. The bottom line is that I am inclined to believe you do not have HSV-2. Your symptoms were probably just what they seemed to be, a yeast infection. But I agree the situation is uncertain.
You may know that I directed the Public Health STD clinic at Harborview for 25 years, until 2006. If one of the clinic staff came to me with a question about a patient with an indeterminate HSV Western blot, I would do exactly what you have been advised: re-test and see what it shows. In addition, I suggest you have another conversation with the clinican who did the test and conveyed the results to you. Tell him or her that I suggest the situation be discussed with the current clinical medical director (a close friend and colleague), or one of the other senior clinic physicians. The clinician or doctor might also telephone the lab and discuss the result with a supervising technician to see if s/he can come to a probable answer. Although WB is a very sophisticated test, it is interpreted the old fashioned way: a human being examines a pattern of fuzzy lines on a paper test strip. Sometimes a senior, highly experienced technologist can come up with an improved interpretation.
It would be helpful if you can also find the actual numerical values for both HSV-1 and HSv-2 on the blood tests done at the Polyclinic. If the HSV-2 results are as low as you imply, it is likely you don't have HSV-2. The combination of that result with the current WB might sort it all out.
Another option: talk to your Harborview clinician about having a BiokitUSA HSV-2 test. If that's negative, it would argue strongly against having HSV-2; if positive, you probably have it. This also might be something the clinician will need to speak to the medical director about.
If all this doesn't sort it out, I agree you should go ahead with a repeat WB in a few weeks. However, I'm not sure it's necessary to wait as long as 12 weeks. A month or so might be sufficient.
And if all that fails to provide a clear answer, ask your STD clinic clinician to refer you to the clinical services of Harborview's Virology Research Clinic, i.e. as a non-research patient. The non-research service is also called the Remington Clinic. It is arguably the most sophisticated herpes clinic in the world; if anyone can accurately sort it out, they can do so.
Your childhood chickenpox and thyroid tests really are not relevant. I doubt they have any influence on any of the HSV test results.
Good luck with all this. Let me know how it shakes out.
HHH, MD
You may know that I directed the Public Health STD clinic at Harborview for 25 years, until 2006. If one of the clinic staff came to me with a question about a patient with an indeterminate HSV Western blot, I would do exactly what you have been advised: re-test and see what it shows. In addition, I suggest you have another conversation with the clinican who did the test and conveyed the results to you. Tell him or her that I suggest the situation be discussed with the current clinical medical director (a close friend and colleague), or one of the other senior clinic physicians. The clinician or doctor might also telephone the lab and discuss the result with a supervising technician to see if s/he can come to a probable answer. Although WB is a very sophisticated test, it is interpreted the old fashioned way: a human being examines a pattern of fuzzy lines on a paper test strip. Sometimes a senior, highly experienced technologist can come up with an improved interpretation.
It would be helpful if you can also find the actual numerical values for both HSV-1 and HSv-2 on the blood tests done at the Polyclinic. If the HSV-2 results are as low as you imply, it is likely you don't have HSV-2. The combination of that result with the current WB might sort it all out.
Another option: talk to your Harborview clinician about having a BiokitUSA HSV-2 test. If that's negative, it would argue strongly against having HSV-2; if positive, you probably have it. This also might be something the clinician will need to speak to the medical director about.
If all this doesn't sort it out, I agree you should go ahead with a repeat WB in a few weeks. However, I'm not sure it's necessary to wait as long as 12 weeks. A month or so might be sufficient.
And if all that fails to provide a clear answer, ask your STD clinic clinician to refer you to the clinical services of Harborview's Virology Research Clinic, i.e. as a non-research patient. The non-research service is also called the Remington Clinic. It is arguably the most sophisticated herpes clinic in the world; if anyone can accurately sort it out, they can do so.
Your childhood chickenpox and thyroid tests really are not relevant. I doubt they have any influence on any of the HSV test results.
Good luck with all this. Let me know how it shakes out.
HHH, MD
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