Accuracy of Herpes Antibody Tests

[Ellen704]

About five years ago, I had a lesion on my vagina that was thought to possibly be herpes.  It was cultured and the result was negative.  About a year later, I had an HSV Type 2 Specific blood test that also came back negative.  About a year after that, I had another Type 2 Specific test from another provider that was also negative.  In subsequent years, I had two more Type 2 Specific tests and two Type 1 Specific tests; all results were negative.

I recently had another test from yet another provider that tested for the Type 1 and 2 antibodies separately, but the same test also gave a composite, non specific test result.  The Type 1 and 2 Specific results were negative, but the composite was positive.  How is this possible?  The provider who gave me this last test said the positive result could be the result of another kind of herpes antibody present in my system such as chicken pox.

Over the years I have worried excessively regarding this issue.  However, to my knowledge, I have never had any more lesions.  I have been checked many times.  The thing I am worried about is that I have a lot of irritation and my vagina is red and painful much of the time.  It stings and I will have shooting pains.  Also, the pain mostly occurs on one side, but it is red everywhere.  I have been told by many health care providers that it is just irritation, but I can't help but think that it is attributable to herpes.  Are recurrent symptoms usually typical in appearance (such as sores or lesions) and should I trust the doctors that the irritation is not attributable to herpes?  Should I get a Western Blot test or should I trust the knowledge of the health care providers that I have dealt with who say these tests are accurate?

As a final question, if one does have herpes, should one wash their genitals to avoid spreading the disease to other areas of the genitals; like after having intercourse?

Any response that you can provide will be greatly appreciated. Thanks.

[Edward W Hook, MD]

You are asking good questions.  To cut to the chase, you do not have herpes.  The lesion that you were concerned about five years ago was culture negative and since then you have had several antibody tests which show no evidence of herpes whatsoever.  There is little more that you need to do to prove that you do not have herpes.  As for a Western Blot test, these tests are very good at sorting out positive and equivocal tests but add little diagnostically to folks who have negative antibody tests (Put another way, they are no more sensitive than the other blood tests, they just do a better job of differentiating which virus is present or in sorting out false positive tests from true positive tests).  The combined tests are a mess - I ignore them and would urge you to do the same.

Regarding your vaginal irritation, I will not dismiss it and that other health care providers have attributed your irritation to other causes suggests that they do not dismiss it either. AT the same time, the evidence is very much against this being herpes.  While I cannot tell you what the source of the irritation is, I can comfortably tell you that is not herpes and would suggest that you work with a health care provider to address it.  Sometimes these things take a bit of trial and error.

I hope this helps.  Take care.  EWH

[Noob12]

I wish more women would be as responsible as you. I think you are fine, if all of these test have come back negative, you are probably fine; especially since you have had them a year apart? One thing though, you didn't mention if you had partners after you had these tests. If you did, the test results are only good after about 3 months (for the most part; there are no absolutes) after your last encounter. You should not have sex with anyone for 3 months and then get a test. That is the only way you can know for sure.