血检疱疹的准确度 [复制链接]

对吧abcd哥，确实有这样的说法吧，并且还是medhelp上的专家这么说，所以国内医生并不是乱说，血清检测确实没有那么准，我只是看见论坛上相信血检的和不相信的都太片面了，还有就是视westernblot视为终极测试的都不太客观
大家集思广益对事情会越来越了解的。
我还看到一个人westernblot阴，其他血清法时阳时阴，排除了，结果传染给别人了，在medhelp上问hhh，hhh就告诉他确实有这样的情况，10%的人没有检测到抗体，但的确有病。别讨论定语了没意思，我们干点有意义的事吧，英语好的人多了，做事情去才是硬
道理

I have a question about the sensitivity of the Herpeselect and westernblot IgG test.  For the most part, I hear that the sensitivity for these test range from 97%-99%.  I noticed when reading about some of the clinical trials done to determine sensitivity for these test that the test samples came from individuals with symptomatic infections diagnosed by cultures.  Is the sensitivity less for individuals with asymptomatic infections or is it the same??  Do the amount of antiobodies detected have any correlation with whether the person will have symptoms or not??  I have heard that 9/10 people who have herpes didn't know they had it.  That leads me to believe that they had no or very mild symptoms and were diagnosed by a type specific blood test.  Would you agree???  So when it comes down to it I am really just wondering if symptoms and amount of antibodies are related.  Do you know of any or have you been involved in any trials to determine this??

Thanks doctor!

The sophistication of your question and some of the terminology suggest you might be a health professional, so I'm responding with professional rather than dominantly lay terminology.  Let me know if I'm wrong or you otherwise don't follow.

Those sensitivity estimates are about right, although maybe a bit on the high side.  HerpeSelect is more sensitive than Western blot; the latter might be closer to 95%.  Also, this relates to time since infection, because it takes longer (up to 6 months, sometimes longer) to seroconvert by WB and usually not more than 3-4 months for HerpeSelect.  (The difference is even more marked earlier in the course.  At about 6 weeks after acquisition, HerpeSelect is ~80% sensitive, vs ~50-60% for WB.)

There is no known difference in serological test performance for symptomatic versus asymptomatically infected persons.  This is hard to study, however, because as you suggest, most asymptomatic persons indeed are diagnosed serologically.  Since such people generally don't have positive culture to serve as the gold standard, there isn't any clear way to be certain.  But the opinion of the testing experts is that there probably is no difference.

The strength of a positive reaction (ELISA optical density ratio 5.5 vs 4.0, for example) is unrelated to symptomatic vs asymptomatic infection.  The OD ratio has only a loose relationship, however, to the amount of circulating antibody; it's not like a titer, for example.  That is why the test is intended for interpretation dichotomously, i.e. positive vs negative.  I would guess, but do not know, that published data on this are available; if you have access to Medline, see what you can find by searching for Rhoda Ashley Morrow as the author.  (She committed matrimony a few years ago.  Some of her work was published as Ashley, more recently Morrow; and maybe a couple of papers as Ashley-Morrow.)  Or contact Focus Technologies.  If you are a health professional (or maybe even if not), they might be willing to share available data.

Regards--  HHH, MD .

Grace,
I've read on this site that a small percentage of people never develop antibodies after infection. My question is for clarificationon this. Does: a) a person develops antibodies but they just aren't detectable by blood test or b) if its possible for a person to be infected with hsv and just never develop any antibodies.  Thanks   .

The immune response is very complex and there are more than just 1 type of antibodies for starters.

The herpes blood tests we currently have only look at certain sections of the igg antibodies to see if you are infected or not.  The WB looks at the most parts which is why we recommend it in many situations.  Just because you have herpes and it can't be picked up on the tests we currently have, doesn't mean that your body didn't develop any antibody response to the virus.

Only about 2% of folks who have hsv2 won't be detected on the blood tests we currently offer. If you are someone who has had multiple negative tests, odds are you really do not have it.

grace

有点营养吧
比扯犊子强吧  
高人们出来讨论

.Your situation is complex and will be difficult to answer definitively.  I will make several comments as to possibilities however, as to which is pertinent to your situation, this will be very difficult to sort out.  

You state your HSV-2 was diagnosed by culture.  Given your lack of antibody development since then, I would make sure that indeed the culture was positive and that the lab did the necessary testing to differentiate between HSV-1 and HSV-2 (some do not, just reporting a culture positive for HSV).

Secondly, the HerpeSelect only tests for certain patented HSV-2 proteins using their own methods.  In nearly all, but not all cases, the HerpeSelect is adequate for antibody diagnosis of HSV 1 and HSV-2, gives results a bit sooner than the Western blot and is cheaper.  For all of these reasons, in most cases it is the preferred type of test.  On the other hand, particularly for sorting out abnormal situations (including the 3-5% of persons with proven HSV who do not develop a positive HerpeSelect result), the Western Blot are preferred, in part because it tests for antibodies to all of HSV-1 and HSV-2 proteins.  You did not mention your results for HSV-1 but they should be available and are relevant due to the occasional cross reactions between antibodies to HSV-1 and HSV-2.

Among experts there has been discussion of rare patients with initial HSV-2 who have DELAYED antibody development as measured by both HerpeSelect and Western Blot which has been attributed to immediately starting suppressive therapy after diagnosis.  In these anecdotes, when the patient is taken off suppressive therapy they sometimes go on to develop antibodies (and recurrences).  This is a rare occurrence and there are no studies of this phenomenon at this time.  

Finally, you mention the clinical diagnosis of genital HSV.  This is of proven unreliability.  Studies from the University of Washington indicate that even when STD experts are the ones making the diagnosis, their clinical diagnosis of genital herpes is incorrect about 25% of the time.  In addition, some clinicians continue to think that all genital herpes is due to HSV-2, another error.

Whether any of these circumstances is relevant to your situation I do not know.  They are the major possibilities.  To address your question, the first step is to verify hw your original diagnosis was made.

Hope this helps.  EWH
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Whether any of these circumstances is relevant to your situation I do not know.  They are the major possibilities.  To address your question, the first step is to verify hw your original diagnosis was made.

Hope this helps.  EWH
.

Doctors, last year I received a ** from a girl and at 8 weeks I had a red bump on my foreskin. It lasted about 2-3 days and then was gone. I think the irritation was from more friction than usual during wanking off as it was taking longer to finish and was multiple sessions. There was no itch pain or burning. It was a single bump. I tested at 13 weeks and was negative for hsv 1 and 2 on igg. Of recent I had a condom break with a girl on april 9th and then received an unprotective ** on april 26th from another girl (she claims she never had an outbreak ever and there was no visible bump on her lips) on May 10th I had 2 red bumps on my foreskin (area between shaft and head). Again no pain itches or burn sensation. I could touch them and it didn’t hurt at all. They were very small and not right next 2 each other. 1 went away in 3 days and the other in like 5 days. I also had a fever that week but this was determined to be strep.  I immediately went to the urgent care and had a physician assistant look at them. She didn’t think they were hsv and claimed she saw patients with hsv before. She said all of them said theirs came with pain. She did say she couldn’t swab it though and I know from here you say you can swab anything so maybe she was misinformed of what hsv could look like? I was tested for igg and igm for type 1 and 2. Again I am negative. I took pictures of the bumps. I went to a dermatologist and she thought there was no concern (the pictures weren’t the best quality though so I don’t know if it represented what actually was there) but she thought they looked glandular. Possibly from irritation or yeast infection.  So here are my questions.
.

First, the chance of catching herpes from a single oral sex exposure is extremely low.  The combination of that low risk plus the negative blood test 13 weeks later amounts to 100% certainty you didn't catch HSV from the first exposure.

Second, both the symptoms and the negative exams by knowledgeable doctors -- a dermatologist in particular -- argue strongly against herpes from the second pair of exposure (condom break and another oral event).

To your specific questions:

1) I recommend against further testing. The chance of herpes is too low, and although the available blood tests are good, they aren't perfect.  The chance of a misleading false positive result probably is higher than the chance you caught HSV from the April exposures, so why bother?  But if you insist, just have the test at 12 weeks.  It's time since exposure that matters, not symptoms.

2) Although true that the blood test misses a few infections (around 10% of HSV-1, probably 1-2% for HSV-2), the combination of low risk exposure, lack of typical symptoms, plus negative test results is 100% reliable for all practical purposes.

3) IgM indeed is a poor test.  Don't do it; the results are more often misleading than helpful.

4,5,9) You are obsessing too much about these details. Initial herpes lesions often are widespread, recurrent ones in clusters.  The symptoms of HSV-1 and 2 are not different at all, except in lower recurrence frequency for HSV-1.

6) Initial HSV symptoms occur at the sites where the virus enters the skin, typically at sites of maximum contact/friction during sex.  Thus the head and shaft of the penis, vaginal opening and labia minor, etc.

7) No, this is not a valid assumption.  On average, initial herpes is worse than recurrences, but still many new infections are mild or cause no symptoms at all.

8) I recommend no further testing.  

All things considered, it seems apparent you are somewhat irrationally obsessed with genital herpes.  Nobody wants it, but for the most part genital herpes is a relatively mild, easily managed conditions.  It isn't worth the level of concern you seem to have.  Take common sense precautions (condoms for genital sex with new partners, etc) -- then live a normal life without worry about it.

Regards--  HHH, MD

这个对于不典型症状的有点用吧。
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