False Negative ?

[rollingstone1]

Hi Terri- A long and draining story looking back I hope you can help. 5 years ago I slept with someone 2x in a 2 week period both times a condom was worn with no problems. I believe the 1st time was with the lambs skin condom though. This woman was confronted later and said she did not have herpes although was not too convincing and we soon parted ways. I definately had HSV sypmtoms within 2 weeks ( shooting leg pains red bumps on the skin that popped up and reseeded but no obvious lesions or blisters) Being that already have HSV-1 I know what they look and feel like. These bumps and shooting pains lasted a good 6 weeks. So At 5 weeks past exposure I purchased an online test with labcorp IGG specific and tested HSV-1 positive (which I knew ) and HSV-2 negative. Learning this was too soon to test I went back at 12 months 20 months and again at 5 years ( last week) …all HSV-2 test came back negative for the specific IGG test. The reason I keep going back is because I have been in 4 relationships since and 3 out of the 4 woman while I was with them at some point complained about nuerological aches and numbness in their hips/back legs and each time it made me wonder If i had given them HSV that I was testing negative for!! The 3rd one after giving me oral developed a cold sore days after that she said she may of had one as a young child but couldn’t remember which scared me again. The 3rd out of 4 I am with and now she is complaining about the very same nuerological numbness that the others complained about..numbness in one leg, hip soreness lower back issues. None of the 4 women outside of the cold sore as of yet had ever complained about any other issues or thinking they had an std or I’m sure I would have been approached. Whats so confusing about this is after reading post answers from DRs. Handsfield Dr.HHH and yourself some things don’t add up. Please tell me if these things are true .. Current HSV-1 infection will practically eliminate any chance of HSV-1 genitally? 2) Each IGG specific test is accurate in itself and stands alone and 4 negative test in a 5 year period almost guarantees a true negative test result ? Or is it once false negative .. always false negative regardless how many test are taken ? 3) Primary or initial outbreak has no nuerogical symptoms attached to it? Only re occuring outbreaks 4) Red bumps on the buttocks is not somewhere for the primary or initial outbreak to occur? BTW I have not had any outbreaks that I can speak of in 5 years unless they were so minimal I didnt even notice.and I have never had anything on the Penis of any kind. I must say recently I did get 1 raised bump that was only around for 2-3 days and am wondering if that could have been a mild outbreak… sorry for rambling. Bottom line is do you think someone like myself should or would benefit from a western blot to finally know my status once and for all ? Thanks Terri I appreciate what you do !!

[Terri Warren]

Current HSV-1 infection will practically eliminate any chance of HSV-1 genitally?

Correct

2) Each IGG specific test is accurate in itself and stands alone and 4 negative test in a 5 year period almost guarantees a true negative test result ? Or is it once false negative .. always false negative regardless how many test are taken ?

In my experience, once the IgG misses an infection, assuming adequate time has passed since infection for testing, it always will miss it

3) Primary or initial outbreak has no nuerogical symptoms attached to it? Only re occuring outbreaks

No very frequently primary infections have neurological symptoms

4) Red bumps on the buttocks is not somewhere for the primary or initial outbreak to occur?

Correct

BTW I have not had any outbreaks that I can speak of in 5 years unless they were so minimal I didnt even notice.and I have never had anything on the Penis of any kind. I must say recently I did get 1 raised bump that was only around for 2-3 days and am wondering if that could have been a mild outbreak… sorry for rambling. Bottom line is do you think someone like myself should or would benefit from a western blot to finally know my status once and for all ?

I think if the western blot would help you put this behind you then yes, I would advise it. Sometimes we do thinks just be sure – and I think that’s totally fine, so that we can move on with our lives and stop worrying about what MIGHT be.
Terri

[rollingstone1]

Thanks for the reply…I guess the best thing may be the western blot for best confirmation being I haven’t had any obvious outbreaks or lesions that blister to swab. And i guess all other specific scenerios are really irrelevant and would still point me to the WB since I keep testing negative. Some questions regarding WB..I have read its mostly used to catch the false negative in HSV-1. I have also read the WB is a 98% accurate test including HSV2. Is this true ? If so taking the WB for HSV-2 is going to possibly catch the 3% difference in accuracy between the 95% of the IGG type specific and the 98% of WB. BTW being that all my previous test were done by labcorp I went to quest diagnostics for an IGG and waiting for results. Read where the two labs perform the same test but differently. So I guess I would need to know what is my next move for the WB ? Cost ? etc… I would like to do this thru your facility ( instead of getging my primary dr. Involved )Would you write an order for a lab near where I live ? How long does it take for results once the draw has been completed ? Please advise. Thank you for your help ! Being positive would really be disheartening being a condom was worn no lesions ever on the penis no obvious out teams in 5 years since AND being false negative to boot ! I do agree though it needs to be done so I can move on from something that MIGHT be…

[Terri Warren]

LabCorp and Quest do not perform the same test – They use the same technique but different tests. LabCorp uses Captia and Quest uses herpeselect.

Our clinic orders about 25 western blots per week from all over the country and world. It can be drawn at a lab near you and they will ship it to UW and handle all the details. It’s very easy. The western blot does pick up a few positives for HSV 2 that are missed by the ELISA correct. Not many but a few. It picks up lots of HSV 1 that the ELISA misses. We would be happy to arrange this for you.

Terri

[rollingstone1]

Hi Terri,

The quest diagnostic test I was waiting on came back negative. No specific # just < 0.91. When you say the test are different between Labcorp and Quest what do you mean ? Aren’t they both looking for the same protein but in a different way ? I have read where sometimes one test can pick up a positive when the other test can’t ??
I am leaning towards the western blot if for nothing else than to put this behind me. I do have some questions that would help me understand things better regarding false negative. And maybe someone else can get a better understanding also.

1. Would the fact that I am HSV-1 positive for 30 years and have also having shingles 30 years ago have any effect on the possibility of being false negative for HSV-2 ? Or would that actually make a false negative less likely ? Just for the record my positive HSV-1 test results were 3.91 5 years ago if that matters.

2) Is there a kind a HSV-2 strain that may produce such atypical symptoms that the initial outbreak would appear somewhere else other than the point of entry ? And if so, would that strain react in a similar way to the newly infected person ? And so on as its passed from person to person ?
Of the 4 women mentioned previously 2 of them I lost contact with within a couple months and cant really say if they had other symptoms than the nuerology issues after we parted. The longest relationship of the 4 I still talk to and she has never said anything about issues of herpes symptoms other than I remember her saying how her leg and hip felt strange once. The current relationship I am in was having the same neurology issues. Felt weak and sick to her stomach one day, sore from the hips down, lower back soreness, leg numbness on one side. All those issues have cleared up 2 weeks later and still no other complaints about something is wrong, I went to see a dr conversation. She also went thru her menstrual cycle which I thought for sure would bring on problems if she was infected. Again if this was HSV-2 wouldn’t one expect more symptoms?

3) And as well as for me…
Isn’t it true that if I was HSV-2 positive I would of had more noticeable outbreaks ? Its been 5 years and nothing that I can say uh-O I think i am having an outbreak.

4) Does a herpes blister ever fill up with a very noticeable white puss like substance ? Break open doesn’t ulcerate and then not really scab over ? Or is it always more watery like the ones I get on my lips ? BTW those are very typical, itchy, the blister appears within hours, grows and is painful to touch, breaks open hurtsand then scabs for 3-4 days before healing. Are HSV-2 blisters the same as HSV-1?

5) Lastly, You have said that the IGG specific test for HSV-2 has a 97% accuracy rate. What in your opinion would be the chance I possibly contracted genital HSV-1 after already having oral HSV-1 ? Could that explain the absence of outbreaks ?

Thanks again Terri, Its nice to have a place to turn to with questions and concerns

[Terri Warren]

1. Would the fact that I am HSV-1 positive for 30 years and have also having shingles 30 years ago have any effect on the possibility of being false negative for HSV-2 ? Or would that actually make a false negative less likely ? Just for the record my positive HSV-1 test results were 3.91 5 years ago if that matters.

Neither of these conditions have an impact on the results of your HSV 2 test.

2) Is there a kind a HSV-2 strain that may produce such atypical symptoms that the initial outbreak would appear somewhere else other than the point of entry ? And if so, would that strain react in a similar way to the newly infected person ? And so on as its passed from person to person ?
Of the 4 women mentioned previously 2 of them I lost contact with within a couple months and cant really say if they had other symptoms than the nuerology issues after we parted. The longest relationship of the 4 I still talk to and she has never said anything about issues of herpes symptoms other than I remember her saying how her leg and hip felt strange once. The current relationship I am in was having the same neurology issues. Felt weak and sick to her stomach one day, sore from the hips down, lower back soreness, leg numbness on one side. All those issues have cleared up 2 weeks later and still no other complaints about something is wrong, I went to see a dr conversation. She also went thru her menstrual cycle which I thought for sure would bring on problems if she was infected. Again if this was HSV-2 wouldn’t one expect more symptoms?

Some people just have no symptoms of herpes infections. It is possible that the initial infection was missed and that recurrent symptoms showed up in an extra genital site.

3) And as well as for me…
Isn’t it true that if I was HSV-2 positive I would of had more noticeable outbreaks ? Its been 5 years and nothing that I can say uh-O I think i am having an outbreak.

Not necessarily.

4) Does a herpes blister ever fill up with a very noticeable white puss like substance ? Break open doesn’t ulcerate and then not really scab over ? Or is it always more watery like the ones I get on my lips ? BTW those are very typical, itchy, the blister appears within hours, grows and is painful to touch, breaks open hurtsand then scabs for 3-4 days before healing. Are HSV-2 blisters the same as HSV-1?

They are very similar yes.

5) Lastly, You have said that the IGG specific test for HSV-2 has a 97% accuracy rate. What in your opinion would be the chance I possibly contracted genital HSV-1 after already having oral HSV-1 ? Could that explain the absence of outbreaks ?

I think the chances of you contracting HSV 1 genitally after having it orally are very close to zero.

If a western blot would help you move past all of this, I recommend that you do it.

This was your final post on this subscription. If you have more questions, feel free to renew.

Terri

[rollingstone1]

Hi Terri,

I am seriously considering the WB. I sure thought this was behind me and the funny thing is I don’t think the lack of assurance of being HSV-2 negative has anything to do with me, but more so the women I have been in relationships with over the last 5 years. I’m sure the WB is costly and before I commit to that I want to ask a few more questions about my situation.
1) What is it about the WB that could catch a positive HSV-2 when the labcorp and the quest could not ? Both those test have an extremely high accuracy rate. ( i have read anything from 97-99%). I thought I read recently on another participants question regarding WB and catching false negatives your reply was you have seen it happen 9 times in 33 years. If thats true, the accuracy of the elisa/ herpes select is pretty darn good.

2) I read over on the medhelp site that Dr.HHH said that test results always trump symptoms. If my WB comes back negative can I move on knowing for sure I am negative regardless of symptoms of women I am in a relationship with or even my own ? Is the WB that much more accurate than the ones I have already taken ?

3) I have read on the boards that if what someone might think is a herpes blister{single) and its filled with a white substance,breaks open, doesn’t ulcerate, isn’t painful, then just dries up flaky without a scab then its not herpes…true or false ?

4) Strangely enough I did have one of these in the last 2 weeks.(i took a picture). BTW it looked absolutely nothing like what I had in my initial episode 5 years ago. Can herpes appear in different forms in different outbreaks or will they generally take on the same appearance ?

I ask because I believe a swab test is probably the gold standard in testing as long as its done the first day or two of appearance, with the WB the 2nd best option. I could wait around for a possible blister but who knows when that would be and I can’t run to the dr. every time I think something might be a herpes blister.

Thanks in advance for your reply !

[Terri Warren]

1) What is it about the WB that could catch a positive HSV-2 when the labcorp and the quest could not ? Both those test have an extremely high accuracy rate. ( i have read anything from 97-99%). I thought I read recently on another participants question regarding WB and catching false negatives your reply was you have seen it happen 9 times in 33 years. If thats true, the accuracy of the elisa/ herpes select is pretty darn good.

No, the questions was how many times have I seen a positive swab test and a negative western blot.

2) I read over on the medhelp site that Dr.HHH said that test results always trump symptoms. If my WB comes back negative can I move on knowing for sure I am negative regardless of symptoms of women I am in a relationship with or even my own ? Is the WB that much more accurate than the ones I have already taken ?

Honestly, I don’t think for HSV 2 that the western blot is a lot better than the ELISA, it might be up another couple of percent.

3) I have read on the boards that if what someone might think is a herpes blister{single) and its filled with a white substance,breaks open, doesn’t ulcerate, isn’t painful, then just dries up flaky without a scab then its not herpes…true or false ?

I would say herpes is unlikely . I would not say it is not herpes by any description alone.

4) Strangely enough I did have one of these in the last 2 weeks.(i took a picture). BTW it looked absolutely nothing like what I had in my initial episode 5 years ago. Can herpes appear in different forms in different outbreaks or will they generally take on the same appearance ?

I think recurrences generally look the same but are likely far less severe than first infections.

I ask because I believe a swab test is probably the gold standard in testing as long as its done the first day or two of appearance, with the WB the 2nd best option. I could wait around for a possible blister but who knows when that would be and I can’t run to the dr. every time I think something might be a herpes blister.

If culture is being used vs PCR, it is not better than western blot and even if it is PCR, several conditions can impact the results, mostly including time from symptom appearance to swabbing.

terri

Thanks in advance for your reply !

[rollingstone1]

Some additional questions
1) would a missed Elisa test increase the odds that the WB will miss it too or does the WB stand on its own without regard for the Elisa results ?
2).A high positive Elisa always results in a positive WB
3) A negative Elisa and a positive WB = Positive ?
4) I sure wish my negative test would have come with a specific # and not just < 0.91. Would that have helped solidify my negative result?

Thanks Terri…you are definitely helping me !

[Terri Warren]

1) would a missed Elisa test increase the odds that the WB will miss it too or does the WB stand on its own without regard for the Elisa results ?

The western blot stands on its own.
2).A high positive Elisa always results in a positive WB
Usually, yes though I have had a patient with a 4.8 on the ELISA not confirm on the ELISA

3) A negative Elisa and a positive WB = Positive ?
Yes

4) I sure wish my negative test would have come with a specific # and not just < 0.91. Would that have helped solidify my negative result? well, I would be more confident with a .02 than a .70, yes Try asking the lab for your exact value Terri

[rollingstone1]

Hi Terri,

A few more question regarding false negative and the western blot.

1) Would several false negative on the Elisa increase the odds of the Western blot also being a false negative ? Once missed always missed ?

2) I would assume that if the western blot is considered the gold standard for blood testing HSV. then there must be more extensive steps done within the western blot to give it the gold standard rating…Is that correct ? Or is that just for HSV-1 and that’s why it picks up more missed HSV-1 ?

3) In the 97 % accuracy of the Elisa HSV-2 …is the 3% missed false negatives or false negatives and false positives combined ?

This was my last post. Thanks for all you do !

[Terri Warren]

No, a repeated negative ELISA doesn’t necessarily mean the western blot will agree.
Yes, there are more extensive steps involved in the western blot. Many more steps to get clarity, yes.
The 3% is missed positives, compared to people who are culture or PCR proven

Terri

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