[Question #3670] HIV and HSV Test

35 months ago
Hi Doctors,

In my interaction with Dr. HH he mentioned that IGM tests are useless for HSV. Post exposure at 30 days and 65 days twice I had taken HSV 1&2 tests both IGG and IGM and fortunately they both were negative. Dr. HH had said for a more conclusive result I need to wait 16 weeks. So yesterday at almost 175 days post exposure - almost 6 months I went and took 3 tests.
1.)HSV 1&2 IGG by western blot - negative. Your opinion on this test.
There was an option of HSV 1&2 IGM by western blot but I opted for the IGG by western blot test. Hope I made the right decision.
2.)I also took a test called RPR. I guess this is for syphillis. At 6 months is this accurate?
3.)I also took an HIV test but again from the same lab and same CMIA test. HIV1/2 antibody and p24 Combo test at almost 6 months post exposure. This is my 5th Combo test from the same lab. I have taken the same test at 30days, 65 days, 82 days, 137 days and  now 175 days post exposure. Hope at 6 months the test is fully conclusive and 5 Combo tests are hopefully not missing an infection because I have swollen lymph nodes and a white tongue post exposure. Do you suggest I take a western blot test to definitely exclude HIV? 
I should add I have taken two PCR RNA HIV 1 tests at 10 days and 82 days post exposure but no PCR RNA for HIV2. 
4.) I have also taken a HEP C RNA test the results for which haven’t yet arrived. I had taken a Hep C antibody test at 65 days post exposure which was negative but I wanted to confirm with an RNA test now at 6 months.

Please let me know what do you feel about my testing and have I taken the right tests ? I also took a CBC and everything normal except  MPV - Mean Platelet Volume cane at 10.8 which was above the normal range. Does this indicate anything? 
35 months ago
Hi
Just got my HEP C RNA result and it’s not detected. Now can I rule out HEP C basis this RNA test after 6 month of exposure and a 65 days HEP C non reactive test put together ? 


Edward W. Hook M.D.
Edward W. Hook M.D.
35 months ago
Welcome back to the Forum.  I'll be answering your questions today.  All of your testing is now conclusive with respect to your encounter nearly 6 months ago.  It is more than past time for you to stop worrying and stop testing and move forward without more concern and without further questions related to this exposure.  In answer to your specific questions:
1.  This test is fine.  It is now time to stop testing for herpes.  Be.ie e your results.
2.  Yes, this is a Syphilis test and results are conclusive at any time more than 3 months after an exposure (probably sooner) but certainly at 3 months).
3.  Your last 4 tests have been conclusive.  You need to believe the results and look for other reasons for your swollen nodes.
4.  Your hepatitis C results ( which, for practical purposes is not an STI for heterosexuals unless the practice receptive rectal intercourse) are conclusive.

Your mean platelet volume does not have any significance regarding STD or HIV risks.  Take care.  EWH
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35 months ago
Hi Dr.Hook

Good Morning !!

Thanks for replying. Can you please tell me a little more about the certainty of the HSV 1&2 IGG by western blot test I took. The reason I ask for more certainty is because I read on this forum itself that HSV testing is not so reliable. IGG testing is useless as suggested by Dr. HH but also IGG testing is not accurate and has false positives and also misses infections as read by me on this forum - comments made y Ms. Warren.
Was IGM antibody by western blot a better test to take than IGG antibody by western blot for HSV1&2? If yes I will take that test. 
I’m getting this recurring boil/pimple/sore on my lip.
How realisable is the IGG western blot HSV1&2 test and how’s the accuracy. Does this test itself also miss infections ? I made a lot of effort and invested a lot of money to get this test as it’s not readily available in my country. I had to fly to a different city altogether and stay there for 2 days and got my testing done just to be sure. So please let me know. 
35 months ago
The reason I ask very specifically as my partner is HSV 1&2 negative and wants me to be sure if I have HSV 1 or 2. Hence all the effort and flying to a different city and testing. I read the western blot is the gold standard for HSV testing. I just didn’t know which HSV test test by western blot IGM or IGG? Got confused with that. I need to be 100% sure of my HSV status and need your expert advice. Let me know without any hesitation if I need to get the IGM by western blot. I am more than happy to make that effort again to test rather than leaving a chance even if it is minute. Hope you understand my concern. 
35 months ago
I will be highly grateful if you share your knowledge and expertise on the IGG and IGM testing by western blot for HSV. Accuracy and timing , is 6 months enough. I don’t know and hence I’m here. What is the difference between the two? If I asked you before taking the test what would have you recommended IGG by western blot or IGM by western blot for HSV or both ? Guide me and share you knowyBout these tests so that I understand please. 
Edward W. Hook M.D.
Edward W. Hook M.D.
35 months ago
When I answered your question earlier I thought I remembered your earlier posts but was unable to verify it.  I have now gone back and reviewed your earlier posts and verified the repetitive, inappropriately anxiety-driven nature of your questions.  Thus I repeat what I said to you a month ago- "I repeat - "My advice, and my only advice for you is to put your concerns about HIV aside and see a doctor to get their assistance in sorting out what might be truly causing any symptoms that you might have."  None of these additional, self-perceived symptoms warrant any concern.  Your HIV test results are conclusive.  As I indicated before, your symptoms and concerns in no way supercede the fact that you have conclusive HIV test results.  The help you need is with your misplaced guilt and anxiety.  EWH"  Your continued posts represent abuse of our Forum.  Hence this will be the final relies to your questions.  Future questions may be deleted without a response and without refund of your fee This includes continuing anxiety driven questions about HSV..

IgM testing of any sort for HSV is waste of time and money for many reasons.  These tests are frequently false positive and miss infections. 

There are now commercially available Western blot tests that are no more and perhaps less reliable than the HerpeSelect IgG test.  OTOH, the gold standard blood test for HSV is a Western Blot test performed at the University of Washington in Seattle.  Some labs or doctors offices will send specimens to Seattle for this test but many will not.

While nothing in science of life is 100%.  Your combination of repeated negative tests for HSV-2 and the absence of outbreaks is strong evidence that you do not have HSV-2 (HSV-2 virtually never causes oral lesions).  Because the IgG tests for HSV-1 are less reliable than the tests for HSV-2 and given the recurring nature of your lip lesion ,, the best way to determine if it is due to HSV-1 is to have a PCR test done on a swab specimen from a fresh lesion.  Blood tests will be less helpful but again, the University of Washington Western blot is the best blood test for HSV-1.  At 6 months, the tests are reliable.

Please read the warning about repetitive questions above.  My best advice for you is that you would benefit from professional counseling for your difficult to control, inappropriate anxiety. 

EWH

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35 months ago
Hi Dr. Hook

Thanks for replying. I have read your previous replies very well and also took your advice. I have put my concerns about HIV aside as per your advice. I was going to get a HSV test so got another HIV test. I thought all western blots for HSV are reliable and same. 
I didn’t know the only reliable one was At University of Washington. As per what you say HSV testing is reliable given 3 negative tests. What do you feel are the chances of 3 tests missing HSV1. 
I ask because I get confused is it a sore or a boil. It looks like it has pus in it and hurts when I press it. This is the second time it has come at the same spot on my upper lip. Anyway I’m sorry if you think this was repeating myself as this time my main concern was knowledge on HSV western blot testing and confusion of IGG and IGM testing. 
I will not ask further questions of any kind. Thanks for your help Sir. Have a nice day and a wonderful weekend !!
Edward W. Hook M.D.
Edward W. Hook M.D.
35 months ago
Blood tests other than the University of Washington Western blot miss 25% of HSV-1 infections.  As I already said, if you want to know if your lip lesion is HSV-1, the best test on a recurring lesion is a PCR test on a swab taken from a fresh (24 hours or less) lesion.  End of thread.  EWH
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