[Question #3430] Viral Test Windows

35 months ago
There seems to be a lot of misinformation (or different interpretations) regarding testing windows due to viral load on the web. I have also witnessed discrepancies in test windows for the same STI tests performed by different test providers.

How much time do you recommend to your patients to wait before they test for viruses such as HSV 1/2, Hepatitis A-C, and HIV 1/2 and what would be the accuracy/sensitivity of the test at this time periods? Is there also a viral load period for an HPV infection (I don't believe there is a blood test, but not sure)? For clarity, I am assuming that the test provider would use IGG testing for HSV 1/2 (not IGM) and Gen IV testing for HIV.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
35 months ago
Welcome back to the forum, but sorry you found it necessary. I scanned your recent thread with Dr. Hook and agree with all he said.

Before answering these questions about test performance and timing, I would point out that for some STDs, testing alone is rarely the final last word in whether or not someone is infected. Exposure history, symptoms, clinical exam, and overall expert opinion often are more accurate. This is especially true for HSV and HPV. And the time we advise waiting for definitive results also can vary from one clinical situation to another. With those caveats, in general:

HSV:  IgG test only, never do IgM, which is inherently unreliable with both false positive and negative results. However, many providers don't know this and labs routinely offer IgM testing. Whendone, the results should be ignored. HSV blood tests, primarily IgG, are better studied for HSV2 than HSV1. 80-90% of newly infected people have positive HSV2 IgG results by 6-8 weeks, but it takes 16 weeks to reach nearly 100% sensitivity. 1-2% may remain falsely negative; for HSV 1, up to 30% remain false negative.

HPV:  No blood tests are available either for antibody or viral load. DNA testing (e.g. in pap smears, biopsies, etc) is sometimes used, but true test performance not known. A positve result probably is always reliable, but false negatives probably are common. In general, it is believed local testing doesn't become positive until a few weeks after exposure.

Viral hepatitis:  A, B, and C all conclusive by 6 weeks. However, hepatitis testing rarely is recommended or done after any single exposure, except to known infected partners.

HIV (both 1 and 2):  The main test is antigen-antibody (4th generation), which can be positive as soon as 10-14 days after exposure and is almost always positive (96-98%) by 4 weeks. But 6 weeks is necessary for absolutely conclusive results.

As for when I recommend patients be tested, it depends a lot on the particular clinical situation. For example, if I think a particular infection is quite likely, I would generally start testing well before the end of the window period, and once or even twice more to the end of the window period. If the risk was low, generally a single test after the far end of the window. One size doesn't fit all.

HHH, MD
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35 months ago
Dr. Hansfield, 

I appreciate the reply above and review of my post. I was seeking to clarify testing windows as I took an expensive panel test (5 months post any exposure) and realized that I did not have a fundamental understanding of testing windows. The fee to ask this question is worth the education. Frankly, I am not concerned about having HIV or Hep.  I was concerned that HSV (the test has ruled out HSV-2 at 3&5 months) and/or HPV could be causing my symptoms (I am HSV-1 positive).  

As noted, I have inflammation/redness of the glans, slight swelling of the glans region, a constant dull/irritating pain in the urethra (by the frenulum)/meatus (sometimes other sensations such as a wet or tingly feeling) and post-void dribbling, as discussed in my prior thread. Strangely, the glans of the penis swells (balloons larger than normal) during an erection, causing the meatus to gape open near the bottom. It "calms" down after a period of time and shrinks to normal size, where the meatus closes. I have observed fluid in the urethra (not ejaculation fluid) during an erection as well which I believe is urine.  From all of the information presented to me, my symptoms appear to be unique and I am really trying to rule out any possibility of an STI. 

I have remained undiagnosed which is a tough pill to swallowI have been to 3 urologists and now have had 2 pass me on to someone with a more developed set of experience.  The way that I see it, this is a methodical process and I need to rule out possibilities before moving to a next step. The next step presented to me was a recent referral to a reconstructive surgeon to investigate a distal urethral diverticulum. 

Do you have any additional thoughts beyond Dr. Hooks to share or any ideas on further testing? CMV, Adenovirus? etc... Giving blood for a test is much easier than being cut...


H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
35 months ago
I took another look at your discussion with Dr. Hook. I disagree your symptoms "appear to be unique":  this forum handles things pretty much like this quite frequently, in general terms if not in all the details. There are no STDs, including HPV, that cause any of the symptoms you describe. (HPV is never painful, for example -- except when especially large warts become fragile and cracked, with bleeding, secondary bacterial infection, etc.) Like Dr. Hook, I am confident that your symptoms are not due to any infection, sexually transmitted or otherwise, from the sexual exposure you described in the other thread. Not only are the symptoms incompatible with any STD, but the exposure itself was not one that can transmit STDs. I have no comment about the possibility of some sort of anatomic anomaly of your genital tract -- but if that's the explanation, obviously it isn't something acquired sexually. While I hope that further expert consultation with the reconstructive surgeon (or some other specialist) is able to come up with a clear explanation, and ideally an easy fix, I would caution you about going too far down that path -- and frankly, if I were in your situation, I cannot imagine seeking a surgical solution. There is nothing in what you describe that sounds at all dangerous or serious in any way, i.e. that will ever harm you or your current or future sex partner(s). Sometimes we humans have to live with unexplained symptoms. Usually we do that just fine, once we understand it's nothing serious.

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35 months ago
Thank you for the response and I appreciate your comment about the surgical path. It would be the last resort option for me. You can close the thread as I have no additional questions at this time.

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
35 months ago
Thanks for the thanks. I hope this additional discussion has been helfpul. Best wishes.---