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Is it possible to have herpes but test negative on a blood test?
vegasgm posted:
Hi everyone,

I'm looking for some advice. I had what I think was an initial outbreak of herpes on my penis back in February. Since that time I have had neuralgia in the back of my legs as well as strange pains/uncomfortable feelings in my penis, scrotum, some of which are quite painful.

I had an iGg blood test done at 3 months which came back negative. At 4 months I had the same test done and it was positive, but the igm was negative. Then at 6 months had the igg/igm test done and all were negative.

I also went to see a urologist who put a probe down my penis to look for internal sores - everything was normal.

The other twist to my tale is that I had a rash on my neck 3 years ago which was cultured and came back positive for HSV 1. But the HSV 1 blood test recently has been negative each time.

My doctor thinks I'm negative and that it must be something else, but I have read that some people don't test positive on a blood test for a long time.

Is it possible that I don't produce antibodies - would that be normal?

So I'm very confused and wondered if anyone had any thoughts or similar stories.

lookingforaccuracy responded:
A note about the blood tests. which can be confusing. Here's in general what I've learned about it in doing some research.

The IgM is a broader and less accurate test for all intents and purposes of detecting a specific type of Herpes simplex. Terri has written before that it does not distinguish between HSV 1 and HSV 2. It also can detect other Herpes viruses present ("Cross reactions") besides the Simplex viruses such as Herpes Zoster virus (Chicken Pox), Epstein-Barr virus and a few others I've seen listed. The test results sheet will usually explain this as well. So, basically, IgM tests 'can possibly' give false positive results in regards to determining HSV1 and HSV2

Also, the IgM tests detect more recent developed antibodies, whether primary or reactivated. (Which, judging from reading Terri's article, is generally the reason some doctors use the IgM test in addition to the IgG test) But again, IgM doesn't distinguish exactly what virus it is detecting. Also, IgM levels can be tested too early before antibodies have developed or too late when IgM levels have declined below detectable levels. Results obtained serve only as an aid to diagnosis and should not be interpreted as diagnostic in themselves.

The IgM level is tested using two different methods. One is the EIA methodology and then it's followed by a confirmatory one called the IFA methodology which tends to be more specific.

So, a result using the EIA method could give an IgM result of "Detected" but then the follow up confirmatory IFA method could give an IgM result of negative, (<1:10) which in effect would cause the overall IgM verdict to be considered negative by a lab. (Makes you wonder why they bother with the EIA method when testing for a specific Herpes Simplex Virus.)

Then the IgG test is the more type specific test ("HerpeSelect") which DOES distinguish between the HSV1 & HSV2. In fact, some clinics only do the IgG test. It is considered more accurate. However, it only detects previous exposure and the level of antibody response may not be used to determine an active infection or disease stage. So, theoretically, if a negative result is found with the IgG test and you suspect that you're still in the very early stages of a recent exposure, then the test is recommended to be repeated in 4-6 weeks to give the antibodies more time to show up.

Clear as mud?

Generally speaking, IgM test results should not be relied on for an exact diagnosis of HSV. The IgG test is the one you want to pay most attention to. Like I said, many clinics order only the IgG test.
lookingforaccuracy responded:
Also, just curious about the probe that the Urologist used. Is that painful at all or is it lubricated well enough etc to prevent any pain? Inquiring minds want to know.
WD2011 responded:
Your first occurance of Herpes can be accompanied by "flue like symptoms", etc, etc. This site has very accurate info as to first occurance symtoms. If you have another set of blisters appear get down to the lab immediately and have them swabbed so proper eval can be done. Did you get a Rx for Acyclovir or other med?

The neuralgia sounds like the typical "prodrome" you get before the blisters appear with herpes. Its a tricky disease, there's oral and genital and you can have both in both places. Refrain from sexual activity during outbreaks, use a condom at all times. Have your doc get you on anti-viral, if they think that's a good idea. Be responsible and notify sex partners in advance--but get proper information. You can spread herpes even with a condom in place (on place?). Its a skin disease and its for life. You may not have outbreaks with any regularity. Something like 45 million of us in US have it. It can be dangerous with pregnancy and delivery.
betsyo1967 responded:
even the best blood tests still miss 1 out of every 10 hsv1 infections. you know you have hsv1 and you know where it is located at regardless of your test results.

does not testing accurately on the herpes igg blood tests for hsv1 mean you aren't testing accurately for hsv2? no it does not. they are 2 totally separate tests and have different levels of accuracy associated with them.

the herpes igm test is a very flaw test and current cdc recommendations are that it not be used in adults for the purpose of diagnosing herpes. it shouldn't have been drawn on you.

when you are getting tested for herpes, are you getting type specific herpes igg blood testing done? also can you get the hsv2 igg result that was positive and post the actual numeric results here for Terri or I to look at - e.g. hsv1 igg .34 and hsv2 igg 1.2 or whatever they are?

will herpes cause non-stop/frequent neuralgia like this? no it does not. you should be seeing a neurologist at this point for a further work up to see if you have any nerve issues causing your symptoms.
Talking about std testing is NORMAL and something we all should be doing EVERY TIME before we have sex with a new partner :)
vegasgm replied to betsyo1967's response:
My most recent results were:

HSV1 0.13
HSV 2 0.33

This was at 6 months post exposure. So both very low negatives....
abe648 replied to lookingforaccuracy's response:
I had similar procedure to assess a bladder issue and it was 0not painful. A bit uncomforable but not painful. Hope that helps you.
Life can go on with Genital Herpes. If you are alone then there is someone who will love and accept you even with Genital Herpes. :-)-
lookingforaccuracy replied to abe648's response:
Thanks abe648. I was wondering. I had some pain while urinating a couple months back. No flu symptoms or fever or any of that. Just a little temporary constipated bloated feeling and the urine pain that came out of nowhere after I woke up from a nap one evening. Anyway, a urine test proved negative for anything, so, the urine pain was never resolved. The pain lasted fro a couple of weeks then eventually disappeared with no problems since. I didn't know about any possibilities of a sore inside the urethra until I read this thread. Dr never mentioned anything either. Otherwise, I probably would have asked about such a procedure. This was all a few months after I had had an encounter with a massgae girl who performed oral. I had also had HSV type specific blood tests done at that time which came back negative also. Anyway, good to know about that procedure and that it doesn't hurt. Thanks again!
evisa replied to betsyo1967's response:
The problem is that when you see a doctor these days and ask to be tested for STDs, they DON'T TEST for herpes. You have to specifically ask for it, otherwise they won't test for it if you just ask to be tested for STDs. My partner & I got tested for "everything" before having sex and then I got herpes anyway because our "everything" tests didn't include herpes!

I'm disgusted with myself for not knowing that I had to ask for a herpes test (not just "all STDs") but I'm even more disgusted by our medical system.

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