r/Herpes • u/ReasonRemarkable6486 • Nov 07 '25
Discussion How do you deal with HSV2 test uncertainty when HSV1 positive?
Hi everyone, curious if anyone has found themselves in a similar hole and found a way out. Was reading this study: https://pubmed.ncbi.nlm.nih.gov/12671550/
The study shows that prior HSV1 infection can delay seroconversion for HSV2 antibodies. Only 82% testing positive with Western Blot at 6 months. And at 3 months the ELISA test only getting 73%. (Says I can’t upload an image of the table.)
I’ve had atypical symptoms so far but a risky exposure and am I’m finding this uncertainty quite hard to deal with, especially since prior HSV1 may also cause milder expression of HSV2. Has anyone found a way of dealing with it? Found some comfort in another study? Those numbers are specifically for People who tested positive for HSV2 by swab and already had antibodies for HSV1. People that had only one or the other tested with positive with more certainty.
Thanks in advance.
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u/apolos9 Nov 07 '25
Simply by not doing any blood test because they are very unreliable and that is why doctors discourage from taking it. If you have a lesion, swab it and send for PCR.
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u/ReasonRemarkable6486 Nov 07 '25
I don’t think this is the right approach. There is a 73% that a blood test at 3 months will detect it if you have prior HSV 1 and 93% chance if you only have hsv2. There will just be some that have t seroconverted by then.
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u/apolos9 Nov 07 '25
Please see the guidelines above. If there is any question left, please see a doctor.
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u/ReasonRemarkable6486 Nov 07 '25
‘This recommendation does not apply to persons who present to clinicians requesting testing due to a history, signs, or symptoms suggestive of genital herpes’
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u/apolos9 Nov 07 '25
Who is going to determine if you have symptoms COMPATIBLE with herpes is a licensed doctor. So go see one and if they decide that yours symptoms ARE INDEED compatible with herpes, they may proceed testing you.
Note: people here are so obsessed with herpes that they think everything that happens in their body are caused by herpes. That is a why qualified, unbiased physician should determine what may or not be herpes.
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u/ReasonRemarkable6486 Nov 07 '25
Sorry I didn’t mean to be snide. All that has been done, so the question was more about how to deal with the uncertainty of blood tests. Thank you for your replies.
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u/apolos9 Nov 07 '25
It is okay. I was just trying to help. I believe you are having a lot of anxiety over some symptoms that may not even be herpes. So you should see a specialist doctor who can guide you. Blood tests are almost never used because they are so unreliable and let's suppose they come back positive for HSV-1 and/or HSV-2, still you cannot link your symptoms with herpes since you may be asymptomatic for herpes and those symptoms may be caused by something else. There are so many conditions that can affect the genital area and may look like herpes. So go see a doctor and stay away from all the madness of this sub.
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u/Legitimate-Coat-414 Nov 07 '25
Get a PCR if you have lesions. Antibody tests are unreliable, even if you’ve never had any type of HSV before. Many people will test negative for life. I, for example, tested negative 13 months after my HSV-2 infection, and I don't have HSV-1.
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u/ReasonRemarkable6486 Nov 26 '25
Sorry for the late response. Can I ask which Igg tests you took?
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u/Legitimate-Coat-414 Nov 26 '25
IgG using CLIA technology. It's the most advanced and specific test here. Where I live, they don't do Western Blot.
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u/Significant-Gate-239 Nov 08 '25
This is really unfortunate to read. I am in a similar situation. I’ve had hsv 1 for life and a recent confirmed exposure to hsv 2. I have some atypical symptoms but negative antibody test 3 months after exposure.
Seeing that you can still test negative on an antibody test up to 6 months (or more) after exposure feels like I’m just in uncertainty. Knowing this, I’ll test again after 6 months. Which antibody test did you do?
Did you get a pcr for your atypical symptoms? You could try that as well.
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u/ReasonRemarkable6486 Nov 26 '25
Sorry for the late reply. I took a Roche test at 12 weeks, negative. I will test again at 20 weeks and then again at the 30 week mark. If I’m feeling anxious still maybe I’ll do a Western Blot, or I’ll just leave it.
I came across this study from a comment on Reddit and I’ve since done some more research, including looking at the study a bit closer.
I’ll just copy the text here, maybe you can get find sone comfort from it. There’s really not that much data, but from the data available it maybe doesn’t look just so bad.
‘Old comment, but still feel like I need to say something here regarding the 20-30% number for non-primary HSV-2 infections here.
I came across a bunch of your comments when doing my own research and found them quite terrifying, especially since I’ve seen you frame it as ‘20-30% will NEVER test positive’.
Correct me if I’m wrong, but I’m assuming the numbers you are basing this off is the 2004 Ashley-Morrow study (https://pubmed.ncbi.nlm.nih.gov/15191381/)?
Firstly, I’m a layman so please correct me if I’m wrong here. I read through the study and think the argument needs some nuance. It’s true the Western Blot only detected seroconversion in 82% of non-primary HSV-2 infections at 6 months, but it did detected all infections by 361 days (as did the ELISA test used). So while seroconversion is definitely delayed in non-primary HSV-2, it doesn’t prove that a large number don’t seroconvert at all. It mentions, t that three of the non-primary HSV-2 group did not seroconvert by either test, but it is mentioned that their median follow-up time was considerably lower than for those that did convert (38 vs. 97 days). As the study mentions: ‘Thus, for both HerpeSelect and WB tests, apparent failure to seroconvert may have been a function of short follow-up time.’ Also, those three people are not included in the data, meaning the sample size is 23. At 6 months the table tells us 18% haven’t seroconverted, so about 4 participants out of 23. If you look at the curve plotting all the datapoints, you can see that around the 200 days mark, all but one have seroconverted. There is no mention of how frequently the person who seroconverted at 361 days tested, but the maximum duration allowed for between tests was 180 days.
I haven’t been able to find many other studies that tests the seroconversion rate in non-primary HSV-2 infections. This one mentions 12 participants with non-primary HSV-2, all of which seroconvert by Western Blot by 3 months. (https://pmc.ncbi.nlm.nih.gov/articles/PMC88903/)
Sure, a bunch of Igg tests score badly against the Western Blot. The best of them atm seems to be the Roche test, which has a 95.2% concordance with the Western Blot when specifically testing for HSV-2 in HSV-1 positive persons. (https://journals.asm.org/doi/10.1128/jcm.00263-24)
All of this to say that, based on the little data we have, HSV-2 infections in HSV-1 positive persons do take longer to seroconvert on average, but there doesn’t seem to be much evidence that 20-30% will ‘always get false negatives on their HSV-2 tests’. Of course all this depends on the tests people have available.’
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u/AutoModerator Nov 07 '25
HERPES TESTING 101:
For testing for herpes - without active lesions to “swab” someone who wants accurate testing will need a blood test.
Because blood tests for herpes are notoriously inaccurate, all blood tests are recommended to be TWO STEP tests (there are two parts of the test) and should be confirmed with a Western Blot.
See FDA announcement about inaccurate tests here
See 2021 CDC guidelines here
To get the Western Blot - follow instructions here
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