This study is kind of scary

[marky]

Hello Nurse Warren… your site is a godsend! Last year I got out of a relationship with my ex girlfriend who had genital herpes type 2. I figured I would get tested and that would be the end of it.

I did a herpeselect after four months and then a Western Blot after seven or eight months. Both were positive for HSV 1 (pretty certain I’ve had it orally since childhood) and negative for HSV2.

I ran across this study on the herpes forums though, that really scared me, and I cant find any info that is really conclusive.
http://journals.lww.com/stdjournal/Fulltext/2003/04000/Time_Course_of_Seroconversion_by_HerpeSelect_ELISA.7.aspx

It’s by Anna Wald claiming that the Western Blot only picked up 87% of hsv 2 infections from people who already had hsv 1 (people like me!)

Now the article does also say:
Nine of 113 subjects—3 infected with HSV-1, 3 with HSV-2, and 3 with nonprimary HSV-2—did not seroconvert by either test (median follow-up time, 38 days; range, 15–167). Thus, for both HerpeSelect and WB tests, apparent failure to seroconvert may have been a function of short follow-up time.

So it is possible that the 3 nonprimary folks who failed to seroconvert were tested too early, but the study never tells us WHEN they were tested, just gave us a collective day range for all three groups.

What I am asking is, how can we trust a Western Blot if the only published info says 87% or 1 out of 7 folks may get a false negative? I come to this forum to ask, because I know you have worked closely with the University of Washington and probably directly with Dr. Wald. I thought about maybe trying to contact Dr. Morrow (didnt she invent the test?) What has been your experience through the years?

[Terri Warren]

That study is almost 10 years old. The timing of the blood draws is unclear and also antiviral therapy, we now know, can definitely impact development of detectable antibody. I think if I asked Anna now (and yes, we work very closely together), she would say that the vast majority of people who are going to become positive on the western blot will do so by 4 months if they are not on daily antiviral medicine. And it is also true that HSV 1 people take longer to seroconvert but not a huge amount longer. Maybe a month. I have had 9 culture positive patients over the 33 years in my clinic who have not serconverted on western blot ever. There could certainly be more but I don’t know about them.

My opinion? Accept the western blot status and move on. You’ve done a terrific job of accurate and reliable testing. What else can you really do? Most people would have just accepted the ELISA but you went even further. At some point, you will need to accept these and move on with your life. I hope it is now.

Terri

[marky]

i didnt think about if they were on suppressive therapy… I wonder if that played a role? Can I ask, Nurse Warren, how big of a percentage are those nine patients? Have you seen hundreds of patients with culture proven hsv2′, thousands?

I know nothing is definite in biology, and medical people have to cover their butts when they say things for legal reasons, but the lack of clarity sometimes can be hard to deal with…

“…the vast majority of people who will become positive by western blot will do so by 4 months…”

I appreciate the encouragement, but what does that mean? Does it mean that the vast majority of hsv2 infected people will become positive in four months because the western blot is accurate, or does it mean if you are lucky enough to be a person in the 87% (or whatever) that the WB has the capability of detecting then you will good in four months… see how the language is fuzzy?

I hope this doesnt seem like I am badgering you or the point.. I am not the kind of person who stirs the pot like this, but this is just serious stuff for some people… sometimes i wish i could be less cautious and be free in the wind like some folks, but im not built that way…

[Terri Warren]

Oh, thousands, for sure. But not all of them have had western blots – if they have a positive culture, for practical purposes, they don’t need a western blot.

Yes, the vast majority of people who are infected with hSV 2 will become seropositive on the western blot within four months IF they don’t take suppressive therapy. I would say two weeks of antiviral therapy would not impact the western blot at 4 months but longer, might. We have had a person be on suppressive therapy for 9 months, starting when she was first diagnosed, and she did not seroconvert until we pulled her off therapy to document her infection (she did not have a positive swab test, only a visual exam due to cost).

I don’t feel like you are badgering me. I do think you’ve done what you can to determine your antibody status. I wouldn’t at all describe you behaviors as casual or not cautious.

Does that explanation make it any clearer?

Terri

[marky]

Hello Terri,

this thread is 6months old now, and I can happily report your words have gone a long way in the last six months in my moving on. I re-read this exchange whenever I get nervous and then I feel better. I had hoped you could answer one more thing, and it is nit-picking for sure, but I am sure you are used to use hyper nervous folks scrutinizing every detail…

but here goes:
When I asked about the 9 patients that swabbed positive and never blood tested positive, you said they were a tiny fraction of thousands of patients, but not all patients got tested after their positive swab because the diagnosis is already made at that point.
Is it too much to ask for you to ballpark the amount of patients you swabbed positive and then you blood tested positive? I think if we want to gauge how often the western blot makes false negative results, that group of people who had both swab and blood tests to look at would be the population of relevance, right?

[Terri Warren]

I’m glad that the post has helped you.
That’s correct – many people with a positive swab test do not get tested subsequently. Some do, for sure, just because they want to confirm their diagnosis and some are trying to time their virus acquisition date. I don’t really have a percentage that I can give you. Lots of our patients we diagnose by swab test also enroll in herpes studies at our clinic and they have to have a positive western blot to participate so that adds to our numbers as well.

Terri

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