> I've read that serological (ie, testing for the antibodies) based tests are
> useless for testing for herpes since many if not a majority of people will
> test positive for the antibodies but not actually have the virus in them
> (but they may have had some limited past exposure).
No sorry that simply isnt true. Herpesviruses set up life long infections
and so the vast majority of people with any sensible level of antibody
will be carrying the virus. There will be a few exceptions, but they will
be vanishingly small in number, Im possibly one having been exposed to
vast numbers of proteins from these viruses in my time but avoiding
gettign near my infectious stocks (although by now Id expect my antibody
levels to be declining since I dont work on the virus anymore).
This is a distinct difference from most viruses which infect and are then
cleared completely from the body and leave behind an immune response for a
significant period of time. For most viruses then your statement above IS
correct positive antibody gives a measure of exposure/immunity and not
presence of the virus, but herpesviruses sit outside that classification.
You will get a much higher level of serological positives than you get
people with disease - if people assume this means that the serology
is only picking up past exposure and not current risk and that those that
are positive yet have no disease are mistakes then they are missing
significant points in HSV biology, namely silent infections, asymptomatic
transmission, recurrent infection, latent reservoir etc etc etc
Serological tests DO have limitations, the main one being that they cannot
tell you what location is infected on an individual. They measure a
systemic response to infection after all, so an HSV1 or HSV2 positive
response doesnt say where you are infected - although HSV2 positive gives
a fairly strong indication. HSV1 unfortunately runs into a barrier here -
about 1/3 of new cases of genital herpes are HSV1 which most people assume
is just cold sores on the mouth...HSV1 serology therefore aint
terribly helpful in many cases for trying to decide if a person has
genital herpes - although a positive result says they have HSV1
somewhere.
However that effect is based upon problems with identifying location of
infection and specific infectious agent - NOT that the tests see old
infections and fail to show where the virus is.
Another limitation if I remember correctly is in disease strike rate.
Serology cannot reliably say if an infected individual is going to get
recurrence and at what rate.
> The only true test would be a culture based exam, to see the actual presence
> of the virus.
Culture/lesion scrape based exams can answer this question...'Are these
lesions here and now herpetic in origin' - at least potentially - and
thats something no serology test can do. Timing of presentation to
a doc and other technical issues give high false negative results, which
is why serology becomes important.
What the art of medical practise does is take the solid answers from a
series of tests specific to an individual, look a the information for
populations on a given disease and use that info to assess the most likely
issue for any patient - that will include things like what lesions do they
have, where, what about their partners, what agents does the serology say
they have, what was negative, did I get a decent culture, do I want to get
another and so on.
> Is this true? Or is it impossible to have the antibodies but not have the
> actual virus?
The basic premise that serology picks upa swathe of people who dont have
virus in them and have merely been exposed is false.
As to the question of is it impossible to have antibodies and not have the
virus...
<scientist mode>
Its not impossible,
<end scientist mode>
....but the conditions and results of those conditions required to observe
this are rare eg natural immunity resulting in clearance [note Ive not
heard of a case of this but its theoretically possible and Ill be surpised
both if it hasnt happened and also if anyone has ever actually spotted it
reliably], working with components of the virus that produce a reaction
but never have live virus present (thats basically one way to vaccinate
remember) and so on. THey are also not going to result in reactivation and
rechallenge so the immmune system the antibody response is likely to wane
over time.
Such an event are vanishingly small such that serology is going to be as
reliable for telling you if you are infected or not with HSV1 or HSV2 as
any culture test.
Ask a question that serology cannot answer (see above) and then it will
fail you - but thats a question of asking the right question and using the
right tool to answer it, not the basic validity of the test.
Tim
--
When playing rugby, its not the winning that counts, but the taking apart
ICQ: 5178568
Yoshi2me - 12 Jun 2006 02:43 GMT
Just wanted to add a little to what Tim said...
http://www.yoshi2me.com/genital-herpes.html
Hope this helps,
Angela :)

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