[DoctorTan]

I agree with Boss. Your problem is psychological.

OK let's talk about HSV testing. You PMed me a question but I thought it would be better to answer it here and share the info with everyone.

There are 2 groups of patients who carry HSV.

Group 1 - symptomatic patients
To make the diagnosis in these patients is really straightforward. It could be purely clinical i.e. you look at the blisters/ulcers and immediately you know it is HSV because it looks exactly like what is shown in textbooks. If you are still not sure or you want to know which type it is, you swab the base of the ulcer/blister and send it to the lab for a HSV PCR test. This has largely replaced viral culture tests we used to do which were highly non-sensitive.

Group 2 - asymptomatic patients
First of all you have to ask yourself and your patient the question "why the hell are you testing in the first place?". Let sleeping dogs lie and let the patient live his life in blissful ignorance.

But you absolutely have to know if you are infected or not if not you will go mad. That's fine.

You then have to rely on serologic tests. In other words, you have to test for HSV antibodies and not HSV virus. The problem with serologic tests is that they are extremely difficult to interpret. There is a lot of cross reaction. For example, most people carry HSV 1 and this may cause the HSV 2 results to become false positive. Even getting a chickenpox vaccine may cause the HSV serologic tests to become false positive.

So you want serologic tests that are as specific as possible. The Gold Standard is the Western Blot test. As far as I know, there is only 1 lab in the world that does this and they only do it for research purposes.

A good alternative is Type Specific Serologic Testing. I have personally called the labs in Singapore that I use for HSV serologic testing and they have told me that the tests that they do are TSST tests. I have my doubts but let's just take that at face value.

The labs use a cut off index value of anywhere from 0.80 to 1.1 to say a test is "positive" for HSV infection. I call bullshit on this. From the studies I have read, it should be > 3.50. So if you HSV IgG index reads > 3.50 you can more or less (99%) say that you have been infected with HSV.

The problem is when your reading comes back as 2.0 or 2.5 or 1.8 and you do not have any symptoms. Are you infected or not? Nobody knows. You can re-test in a few months to look for a SIGNIFICANT INCREASE in titer but most of the time, this does not help either. SIGNIFICANT INCREASE means it must rise above 3.50. If you go from 2.0 to 2.8, you are still none the wiser.

The other problem is the window period. This is the time from infection to when TESTS CAN PICK UP THE INFECTION. This is very different from saying WHEN THE BODY STARTS PRODUCING ANTIBODIES. The body starts to produce IgM antibodies (more on this later) as early as 3 weeks from infection. And IgG antibodies no later than 6 weeks form infection. Very frequently, IgG can be produced much earlier. So the doctor who informed you that the HSV IgG test at 28 days is "90% to 95%" accurate is absolutely correct. From the studies I have read, HSV IgG tests are accurate no later than 16 weeks from infection.

IgM is produced much earlier so some doctors use this test to detect an infection earlier. The problem with IgM is that is disappears very fast also. So it has very limited utility in diagnosis. Furthermore, IgM cannot differentiate between HSV 1 and 2.

Last thing: even if your HSV test came back positive, you don't know when you caught it anyway! Maybe your parents had cold sores and passed HSV 1 to you as a child. So now you test positive for HSV 1 and going to freak out when you have been living with it happily all your life? Maybe you caught HSV 2 from your 1st GF, been symptom free all this while and now you are going to freak out?

After knowing all this you still want to test?
Listen to good advice from everyone here. You have no symptoms. Leave it.
Live your life. Be happy.