Confused! Positive culture then a negative blood test!

[differentresults]

I am a 27 yr old male. In Aug 2009 I feared I caught something from a sexual partner after unprotected sex. The outbreak occured on the base of the shaft of my penis about 2 or 3 days after contact. I got a culture test done which came back POSITIVE. I had 5 more outbreaks during the year after.

I have since been abstinent but a year later began taking a daily dosage of Acyclovir 200mg in August of 2010 (one pill twice daily) and have not had an outbreak since. Last week (a year and a half after the culture test and a year and half after the last time I had sex) I got some blood tests done just in case the culture test had been wrong. I had blood drawn and tested for HSV-1 and HSV-2 and both came back NEGATIVE! The tests were type 1 and type 2 specific Ab, IgG tests which I am to understand give very accurate results. The lab personnel was confused as to the negative result after a positive culture. I then spoke to the doctor who made it seem that it was normal and I was fine and do not have it an STD because my body fought it off. In the same breath he stated that the STD was now dormant in my system and the negative is a good thing meaning that I cannot give someone else but it could come back if I am stressed or come in contact with it again.I am just very, very confused.

Do I have Herpes or do I NOT have Herpes? And how can I have gotten a positive and a negative? Is there such thing as a false positive culture test? What does a negative blood test a year and a half after having sex and becoming possibly infected mean?? Does being on daily dosage of Acyclovir affect the blood test and the antibodies?

Please help I am very confused, very concerned, and not sure who to talk to as I don't believe the doctor was very knowledgeable on the subject. I also have a new serious GF (we have had oral sex only) but have yet to tell her I have Herpes and don't want to tell her something wrong that could either drive her away or put her health at risk. Please help!

[Terri Warren, RN, Adult Nurse Practitioner]

So you were not on antiviral therapy from August of 2009 to August of 2010, right?  That's plenty of time to have made antibody detectable by this test.  

And yes, I have a few patients who don't make antibody detectable by the tests we have available.  You could try getting a western blot antibody test, but I have just a few patients who have swab tested positive from lesions that were also not positive by western blot, even years later.  

My advice:  consider that you are one of the few people who don't make detectable antibody, but are infected with HSV 2.  You should be on daily antiviral therapy to help protect sex partners from herpes.

Terri

[Terri Warren, RN, Adult Nurse Practitioner]

The fact that you don't have detectable antibody probably means nothing in terms of the severity of your herpes or the chances you would transmit.

I don't have any reason to believe that you don't have herpes, no.  I would trust the swab test from a lesion over the antibody test at this point.  You could get a western blot, yes, but even if it is negative, I personally would believe the culture from the lesion.

Terri

[differentresults]

That is correct. I was not on medication during that first year as I was not having any type of sex so didn't feel it necessary. I did have some outbreaks but nothing I couldn't deal with at the time. The only reason I got on the daily dosage was because I began a new relationship and wanted to protect her (though we have only had oral sex) as well as for my insecurity.

Thank you for your advice. I have two additional questions: first, considering that I don't have any antibodies detectable, what does that mean for me? Does it mean that I have really low form of herpes or does it mean that it is rampant and my body just isn't trying to fight it off? Basically, am I less or more likely to pass it to someone else during sexual activity?

Second question, is there any reason for you to believe that I possible am NOT infected with HSV-2? I trust your judgment but do want to be 100% sure. I will consider finding a GP and doing the western blot test too. Would you suggest having more blood drawn and tested too?

Sorry, I know that was more than two questions. :) Thanks for your continued help.

[differentresults]

Yes, the lesion swab result was typed as HSV-2. I started the daily antiviral therapy in august 2010 and am still on it today, so I have been on it for a total of 5 months now. I began it when I started dating the woman I am with. I have not had an outbreak since beginning the daily therapy.

I understand that a culture test is more reliable, but is there precedent for a false positive on that? I don't understand how a year and a half later there are NO present antibodies so that a blood test would come back negative.

Considering that you do believe that I have Herpes, would you recommend being on the daily antiviral therapy or only take if I have an outbreak?

Thank you for your help with this.

[Terri Warren, RN, Adult Nurse Practitioner]

You do have herpes.  I would rely on a positive culture from a lesion over the antibody test.  Was the lesion swab typed (HSV 1 vs. HSV 2)?  How long have you been on daily antiviral therapy?  You mentioned August, but was that when you started?  One month only?    If you answer these questions, it will help me answer yours more completely.

Terri