What Herpes test is earlier and most accurate for the recent virus infection, why negative results and outbreak, read carefully and understand herpes test results.

Herpes are group of 8 virus types, only two of them cause disease, one of them is Herpes simples virus (medical term is HHV 1,2 or HSV 1,2)
Herpes infection is one of sexually transmitted diseases which include AIDS and chlamydia for example.

Herpes simplex virus type 1 and type 2 (HSV-1 and HSV-2) are pathogenic to humans and belong to the herpesvirus family. All herpesviruses are composed of relatively large DNA genomes. 

Like other herpesviruses, HSV-1 and HSV-2 follow a productive lytic infection and establish a latent lifelong infection in the host. In the latent stage, the production of infectious virus particles is inhibited but periodic reactivation and successive cycles of virus replication lead to reproduction and spreading to further susceptible persons.

In general, HSV-1 infection rates are markedly higher compared to HSV-2 Both, HSV-1 and HSV-2 infect epithelial cells of the mucous membranes, HSV-1 localizes preferentially in the orofacial region (Herpes 1 called Herpes labialis) and HSV-2 in genital and anal areas (Herpes 2 called Herpes genitalis). The infection only spreads when a susceptible person comes into close contact with tissue or body fluids containing the virus.

Who is exposed to have herpes infection?

In general, primary HSV-1 infection occurs during childhood, while HSV-2 infection is usually acquired sexually in early adulthood. Perinatal infection of the newborn can lead to a severe generalized neonatal herpes infection which has the medical term Herpes neonatorum. Thus it is always recommended to determine a woman’s HSV status during pregnancy, including discrimination of HSV-1 und HSV-2, to estimate the newborn’s risk for perinatal infection.

How long does it take to get herpes test results?
Results for a rapid herpes virus culture may take 2 to 3 days, anti-herpes antibody detection test results are ready in a day. PCR test results are ready in 1 to 3 days.

Serological Herpes testing, is it reliable?
The story behind antibodies tests is that: when a virus invade the body, our immune system take the responsibility to kill and eliminate this virus from all body tissues, the first immunity weapon is IgM antibodies which take the first impressions about virus and send them to the core immune system, which in turn continue to build suitable antibodies that fit to all virus aspects,

finally the immune system understand the integrity of the invading virus and send the larger IgG antibodies, so that when we see IgG positive test we know that the body has fully eliminated the virus,
and IgM positive test means the beginning of immunity war against virus, of course the beginning of virus invasion could precedes the body response by 2 – 6 weeks and up to 3 months, which called the dormant period, window period, or virus outbreak, 

That is why can you have herpes and test negative. while this waiting period the Herpes antibodies test is not useful to detect herpes infection, instead take a PCR test from sores directly and virus culture from open blisters and fluids as CSF or urine.

HSV 1/2 test results interpretation

Positive IgG antibodies against Virus herpes 1 means the body is immune to this virus or the immunity still build up, the same for IgG antiherpes antibodies means an old infection that the body has built defense against

Positive IgM anti-herpes antibodies Virus 1 and 2 means the body just started the immunity response against the herpes virus, while beginning of the virus infection may be occurred several weeks ago.

In the acute stage of herpes infection skin lesions with characteristic blisters (“cold sore”) occur by HSV-1 or genitalia sores which associated with STD infections. Severe manifestations, such as an HSV-associated encephalitis or herpes corneae are rare. Herpes simplex virus infects the neurons of the dorsal root ganglia, where it causes lifelong latent infection. The virus is often reactivated, leading to recurrent symptoms.

Which Ab. test can detect herpes virus earlier?
In the acute stage of infection direct detection of the virus from the vesicles content via PCR is indicated. In addition, detection of IgM antibodies against HSV is important to confirm acute primary infection. However, not all patients produce IgM antibodies in the acute phase of infection; besides, IgM antibodies may also be detectable in cases of recurrent or persistent infection.

What is the most accurate specific test against herpes virus types other than PCR test?
What is against HSV-1 glycoprotein G (G1) or HSV-2 glycoprotein G (G2)?
Classic ELISA Antibody Blood Test

• Can't distinguish between a current infection or a recurrent herpes infection.
• Delayed period: herpes antibodies take up to 2-12 weeks post infection to appear in the blood.
• Positive Ab. results not specific for Herpes type 1 or 2.

Glycoprotein G (gG) based herpes testing is most accurate Ab. tests:

Since HSV-1 and HSV-2 are immunologically very similar, almost all antibodies formed in an infected individual are cross-reactive. The HSV type-specific glycoprotein G is an exception, because these antigens of both viruses differ sufficiently. However, glycoprotein G almost only induces the formation of IgG antibodies. 

Therefore, detection of IgG antibodies against HSV-1 glycoprotein G (G1) or HSV-2 glycoprotein G (G2) allows for the differentiation of an HSV-1 infection from an infection with HSV-2.

In the early phase of primary herpes infection, the corresponding IgG antibodies are not yet produced. As a rule, IgG antibodies against HSV-1 are formed two to three months after a primary infection with the type 1 herpes simplex virus. IgG-class antibodies against glycoprotein G2 are detectable several weeks after primary infection.

The test uses HSV-1 glycoprotein G as coating antigen, and if the blood or aspirate sample contain herpes antibodies, reaction specific for each type if happen, an analyzer detect the reaction products and convert it to numbers that we can interpret.

Advanced ELISA based tests for the quantitative measurement of specific anti-herpes antibodies in human serum or plasma.

1. Anti-HSV-1 IgG is an ELISA based test system intended for the qnt. measurement of IgG antibodies against Herpes Simplex Virus 1 glycoprotein G (gG1).
2. Anti-HSV-1 IgM Abs. is qnt IgM antibodies measurement against Herpes Simplex Virus 1.
3. Anti-HSV-2 IgG is qnt. IgG antibodies against Herpes Simplex Virus 2 glycoprotein G (gG2).
4. Anti-HSV-2 IgM Abs. is for IgM class antibodies against Herpes Simplex Virus 2.
5. Anti-HSV-1/2 IgG is for Qnt. IgG antibodies against Herpes Simplex Virus 1 and 2.
6. Anti-HSV-1/2 IgM Abs. is for IgM antibodies against Herpes Simplex Virus 1 and 2.

Antibodies test reference range:

• Negative herpes antibodies: less than 20 U/ml
• Borderline: 20 - 25 U/ml
• Positive herpes antibodies test: more than 25 U/ml

Negative antibodies test for herpes virus mean that you had never infected before, Positive antiherpes tests means you have got infection recently or the infection is old and your body did its job and killed every herpes unit with antiherpes units, however borderline herpes blood test results are neither positive nor negative but it necessitates close follow up by herpes antibody test and PCR for herpes.

Western blot (Immunoblot test) to detect the type of herpes antibodies.

Western blot herpes test, is it accurate results than Elisa?

• The Western Blot Serology has been the gold standard for herpes specific antibody.
• IgG/IgM (Elisa) blood test can tell if one has a current infection or antibodies from a previous infection. However, a positive IgM means that the Herpes infection is active.
• Available over the counter test kits: The POCkit test is specific and will detect antibodies and is available through a physician.
• Western blot results: Most HSV-2 ELISA-positive individuals tested HSV-2 Western blot-positive. Western blot positive without herpes simplex virus type 1 (HSV-1) antibody positive, and even in men without a history or clinical evidence of genital lesions, Clinicians should consider selectively using a higher index value to define Focus ELISA HSV-2 positivity based on either HSV-1 serostatus or clinical circumstances.
• The index value defining HSV-2 positive is from >1.1 but the index >or=3.0 is more correlated with real herpes infection.
• Drawbacks of western blot testing: detection but expensive and difficult to administer.

Does Viral Culture Test really detect herpes virus?

Herpes virus culture is the most specific test for herpes and can tell the type of herpes 1 or 2, samples cultivated are from fluids of active lesions only to avoid false negative culture.

Polymerase Chain Reaction or PCR Test for Herpex Simplex Virus 1,2
PCR test for herpes virus is the most accurate and reliable way to diagnose herpes, based on amplifying the virus DNA/RNA to detect tiny amounts, require active viral shedding, samples for PCR taken from blood, cells or fluids from sores.

Drawbacks of PCR test for herpes: a false positive for HSV2 for persons with an oral HSV1 infection, thick cells-rich fluids can make PCR false positives, PCR tests are limited and more expensive than culture.

Herpes Antigen Test
Looks for the virus itself, based on detecting specific proteins on the virus body, done be taking a swab from the lesions onto a microscopic slide and sent to the reference laboratories, drawbacks: Ag herpes test are very limited, expensive, not specific for herpes type, less sensitive than herpes culture.

Other STD tests for herpes:

TzanckTest or Chickenpox skin test
Not a specific test for herpes and not clinically recommended. Based on using a scraping to look for Tzanck cells.

Do Pap Smear or silver pap test for Herpes detection?
Only accurate for active herpes sores, otherwise false negative and erroneous results would be given, do pap smears test for herpes and other STIs, so that PAP test is not specific for herpes virus alone unless combined with PCR test,

Recommendations:

Herpes test for men including PCR from the lesions/open sores on mouth, lips, or penile or around genitalia, virus culture from pimples leaks, and anti-herpes antibodies test.
Herpes test for women include PCR for herpes simplex virus 1/2, culture of herpes virus taken from the open blister or puss swab or aspiration by a needle, serological test and viral culture from vaginal cervical discharges swab. 

Test for oral herpes simples 1 include specific PCR test but not usually ordered, Anti-HSV-1 IgG, and Anti-HSV-1 IgM.
Test for genital herpes simples 2 include HSV-2 PCR test, serum Anti-HSV-2 IgG, serum Anti-HSV-1 IgM, viral culture from the herpes sores wherever their site.