Remain uncertain of herpes diagnosis

[Lee76]

Hi. I would like some expert advice around conflicting results over herpes. 10 years ago I went for a routine STD screen in a private clinic following the end of a relationship. Part of this screen was a vaginal swab for herpes. To my shock this came back positive. This was not typed. I had no symptoms at that time and following reading up on diagnosing herpes I was puzzled why they swabbed me at all in the absence of symptoms. From my reading I am aware that people can assymptomatically shed.Anyway at the time I accepted this and watched and waited and nothing happened. . Because of the shock I followed this up with serology testing over that next year to allow time for seroconversion. 3 blood tests over that year all came back negative for type 1 & 2. The specialist told me that it could have been a mix up and advised me to move on, which I did. During the past 10 years I had a further 4 serology tests in between 2 serious relationships more out of vigilance and wanting to know for sure. All came back negative again. I have not noticed any symptoms during these years, nothing that Im aware of anyway. But after a stressful year I tecently noticed some unusual tingling feelings in my legs. They aren’t painful, they aren’t long lasting and tend to be in L4/5 distribution (I’m a Physio so am very knowledgeable on neurological symptoms) I don’t feel it is musculoskeletal. There are never any outbreaks following this so I’m not sure if this a prodorme symptom.

My questions are: 1) can people who have herpes never have detectable antibodies on serology testing? 2) can people just have mild tingling in their legs with not having outbreaks? Is that a common symptom? Thank you

[Terri Warren]

Yes, a very few people can have a negative antibody test and still be infected. However, given that they swabbed you with absolutely no symptoms (which of course was an error as you know), the possibility of a false positive or mixed up samples is still present. Also, the antibody test misses about 1-2 of 10 infections with HSV 1, so that could also be going on. If the test misses it once, it tends to miss it every time. If you want to absolutely rule out HSV 1 infection you will need a western blot from the University of Washington.

So hard to know if the tingling has anything to do with herpes or not. That could be many things are you know from disc issues to MS, big wide range of things that could cause that. If you obtain a western blot and are still negative for both, I would chalk the tingling up to either over observance of body symptoms or something completely different than herpes.

I can understand why this must be a confusing situation for you!

Terri

[Lee76]

Hi Terri. Thank you for your prompt and professional response. Yes your are right it has proved confusing and the frustration is just not knowing either way. I had moved on from it but with the new relationship I’m in it became an unanswered issue again. I know that I do have to just move on from it with the uncertainty and conflicting results and part of this I guess had been contacting your services to guide me. I just have a few final questions for you if that is okay?

1. Is serology testing (7 in total over 10 years, all negative for HSV1 & 2) likely to have detected the HSV 2 antibodies definitively do you think? From your previous response and from reading I get the impression that HSV 1 has less accuracy in detecting antibodies to this strain. And I guess this raises the possiblity that if I am positive that it is more likely to be HSV1 rather than HSV2, especially in the absence of obvious symptoms during this 10 year period.

2. Can people who don’t reside in the USA (I live between Australia and NZ) find a way to get a Western Blot. I’m thinking that this is unlikely, but I thought I would ask anyway. This does seem to be the most accurate for serology testing.
Thank you again for your time and expertise. 🙂

[Terri Warren]

The serologic testing you had done would likely pick up, with 97% certainty, HSV 2 infection. So that really does leave HSV 1 as the possible culprit. I do believe that western blot testing is available in Australia, though I can’t tell you how to get it exactly. There is a well known herpes researcher in Australia named Tony Cunningham. I have known him for many years. I believe his contact phone number is +61 2 9845 9005 If you can’t find the western blot or Tony Cunningham, if you can get blood drawn and send it to my clinic, we can arrange to have it run for you. That would need to be accomplished through my clinic, not through here. If there was ever someone who needed it, it’s you with a positive swab and negative antibody tests

Terri

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