Is a biopsy to be trusted?

[hsv1unsure]

Hi Dr. Rockoff,

I have been having recurrent issues for 2 years, first vaginally, which over the past year became a rectal problem. Dispute numerous HSV1 & HSV2 blood tests, I had/have remained convinced that what I have is herpes. I thought this because my partner, a female, has a history of cold sores, while I do not. She performed oral sex on me 6 days after having a cold sore. Issues, though slightly more non-specific, have occurred ever since. Over the past year, I get what feels like a cut/lesion/fissure on the right side inside my rectum. The cut is pre-ceding by itching, and sometimes local discomfort on the outside of my rectum (soreness). While having this “cut” I have had,  over the course of 1 year, 2 negative cultures and 3 negative PCRs. I have been taking Valtrex on and off, but have not taken the Valtrex before I get the culture, but not sure if the Valtrex may still be in the system for some (?). Anyway, over the last 2 months, this issue has been almost constant—coming and going approximately 1-2x a week (whereas it was about 1x a month) which I have learned seems way too frequent for herpes.

In any event, with my last negative HSV PCR, I had a biopsy done. The biopsy diagnosis read –“Spongiotic Dermatitis, Subacute Type.” I want to know if I can really believe this. I would think a diagnosis would be certain, but I perused an article that said that the “Spongiotic Diagnosis”  is often a blanket diagnosis- and not specific.

What are your thoughts, Dr. Rockoff? Do you believe what I am experiencing is truly a dermatitis given my history and everything else?

Thank you.

[hsv1unsure]

Well I have had PCR cultures for herpes which were negative. The biopsy wasn't "looking" for herpes and I just wanted to be sure that these sorts of things are accurate when they come back with a term like "spongiotic dermatitis," but from what you are saying they usually are, is that correct?

[Bhupinder Kaur, MD]

Hello,
It is very rare for a biopsy report to go wrong and report false negative. The only way of ruling it out is by getting yourself tested for genital herpes. Laboratory tests include: culture of the virus, direct fluorescent antibody (DFA) studies to detect virus, skin biopsy, and polymerase chain reaction (PCR) to test for presence of viral DNA. I sincerely advise you to consult a dermatologist and get it ruled out.

I sincerely hope that helps. Take care and regards.

[hsv1unsure]

. I feel this way especially because it gets itchy and then it always occurs in one really small, localized area in around the same spot every time instead my rectum. It just doesn’t really make sense for dermatitis, but it does for herpes

[hsv1unsure]

Thank you for your response. If it *was* herpes, could a punch biopsy have mistakenly classified it as spongiotic dermatitis instead of herpes, or are these biopsies pretty accurate? What I'm trying to figure out is, does herpes exhibit the same sort of characteristics as sub-acute spongiotic dermatitis and the lab person thought it was, or am I safe to assume that doesn't happen...? I'm still really worried about herpes.

[Bhupinder Kaur, MD]

Hello,
I cannot confirm anything without examination but the symptoms are suggestive of spongiotic dermatitis or acute eczema only. Most individuals have no or only minimal signs or symptoms from HSV-1 or HSV-2 infection. When signs occur, they appear as blisters. The blisters break, leaving tender ulcers (sores) that may take two to four weeks to heal the first time they occur. You don’t have any blisters and moreover the tests have ruled out herpes. So the biopsy report seems correct.

Spongiotic means little blisters and it occurs because of an allergic reaction to some allergens. Course of antihistaminic and steroids(topical and oral) are required. Moreover avoidance of the allergens is the main treatment. My sincere advice is to consult an allergist/ dermatologist.
Hope it helps. Take care and regards.