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HSV 2 in children
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HSV 2 in children

I have a 5 year old little girl who has bumps/blisters on her butt.  She had bloodwork done and it came back positive for  both hsv1 and hsv2.  The pediatrician prescribed an antiviral but it didn't touch the "rash" and she said I shouldn't be too concerned. However, nothing was making the bumps go away, so I took her to the dermatologist.  He did cultures, bacterial and viral.  The bacterial one came back positive for staph, but the viral has not come in yet.  The dermatologist did suggest that since we know she is hsv2 positive (and that's what the "rash" looks like) that we probably need to start asking questions about who is spending time with our daughter.  Here is where my question comes in:
1.  Is sexual abuse the ONLY way that hsv2 is spread?

I am positive that she didn't get it from me or my husband so I just need to know where to go from here.  I don't want to open "a can of worms", so to speak, with the extended family if there is no need for concern.

thanks!
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First, you gotta be careful with IgG testing with children (was her testing IgG or IgM?). Grace would advise you better on the matter, but unfortunately she's dropping by once a week or so. I guess IgG testing is not fully reliable with children, it's mostly indicated in an adult population. But I'm not 100% sure, to be honest.

It would be good if you could post her results here (ex.: Hsv1 IGG 1.45, hsv2 Igm 4.5, etc)

Second, if the swab was done in a timely matter, it will tell the story. If her symptoms were due to hsv2, the viral swab will most likely be positive. However, if your child was already taking antivirals, the swab will most likely be negative - maybe a false-negative.

Assuming her outbreak was, indeed, due to hsv2 - yes, sexual abuse is strong possibility.
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Just to clarify - if a child has genital hsv2 (hsv2 in the vaginal or anal area), it means someone rubbed against her down there, had genital contact at least. So, yes, sexual abuse is the most probable cause.
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has she ever had any oral cold sores?
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yes, she's had coldsores for a while now
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well, autoinnoculation of hsv1 to the buttock is a possibility. she could've transmitted her oral infection to her buttock. still, you need to know (a) if her buttock sores are indeed herpetic; (b) what type is it.
again, waiting for the swab results is the way to go.
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i think that her being positive to hsv1 could affect the hsv2 test, could that be right bob rope?
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yes. false-positives for hsv2 happen in adults, often in those who are hsv1+.

but as I said above, I'm not aware of how reliable blood testing is in a 5 year-old.
any news on her viral swab?
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No, no word yet, still waiting!  should be today or tomorrow.
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please let us know what happens missy. best of luck
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blood testing in children her age is highly inaccurate and shouldn't be done :(   We don't have tests approved for use in her age group since she is under the age of 12.  The false positive issues with testing under that age are even higher than with adults due to less blood volume.  It's quite likely her testing was erroneous for hsv2 and honestly we have no way to confirm otherwise for her at her age.


You can't actually determine if these were herpes related from blood testing either.  A lesion culture done early into the episode would've been helpful. Odds are the lesion culture done after she was on antivirals will come back negative regardless.

It's highly unlikely she transmitted her own oral herpes to her buttocks especially with a well established oral infection.

Staph infections, especially MRSA infections, are very common in children in that area.  She should continue to follow up with the dermatologist as needed at this point since it's not unusual for staph infections of the skin to come back repeatedly.  

grace
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any news yet missy?
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NO!  the Dr said it can take 2 wks to get the results of the virus culture, so come thurs I hope to know something.  Also, are any of you familiar with Molluscum contagiosum?  Could it possibly be that?
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101028_tn?1348750963
more likely it's the staph causing her symptoms, not MC. children usually get mc on non-genital areas.
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Well, I got the results for my daughter's test and it came back negative.  However, the nurse said we should probably re-culture though because the bumps aren't gone yet. :(  Made an appointment, hopefully will get answers someday!
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that is great news! how long have the bumps been there for?
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they have probably been there for about 3 months
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101028_tn?1348750963
herpes lesions would never linger for 3 months.

continue to follow up with her provider and/or a pediatric dermatologist.

best of luck!!!

grace
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We got good news!  Seeing the bumps after all of the staph was cleared up and the dermatologist said that the rash could possible be molluscum.  I asked for a biopsy and we got the results yesterday and it was positive for molluscum and negative for HSV 2!  Praise the Lord!!  I wish she didn't have either but out of the two, that's way better.  Thanks for all of the information and well wishes!
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that is great news!
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101028_tn?1348750963
glad you finally got some accurate answers :)

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