Is the Western Blot Worth It?
Every article you have read about herpes testing mentions the Western Blot, calls it the gold standard, and stops there. None of them tell you how to actually get one, what it costs, or whether your particular situation warrants the trouble.
That is what this article is for.
What it is
The Western Blot is a herpes antibody test performed at the University of Washington Virology Laboratory in Seattle. It is the test other tests are measured against.
The reason it is better is not complicated. A standard IgG test looks for antibodies to a single protein on the virus and reports how strong that signal is. The Western Blot separates out the full range of herpes proteins and checks which ones your immune system has responded to. It is reading a pattern rather than a single reading, which is why it can distinguish HSV-1 from HSV-2 with an accuracy the commercial assays cannot match, and why false positives are essentially not a feature of it.
It also comes back differently from what you may be used to. There is no index value. The result is positive, negative, or indeterminate — a word, not a number. For someone who has spent months living by a decimal point, that takes adjusting to.
Why it matters more now than it did
Until fairly recently there was a second confirmatory option: a rapid assay that could be used to check a low-positive IgG without sending blood across the country.
It has been discontinued. It has not been replaced.
There have been new automated IgG tests cleared for use in the last couple of years, from Abbott and from Roche, and you may well be tested on one of them. They are good instruments, but they are screening tests of the same family as the ones already in use. They are subject to the same low-index unreliability. They are not confirmatory tests and they do not solve this problem.
Which leaves the Western Blot standing more or less alone as the way to settle an uncertain herpes result. That is a narrower position than it occupied five years ago.
The practical part nobody writes down
Here is where it becomes a logistics exercise rather than a medical one.
It is not FDA-approved. This does not mean it is dubious — it means the University of Washington developed and validated it in-house rather than putting it through commercial clearance. It does mean it will never appear on a standard panel.
A clinician has to order it. It will not be added to routine screening. Someone has to ask for it by name.
Your usual laboratory may not handle it. This is the part that catches people out. The large commercial labs will not generally draw and process blood for the University of Washington as a matter of course, so in most cases you arrange the blood draw yourself, the sample is prepared locally, and it is shipped to Seattle at your expense. There are exceptions — some hospitals and clinics have existing arrangements that route samples through their own send-out network, and if yours does, this becomes far simpler. Ask your clinic directly whether they can send out for HSWB before assuming you have to manage it yourself.
The cost is not one number. The test itself sits in the low hundreds. Add the blood draw. Add overnight shipping. Self-arranged, people have reported the total landing somewhere in the range of four to five hundred dollars. Patient advocacy services exist that will manage the process for you, and they charge their own fee on top. Verify current pricing directly with the laboratory before you commit — figures move.
Turnaround is about a week. Longer if your sample is one of the roughly one in five where the antibody pattern is unclear and requires additional processing, which adds another week or so.
If you are outside the United States, this is harder. I have clients all over the world, and this is a recurring frustration. There is no local equivalent in most countries. Shipping serum internationally is possible but adds cost, complexity, and customs paperwork. When I was first trying to get diagnosed in Canada in the early nineties, there were no herpes blood tests here at all — the situation has improved, but the confirmatory test remains a single laboratory in one American city, and that is a genuine limitation for most of the world.
When I think it is worth it
A low-positive IgG with no symptoms and no known exposure. This is the clearest case. A number in the low band, in someone with no clinical picture supporting it, is exactly the result the confirmatory test exists for. If you are about to reorganise your life around that number, spend the money first.
Before you tell a partner. Disclosure is difficult enough when the diagnosis is certain. Having “The Talk” on the basis of a result that turns out to be wrong is a particular kind of avoidable harm, and it cannot be taken back.
Persistently equivocal results. If you have repeated the test and it keeps landing in the borderline zone, repeating it a third time will not help. Go to the test that gives an answer.
A discrepancy you cannot resolve. Symptoms that look like herpes with a negative blood test, or a positive result that contradicts a partner’s testing, or conflicting results from two different laboratories.
Pregnancy, or planning one. Where the answer genuinely changes clinical decisions, uncertainty is worth paying to remove.
When I think it is not
A strongly positive IgG with symptoms that fit. If your number is well above the low band and you have had outbreaks consistent with herpes, you are buying confirmation of something you already know. That money would do more for you spent on the thing you are going to be living with.
As a way of not accepting a diagnosis. I say this without judgement, because the impulse is human and I have seen it many times. Some people go looking for a second test, and then a third, hoping one of them will say no. If your first result was solid, another test will not rescue you, and each round of waiting costs you weeks you could have spent feeling better. At some point the more useful question stops being is this true and becomes what do I do about it.
When the logistics are genuinely out of reach. If you are in a country where this is impractical and your result is not marginal, you can proceed sensibly without it. A high-index IgG with a matching clinical picture is not a mystery requiring resolution.
How to actually order one
1. Ask your clinician to order the Herpes Simplex Western Blot from University of Washington Virology. The laboratory code is HSWB.
2. Ask your clinic whether they can send it out through their existing arrangements. If yes, you are largely done.
3. If not, contact UW Client Support Services for a testing kit and the request form. Their client services line is listed on the UW Virology site.
4. Arrange a local blood draw. The drawing laboratory will usually process and package the sample.
5. Ship the sample with the completed form and payment. You will need to buy your own courier label.
6. Results return to your ordering clinician in roughly a week.
Confirm the current process and pricing with the laboratory directly before you start. Details change, and I would rather you checked than relied on a webpage.
What the answer does and does not settle
If it comes back negative, you have your life back from a number that was never true, and that is worth a great deal.
If it comes back positive, you have certainty. Which is worth something too, though it will not feel that way for a while.
What it does not give you is any information about what happens next. The Western Blot is the most accurate herpes test in existence and it still cannot tell you how often you will have symptoms, what sets them off, how contagious you are, or what would settle your body down. It answers one question exceptionally well and is silent on every other question you have.
Those answers come from looking at the whole person — sleep, stress, digestion, hormones, immune function, the history a body has been carrying. Two people with identical Western Blot results can have entirely different experiences of this virus, which is why no single herb, diet or supplement works across the board, and why what actually helps is a custom-tailored plan built around your particular case.
Thirty-nine years as a herbalist, twenty-three of them working with this virus, and I have yet to find a way around that.
If you have your answer and want to know what to do with it
We can go through your history properly and work out what your situation actually calls for. Consultations are by phone or video.
If you have questions first, write to me at christopher.scipio@gmail.com. I read them myself and I answer them myself, at no charge.
Related: what your test results actually mean · when to get tested after exposure · can an IgG test be a false positive
Christopher Scipio is a Registered Herbalist (RH, AHG) and Holistic Viral Specialist based in Vancouver, British Columbia, working with clients around the world. He has practised as a herbalist for thirty-nine years, twenty-three of them as a herpes specialist, and has lived with the virus himself for thirty-six years. He is the author of Making Peace With Herpes.