[Question #1592] HSV diagnosis? IgG vs. Western Blot?

44 months ago
I was checking email before bed and happened to see your post. Thank you so much - this is huge to have what I previously would have considered a very risky event (touching a herpes lesion and then touching someone's genitals) be definitively placed in the "non-risky" category. This could help me let go of all kinds of situational concerns, without feeling the need to ask about them individually. I also saw your response to another user concerned about her child touching an Abreva pump, and found that vastly reassuring as well. 

I went ahead and opened this thread so that there would be an avenue for you to post if you happened to hear from Dr. Wald at some later date (although I already feel much better about the respiratory droplet stuff given the example described above as being a non-risk). I wouldn't expect a post anytime soon - I know you and the doctor have many other more pressing obligations. But if eventually she makes a comment, the thread is here. And when I get the results of my Western Blot (I have it set up with my doc to be drawn and shipped on Tuesday) perhaps I will let you know. Thanks again:)
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
44 months ago
Thanks, Leslie.
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44 months ago
Hello. I expect the results of my Western Blot any day now. I understand that even if it comes back positive, that does not necessarily mean that the ongoing symptoms I've been having inside my mouth are herpes (in other words, I might be an asymptomatice carrier of the virus who happens to also have some other unrelated mouth issues). Correct?

However, I would also like to ask a question in regards to the possibility of the test coming back negative for both Type 1 and Type 2. Since you have done extensive research with the Western Blot and herpes, are you able to tell me if you are aware of any cases where someone has had a POSITIVE  swab (either PCR or culture) for herpes, but the Western Blot has come back NEGATIVE?

I understand that the Western Blot is the very best blood test for herpes. I was just wondering how much stock I could put in the results if by chance (and praise God) they were to come back negative? I still have the lesions in my mouth, but it sure would be nice to lay this whole herpes thing to rest. 

Also, any thoughts as to WHY the Western Blot is so much more accuratethan the traditional IgG tests? This so just a question of curiosity. Do you think it will become a more common method of testing after your research is published about the IgG missing 30% of infections? (I thought I remembered reading a different one of your posts where you mentioned to someone else that your research was going to be coming out soon?)
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
44 months ago
Correct.  Even if the western blot is positive it doesn't mean that what's going on in your mouth is HSV - that could be determined only be swab tests. 
Yes, I have had nine cases in my 33 years career of someone having a positive HSV 2 swab and a negative HSV 2 western blot, and I have ordered literally thousands of western blots in my career.  But this isn't your situation, right? You don't have a positive swab test.  So I'm not sure why you asked that particular question. 
The standard IgG tests look for a single protein associated with the herpes antibody - one that is different between HSV 1 and 2.  The western blot, on the other hand, looks for all of the proteins associated with the herpes antibody (1 and 2).  So here's how I think about it.  The IgG test is like identifying a person by their first and last name.  The western blot is like identifying a person by their first and last name, their address, their phone number, their eye color, etc. 
I don't think western blot will be more common for testing because it is not a mechanized test - that is, you can't do a western blot by a machine, it has to be read by three different people, which is time consuming and one must have incredible technical expertise to read it.  I have looked at positive blots and have just NO IDEA how they can read such fine changes as I have had pointed out to me. 
I'm hoping the paper is moving smoothly through the channels for publication - I got a rough draft months ago and suggested revisions but have not heard back yet.   These publications are handled through the University of Washington (in this case) and sometimes they take a while because several people are working on one paper and each person has to submit their revisions - sometimes they have other responsibilities as well so it takes a little while.
Dr. Wald said is someone was doing a bronchoscopy (exploration of the lung area with a machine) and they had herpes pneumonia, there is POSSIBLY a risk.  That is clearly not your situation.  So the answer is in certain specific situations, there may be some low risk but the situation you describe is not that situation.  I think you should put this worry behind you.  And in your situation, we don't even know if you have HSV 1, right??

Terri
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44 months ago
Hi there. The reason I asked is b/c my Dr, although willing to order the Western Blot, still seems skeptical as to whether a negative result would be definitive in terms of saying i DON'T have HSV. She really seems to think that my body might just never seroconvert in a detectable way. Her skepticism kind of makes it hard for me to be hopeful. Since the WB is the most superior blood test for HSV, I was just trying to think through the logical reasons why i SHOULD be confident in the results. Because I do want to be confident:)

When you say the IgG misses 30% of people infected with HSV, I'm assuming that comes from people whose IgG comes back negative but their WB comes back positive. And perhaps some of them have also had a positive swab for HSV 1? At any rate, I am convinced that the WB is much, much better at detecting HSV than the IgG. 

So then it seemed that the next question was whether there was any evidence that the WB does still miss some infections. I figured the only way to know that (since there is no other superior blood test), would be to ask if the WB had ever come back negative for someone who had a positive swab. And you are correct, I myself haven't had a positive swab - I'm just trying to bolster my confidence in the test, especially in light of my doctor's lack of confidence. She of course doesn't think it's a big deal even if I do have HSV.... She just doesn't think there is really any way for me to ever know for sure. I, on the other hand, would really like to believe that if, in the statistically unlikely event that my WB comes back negative for both HSV 1 and HSV 2, I could just drop this whole HSV thing altogether &move on. I want so VERY much to trust the results. I'm just fighting almost 2 years of a habit of worry - & my dear doc, who only wants to help but who sometimes unintentionally leaves me w/more worry than I already had.  If my WB comes back positive for HSV 1, then I can live w/that &still proceed w/swab tests to try to determine whether any of my lesions are HSV or not. If the WB comes back negative, though, I just want to be prepared to EMBRACE that and move on. What a gift that would be. So my specific ?'s are:
1. I packed my sample per the instructions, in a cold pack & labeled w/biohazard stickers, etc, from the kit. Shipped FedEx overnight. If, during shipping, the box was placed in a cargo area & became frozen (as the weather outside was below freezing), & perhaps later thawed before being received at UW, could that freezing &thawing somehow denature the proteins enough as to cause a false negative result? Or would the lab be able to tell if the sample had been compromised during shipping?
2.In your opinion, if my WB were to come back completely negative, what degree of confidence should I have that I do not have HSV?
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
44 months ago
I think perhaps you are seeking more certainty than the current technology and testing scene can provide.  Could the WB miss some people?  Yes, we know it can, but very few.  What is the likelihood that you would be one of them?  At some point, I think you are just going to have to accept some level of uncertainty, some very small level, and try to help yourself to live with probability, not certainty.  I probably don't have to tell you that this kind of worry is a type of OCD, right?  It would be so helpful if you would pursue some cognitive behavior therapy about this - it's the perfect approach to these kinds of worries.
Yes, the 30% missed is compared to western blot - the same samples were tested by ELISA and western blot, correct. 
We freeze serum sample for 10 years sometimes before ever analyzing them by western blot so yes freezing is just fine. 
I think you should be certain you don't have HSV if it is negative for HSV 2 at well over 99% and for HSV 1, likely close to that though we don't have as much research on this.
I am going to leave this thread open for one most - your western blot results.  Our conversations are bordering on breaking the rules of this particular website - that is, continuing to respond to anxiety driven questions.  So after your results, we'll need to shut down this conversation.
Best
Terri
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