[Question #1352] genital hsv-1 and igg testing accuracy

46 months ago
I have been having lesions on a regular basis ever since i received a hand job at a massage parlor. The girl was putting spit on her hands and vigorously rubbing me on my penis with it(also licked the bottom part of my penis, never inserted in to her mouth). within a week or so i had some discomfort and burning  . i never had any blisters, just redness and paper cut type sores. I went for the Herpes Select test after 12 weeks and six months. The test came back negative both times. Im am very confused based on what i have been reading about accuracy of test . I have read several comments from all of you with different responses as it relates to picking up HSV-1. I have read several responses from Doctor H about the test missing  10-15 % of infections. I recently read a response that Terri gave that said it misses up to 25% of infections. Does this mean per test ? or does are those numbers based on the individual regardless of how many times they take the test ?  My doctor put me on Valtrex for the last 90 days, but it doesn't seem to have helped these episodes. Especially the frequency of them.   The episodes have been monthly or what seems like twice a month. According to some posts i have read from Doctor H . he has never seen someone having genital herpes after a negative blood test after three months. Does he not consider hsv-1 genital the same as hsv-2 ?  Or was he only referring to hsv-2  in his example about negative blood tests because that typically is worse than hsv-1 of the genitals. I thank you in advance for your responses . 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
46 months ago
In our most recent study (paper being submitted for publication now), the Herpeselect ELISA IgG missed 30% of HSV 1 infection.  This means that there is a 30% chance that if a person has waited long enough for have the test done (which you have), the test will miss 30% of people who have HSV 1 infection.  And in my experience, once the test misses an infection, it will miss is almost every time.  If the Valtrex does not help and you've noticed no blisters and it is coming as frequently as twice a month, this is very unlikely to be HSV 1.  I don't know if Dr. Handsfield's comments related to HSV 1 or HSV 2, but I have certainly seen people who have genital herpes and negative antibody tests, particularly HSV 1 due to the poor sensitivity of the HSV 1 IgG test.  That's not to say you have HSV 1 - I don't believe for a moment that you acquired HSV 1 from getting a "hand job" at a massage parlor.  . 

Terri
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46 months ago
Thank you for your response. What is the accuracy for Herpes Select for hsv-2 ?  My doctor did look at my penis and felt the sores could be herpes.  I asked about blisters and he said herpes can present sub-clinically .  As i mentioned , it looks like paper cuts, not blisters.  Truly confused at this point in time. I appreciate you taking the time to respond. All the best 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
46 months ago
Compared to the gold standard of herpes western blot, the IgG test picks up about 93-95% of HSV 2
"present" and "subclinical" are opposites - presents means there is something to see and subclinical means there is not.  Maybe what he meant was that herpes can present atypically - without blisters, and that is true.  But again, if you have HSV of either type, it's not from the massage parlor experience.

Terri
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