Conflictiing Test Results. Any ideas?

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Peter - 26 Feb 2004 02:18 GMT

Hi all,
3 years ago I was diagnosed with HSV2 after about 14 months of various
weird symptoms which totally confused my doctor. During that time I
only showed a classic symptom twice (small cluster of pimple like
things that were very classic outbreak like). They prompted my doc to
do a blood test, and I had a Western Blot which came back as HSV2
positive.

Over the last few years I have had more weird symptoms that were most
likely non herpes related, and continued to baffle my doctor. But
during this time I still never showed any classic HSV2 symptoms.

Fast forward to now. I went and saw a new doc in Jan (who is also an
H specialist) to try and make some sense of what was going on with
me. As part of this he re-tested me for herpes with an EIA type test.
The result came back negative.

So can anyone help me make sense out of these results:
Western Blot +ve 2 years ago
EIA -ve 1 month ago

I know that both tests could give false positives or false negatives.
and I also know of the possibility that over the years my HSV2
antibodies could have dropped off to below the radar. All of this was
confirmed by my new doc.

So what would people suggest? A third independent test? Crack open
the champagne?

So after 2 years of deailing with H I am back in limbo with not
knowing what the hell is going on with me.

TIA
Peter

Reply to this Message

M.L.S. - 26 Feb 2004 03:29 GMT

>Hi all,
>3 years ago I was diagnosed with HSV2 after about 14 months of various
[quoted text clipped - 3 lines]
>do a blood test, and I had a Western Blot which came back as HSV2
>positive.

>Over the last few years I have had more weird symptoms that were most
>likely non herpes related, and continued to baffle my doctor. But
>during this time I still never showed any classic HSV2 symptoms.

>Fast forward to now. I went and saw a new doc in Jan (who is also an
>H specialist) to try and make some sense of what was going on with
>me. As part of this he re-tested me for herpes with an EIA type test.
>The result came back negative.

>So can anyone help me make sense out of these results:
>Western Blot +ve 2 years ago
>EIA -ve 1 month ago

>I know that both tests could give false positives or false negatives.
>and I also know of the possibility that over the years my HSV2
>antibodies could have dropped off to below the radar. All of this was
>confirmed by my new doc.

>So what would people suggest? A third independent test? Crack open
>the champagne?

>So after 2 years of deailing with H I am back in limbo with not
>knowing what the hell is going on with me.

>TIA
>Peter

Hi Peter. Velly strange, indeed.

A false positive from the Western Blot is not very likely.

By EIA test you mean some version of Enzyme ImmunoAssay test? Were
the results quick, like in a few hours?

The only link I've got in the book right now is...

http://cpmcnet.columbia.edu/texts/gcps/gcps0040.html

If there's a weakness in your serological history I would think the
EIA is it. It's certainly more likely to have a false negative than
a false positive.

If you can afford it I'd recommend springing for another Western
Blot, or, possibly cheaper, the HerpeSelect test:

http://babyurl.com/rBw1UT

Hope that helps. Ask more questions if you got 'em.

Mike

Reply to this Message

M.L.S. - 26 Feb 2004 03:39 GMT

> It's certainly more likely to have a false negative than
>a false positive.

Whoops. I've got typological problems lately, or I'm getting too
picky in my old age...

It's a lot more likely to get a false negative from the EIA than to
get a false positive from the Western Blot.

Just curious, because we don't hear of that many EIAs in here, (as
far as I can remember, which isn't that far) but how did they go
about collecting a sample for it? Blood?

And how long before the results were in?

Take care,

Mike

Reply to this Message

Peter - 26 Feb 2004 15:50 GMT

>Hi Peter. Velly strange, indeed.
>
>A false positive from the Western Blot is not very likely.
>
>By EIA test you mean some version of Enzyme ImmunoAssay test? Were
>the results quick, like in a few hours?

Yes it was an Enzyme ImmunoAssay test, which was done by blood
sample, and the results took about 10 days to be returned. My doc
also had a generally high opinion of the lab that did the blood work.

And I forgot to mention that the EIA did come up positive for HSV1 Ig
G

>The only link I've got in the book right now is...
>
[quoted text clipped - 3 lines]
>EIA is it. It's certainly more likely to have a false negative than
>a false positive.

I would tend to agree about the EIA, and the brief research I did on
the net only turned up disparaging remarks about that type of test in
general.

My doc is known as a herpes specialist in my home town, and I found
him to be very knowledgable and open when I talked to him - he came
across as one of the best doctors that I have dealt with in the last 3
years out about 5 doctors on 2 continents that I have seen (but see
the great quote below :-). He stands by the quality of the test, but
does acknowledge the possibility of false negatives.

>If you can afford it I'd recommend springing for another Western
>Blot, or, possibly cheaper, the HerpeSelect test:

Of course, being Australian, it didn't cost me a cent for either of
the tests courtesy of our generous health system (thats if you don't
count the 1 1/2 % levy on my tax, but that gets me access to a wide
variety of health services 24/7 :-)

The down side is that I am currently in the US and won't be back to oz
for many months, so for any more tests I need to track down a suitable
doctor here and see how much the US system will sting me for the
tests. I am not sure if the travel insurance I have over here will
spring for such a test.

But thanks for the links to the other test

Finally, when I emailed my doc back home, I got such a wonderful reply
to my queries:

"What I can say is that in my opinion you probably do not have
genital herpes, but I cannot rule out the possibility that you do have
it."

Peter

Reply to this Message

M.L.S. - 27 Feb 2004 22:20 GMT

>>Hi Peter. Velly strange, indeed.

>>A false positive from the Western Blot is not very likely.

>>By EIA test you mean some version of Enzyme ImmunoAssay test? Were
>>the results quick, like in a few hours?

> Yes it was an Enzyme ImmunoAssay test, which was done by blood
>sample, and the results took about 10 days to be returned. My doc
>also had a generally high opinion of the lab that did the blood work.

So he had to send it out for processing.

>And I forgot to mention that the EIA did come up positive for HSV1 Ig
>G

That makes it even more confusing. Traditionally, the EIA has not
been good at typing, or telling HSV1 from HSV2 and the other way
around. I just found this link, though:

http://www.aruplab.com/guides/faq/articles/0020.1.jsp

"Recently, type-specific purified glycoproteins G (gG1 and gG2) have
been used to develop reliable type- specific immunoassays to detect
antibodies to herpes simplex. The EIA tests used at ARUP are based
on these purified glycoproteins, and when compared to WB, had a
sensitivity of 95% and a specificity of 96% for HSV-1, and a
sensitivity of 98% and a specificity of 97% for HSV-2."

... so it seems there may be some new EIA tests out there, with
fairly decent reliabilities and specificities, though still not as
good as the Western Blot. And, of course, we're not sure which
brand of model number <g> of EIA test you had, unless you were given
that with your results.

So, since I've done a little more reading, and since you give your
doc high marks in most respects, I'd guess that you were given one
of the newer EIA, but of course, that doesn't help much with sorting
out what you've got. Or don't have.

More links, just because:

http://jcm.asm.org/cgi/content/full/40/3/1071
http://jcm.asm.org/cgi/content/full/36/3/845

>>The only link I've got in the book right now is...

>>http://cpmcnet.columbia.edu/texts/gcps/gcps0040.html

>>If there's a weakness in your serological history I would think the
>>EIA is it. It's certainly more likely to have a false negative than
>>a false positive.

>I would tend to agree about the EIA, and the brief research I did on
>the net only turned up disparaging remarks about that type of test in
>general.

>My doc is known as a herpes specialist in my home town, and I found
>him to be very knowledgable and open when I talked to him - he came
>across as one of the best doctors that I have dealt with in the last 3
>years out about 5 doctors on 2 continents that I have seen (but see
>the great quote below :-). He stands by the quality of the test, but
>does acknowledge the possibility of false negatives.

>>If you can afford it I'd recommend springing for another Western
>>Blot, or, possibly cheaper, the HerpeSelect test:

>Of course, being Australian, it didn't cost me a cent for either of
>the tests courtesy of our generous health system (thats if you don't
>count the 1 1/2 % levy on my tax, but that gets me access to a wide
>variety of health services 24/7 :-)

>The down side is that I am currently in the US and won't be back to oz
>for many months, so for any more tests I need to track down a suitable
>doctor here and see how much the US system will sting me for the
>tests. I am not sure if the travel insurance I have over here will
>spring for such a test.

If your travel insurance is worth anything it should cover it,
though I have never had occassion to use any travel insurance, so
I'm just guessing.

>But thanks for the links to the other test

>Finally, when I emailed my doc back home, I got such a wonderful reply
>to my queries:

>"What I can say is that in my opinion you probably do not have
>genital herpes, but I cannot rule out the possibility that you do have
>it."

I bet his mother always wanted him to be a lawyer.

It's possible too, that you have HSV1 genitally, but that still begs
the question on where the earlier HSV2 diagnosis came from.

Good luck and hope you keep us informed if you can.

Mike

Reply to this Message

Grant - 26 Feb 2004 11:02 GMT

I agree with Mike. The western Blot is something like 99% accurate. So, I
would suspect the other test. Especially since it is not a known herpes
test.

ar

> Hi all,
> 3 years ago I was diagnosed with HSV2 after about 14 months of various
[quoted text clipped - 30 lines]
> TIA
> Peter

Reply to this Message

Peter - 26 Feb 2004 15:57 GMT

>I agree with Mike. The western Blot is something like 99% accurate. So, I
>would suspect the other test. Especially since it is not a known herpes
>test.
>
>ar

Yeah, as per my message above, I would also agree as I have not seen
anything too impressive about EIA tests on the net. However, my doc
was one of the best ones that I have seen over the years, is a known
herpes specialist, and he stands by it. Hence my confusion and
questions :-)

But still, the western blot (or any test like this) is not 100%
accurate.

And I don't know if anyone else out there saw last year about the
testing for gonorrhea in Canada where the test machine swapped the
Poitive and Negative results around - so that people who were -ve were
being treated for it, and people who were +ve were being told they
were clean. So *anything* is possible.

For the curious, see this website
http://catless.ncl.ac.uk/Risks/23.19.html#subj2

Peter

Reply to this Message

Grant - 26 Feb 2004 23:08 GMT

Hi Peter,

Where are you in the USA? My Western Blot cost about $130, I think....that
includes the test and the blood draw. The Western Blot is not known for
mixing up types. However, there are other, older herpes tests that were
known quite well for getting type 1 and 2 mixed up. Do you have a copy of
your Western Blot test results? By the way, it is perfectly possible to
have type 1 genitally so if one test says you have type 1, then it is
impossible to rule out genital herpes.

ar

> >I agree with Mike. The western Blot is something like 99% accurate. So, I
> >would suspect the other test. Especially since it is not a known herpes
[quoted text clipped - 21 lines]
>
> Peter

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