Question:
These are my opinions.

I've been reading and I've been searching and I've been paying attention to real people and their stories and even though I am not a dr or a lab technician I'm pretty up on facts and I've come to some conclusions that everyone should be mindful of.

*You can have herpes simplex 1 &/or 2 for years and can still test negative and maybe even never test positive. If you get a blood test and it has (any level of antibodies) pay attention to this- you are probably positive. Antibodies only exist if you have been exposed and exposure means you have contracted the virus.

*If you have participated in a sexual relationship and you have engaged in both sexual intercourse and oral sex and either partner is hsv positive you probably are infected both orally and genitally. Just because you do not have symptoms does not mean you are not infected equally in both locations. The fact remains that you have been exposed in both locations. Don't buy into the statistics that say the virus's prefer locations - they will infect any place they can and you've opened the door. To err on the side of good judgement you should be disclosing this to partners.

*If you have had sexual contact of any kind with someone who has had contact of any kind with someone who has herpes you are taking the risk of becoming infected a first time or re-infected. It doesn't matter whether this was protected or not. Hsv can evade condoms. Ask if your new/potential partner had a previous partner who tested positive or had herpes.

*Only a dr can diagnose you but you need to pay attention to your own body and if something is going on there is a reason. Ignoring it won't make it go away and you may miss your only opportunity to get tested and know for sure if you have herpes before it goes dormant or latent.

Answer:
nice post Caliope. Cut and dry and to the point; exactly what is needed sometimes on this forum!

Answer:
This is a great post. I wish my ex-boyfriend could read this and maybe he could come to terms with how this virus is transmitted.

Answer:
Since getting H I've read lots of stuff on the internet, but then I followed up with searches into research articles. I work in research (genetics instead of virology, tho - too bad!) so I get access to most of the articles thru the university. Anyway, this is what I have been reading when it comes to test reliability...

Both false negatives AND false positives are a problem with herpes tests available to doctors, based upon results when compared to a Western Blot, which is way more accurate.

Yes. False positives can be a problem, too. That is one of the reasons for the debate over standard HSV testing; it's not only that some people don't want to tell people they have an incurable virus (which is a stupid reason IMO cause if you tell people they can learn not to transmit it), but that some people would be told they have an incurable virus and they don't even have it, and would suffer the psychological trauma for absolutely nothing. (I still would rather people know even if there is a risk of false positives, altho I know I am biased since I picked up this lovely virus from someone with no symptoms and no knowledge of his hsv+ status. If he had known, maybe we could have been more alert, or at least I wouldn't have suffered the quite the shock of the diagnosis.)

People have tested positive, and then by Western blot are negative. The readings on those herpes tests do not actually mean 100% for sure you have 1.0, or .9, or .63, or .1 antibody level. People also test negative, and then are really positive by Western blot.

For example, if you get .63 you are told to interpret the test as negative because in most cases (90-99%), were you to do a western blot, you really would be negative. In some cases (1-10%) you may really be positive. Percents are in a range because different studies (cause there are studies based on getting the tests approved and then also studies based in "real-world" clinics) give different rates as to the accuracy.

Don't mistake the reading of .1 as you have been infected but have low level antibody running around. If .1 was counted as positive, the false positive rate of the tests would be astronomical. Also don't make the mistake of thinking that you are 100% in the clear, as there is a small chance that your antibody levels were too low to detect or the test was inaccurate for other unknown reasons. If you have reason to suspect you were exposed, or had symptoms, get retested at another time even tho you have a negative result.

The tests work by letting protein pieces that attract each other bind together, and what happens is not always perfect. Sometimes other factors can interfere with binding, or something else that isn't meant to bind might bind at a low level. When they get the tests approved, supposedly most of the binding problems are worked out, but there is always the chance for error.

Some people might have antibodies present at too low of a level for detection.

It is also theorized that some people might have antibodies that for some reason don't bind to the generally available tests.

In certain world regions, the tests also perform poorly as compared to the results generally obtained in the US, so even local factors (maybe the presence of another antibody to something) might influence test results.

Answer:
thiscantbe - Are you agreeing or disagreeing with my opinions or are you stating that it is just to hard to know for sure?

Just a follow up notation:

I have read that with the Western Blot there are people who have had ob's of hsv tested positive and after a period of the virus being latent or dormant have tested negative again because the antibody levels have become undetectable. They were actually positive for hsv.

Answer:
I agree with most of what you said... if you've exposed yourself, etc, you may have the virus even if you show no symptoms, and that might still be true even if a test up negative, but I disagree with this statement:

If you get a blood test and it has (any level of antibodies) pay attention to this- you are probably positive. Antibodies only exist if you have been exposed and exposure means you have contracted the virus. because at a level the manufacturer calls negative, what it is detecting might not really be hsv1 or hsv2 antibodies - almost all lab procedures are subject to background noise and the tests can be detecting really super low levels of hsv antibodies, but there is a higher chance that it is just background noise. Unless you are at high risk for hsv (multiple sex partners, etc do increase risk), suspect you've been exposed, or had symptoms you are are probably really negative with a negative result. If you do suspect you have it, you might want to retest.

At first I really only concerned myself with the fact that these tests can have false negatives... but after more reading I ran into the fact that false positives are also a problem, unfortunately.

As for a Western blot coming up as a false negative it is possible but much less likely than with the other tests. I haven't read about that in any of the published research articles that I've read so far, but I daresay I've only read the tip of the iceberg on the research out there, there is one journal that frustratingly my institution doesn't grant me access to.

I've actually done Western blots in one lab I worked in, but I wasn't looking for anything as specific as what one would do in a herpes test, so mine were subject to much more noise. There could be many things that could affect the result in a Western blot procedure as there are several steps where something could go wrong, but one would assume in a lab where this is the main research that such errors would be minimal.

Answer:
I have read that with the Western Blot there are people who have had ob's of hsv tested positive and after a period of the virus being latent or dormant have tested negative again because the antibody levels have become undetectable. They were actually positive for hsv. Is this because of inaccuracies of the test or because the antibodies are not there? Maybe the antibodies are there, but the tests will not detect them 7% of the time. Most HSV blood tests are at best only 93%accurate, which leaves a fairly large 7% chance of false negatives.

Answer:
Accuracy of tests, Western Blots

For the blood tests commonly done at the doctor's office, it's possible that antibody levels fall below the limits of detection in false negative cases. It's also possible that for some people the tests are just less sensitive - for who knows what reasons .

For western blots, there is a limit for detection as well but it really is very sensitive... even a low level theoretically should be able to be detected... but reading the low level results can be tricky if the sample for some reason doesn't produce a really "clean" blot. When you read the tests you look for little lines or bands where you know your protein of interest should be located, and in a "messy" blot, you can get faint bands in places you shouldn't (because of binding to proteins that you are not targeting - non-specific binding) and/or the band you are looking for can be so faint, that you can't distiniguish it from the noise; that pretty much sets the limits... how clean is the sample. When people do the same type of procedure over and over, they usually get really good at it, so I would assume that messy sample prep and other errors would be at a minimum, but you know, these tests are performed by real people and sometimes real people make mistakes.

I've been searching for false negative results with the Western Blot. I've read (so far) that a WB can still give inaccurate results during the process of seroconversion (another test actually detected antibodies earlier than the WB). I also found this in an abstract:
"During the study period, 93 (48%) of the high-risk group were culture positive for HSV-2 and all but one case was verified serologically by Western blot. Therefore, the sensitivity for Western blot in this high seroprevalence group was 99%. The false-negative case had longstanding recurrent infection and on retest was found to be a laboratory error." Lab errors really can happen.

Do antibodies disappear over time?

As for whether the antibodies are actually there, no one truly knows exactly how long antibodies last, and the details of how long term immunity is established is still being worked out. Lots of research tho is being done on long term immunity in order to develop better vaccines. Usually, from an real infection (as opposed to getting some vaccines), long term immunity is established (and it is thought to be nearly permanent), which means there would be some level of antibodies in the body at all times, altho at what levels isn't really clear. Because of all the biological terror concerns, several studies were done to evaluate existing immunity for smallpox, and most people who were vaccinated still carry antibodies (we're talking >50 yrs for some people). However, there is a documented case of someone dying of smallpox even tho they had previously received two doses of the vaccine, so clearly long term immunity can be an individual process.

I think it would be rare for someone to be HSV+ but have NO antibodies (even tho it has been proposed several times on these forums as an explanation to the false negative tests), not to say that it's not possible, but research currently doesn't support that as happening very often. Even in people who are asymptomatic, most really have symptoms but they are lucky enough to have milder symptoms or merely just prodromal type symptoms so they don't realize they have herpes. The virus is really active in almost all people who have it, even if they think it isn't. In a study of 53 people who thought they didn't have gHSV but were positive by Western blot, "only 1 of 53 subjects had no clinical or virologic evidence of HSV infection." Most of those people (83%) shed virus at some point in the study, and they only did the study for 3 months; they might have had even higher percent of people who shed at some point if they could have carried on the study longer. Clearly, the virus was still occasionally active in their bodies. Assuming that antibodies decay to zero in many people seems contrary to evidence (again, there could be rare cases but this would have to be RARE), but it does seem more reasonable to think that in some people maybe the levels really are too low to detect or that for some reason their particular antibodies don't perform well with the currently available tests.

Here's a link to an article about the 53 asymptomatic people. I think if you register with the NEJM they will let you read this older article for free.
Wald A et al. Reactivation of Genital Herpes Simplex Virus Type 2 Infection in Asymptomatic Seropositive Persons N Engl J Med. 2000 Mar 23;342(12):844-50.

HSV1 infections are rarely truly inactive as was previously thought, but there is small level of expression of some viral proteins in ganglia. This is probably similar for HSV2. link: van Lint AL et al. Latent Infection with Herpes Simplex Virus Is Associated with Ongoing CD8+ T-Cell Stimulation by Parenchymal Cells within Sensory Ganglia. J Virol. 2005 Dec;79(23):14843-51. I think this is also free to read.

Here's another except from an article on long term immunity noting that latent infections usually give lifelong memory, and in some cases antibody levels might not even decrease:
Woodland DL. Immunologic memory. Viral Immunol. 2007 Summer;20(2):229-30.
The viral pathogens that have proven to be most problematic with regard to vaccines are those that persist in the host and mediate either chronic or latent infections.... Viruses that establish latency in the host often establish memory T cell pools that are maintained for the life of the individual. For example, cytomegalovirus (CMV)-specific T cells persist for years in humans who are latently infected with CMV. As pointed out by John McDyer (Johns Hopkins University, Baltimore, MD), these cells are able to persist in considerable numbers at peripheral sites, such as the lung airways of individuals who had received lung transplants. However, Ann Hill (Oregon Health and Science University, Portland, OR) pointed out that memory T cells specific for different antigens may behave differently. Using mouse CMV as a model of latent viral infection, she showed that T cells to some epitopes actually increased over time, a phenomenon referred to as memory inflation. Interestingly, Kathy Cho (Oregon Health and Science University) suggested that this inflation appeared to be driven, at least in part, by the development of new memory cells from the naive pool. In a postmortem study of trigeminal ganglia, all people with HSV1 DNA detected (thus positive, even more precise than any antibody test) had HSV1 antibodies present. It was a small study, but the people in the study were older (median age 81, ranging from 49 to 98 yr), so this study does not support the idea that antibody levels disappear to nothing over time. link: Selective retention of herpes simplex virus-specific T cells in latently infected human trigeminal ganglia (free text available)

Testing issues: false positives & false negatives

link to a review on a research article on testing, discusses false positive and false negative issues:
Expert review on: Serologic herpes testing in the real world. Validation of new type-specific serologic herpes simplex virus tests in a public health laboratory.

Another article on testing limitations (looks at symptomatic people so doesn't really address false positives, except for when hsv1+ status on certain tests falsely shows up as hsv2)
Inaccuracy of Certain Commercial Enzyme Immunoassays in Diagnosing Genital Infections With Herpes Simplex Virus Types 1 or 2 (read for free if you register).

There are plenty other articles discussing both false positives and negatives with the tests. The false positive issue tho is what stops some officials from encouraging herpes tests for everyone, which is really unfortunate IMO. Again, I know I am biased cause I caught this from one of those asymptomatic people; I really would like have gone into the relationship knowing the risks.

Answer:
ok ok ok, there's all these articles out there saying a bunch of different things. so, lets just take a real world poll; Who here has experienced a false negative or false positive blood test?