Likelihood that Prior Herpes Diagnosis was Accurate? HSV-1 or HSV-2? Virus Culture vs. Antigen Detection.

[jwnyc]

Dear Doctors,

I have been in monogamous heterosexual relationship with a woman for the past 4.5 years.  About 4 years ago I had an outbreak of blisters on my genitals.  I went to a local std clinic and they scraped the affected area.  They doctor was able to give me results the same day and said it was herpes.  However, she did not tell me whether it was HSV-1 or HSV-2.  Since the initial outbreak, I have not had another outbreak.  Since the diagnosis at the clinic, I have had two blood tests for stds with my primary care physician.  Both have come back negative for all stds.  Both tests were done a year apart.  What is the likelihood that I have herpes?  If I do have herpes, is it safe to say that I have HSV-1, because I have not had another outbreak in the past 4 years?  Should I retest?

My wife has not shown symptoms for either.  As a side note, she was diagnosed with shingles as a teenager.  It's my understanding that this would be completely unrelated to my initial diagnosis. 

Also, I am curious as to whether the Doctor at the clinic performed a virus culture test or an antigen detection test.  Is there a difference as far as accuracy goes?  I've called the clinic several times, but nobody can give me a straight answer.  

Please advise.  Thank you.

[Edward W Hook, MD]

Your situation is not an uncommon one.  I would start by questioning your initial diagnosis.  There are very few clinics which can accurately diagnose HSV on the same day.  Yu were certainly not diagnosed using a culture.  You may have been tested with a test called an older Tzanck test which is known to be quite non-specific and have substantial numbers of false positive and false negative tests. As a result, these tests, while widely used in the past, have now fallen out of favor as we have gotten better tests and come to appreciate the limitations due to the current ones.  My advice would be to get re-tested and then go from there.  Whether your wife gets tested at this time or not is a matter for discussion between the two of you.  

Herpes is a complex subject.  The infections are common with HSV-1 being present in over 60% of adults and HSV-2 (the virus which causes most genital herpes) being present in about 1 in 5 Americans.  For both infections, the majority of people who have the infections are not aware that they are infected, either because they either acquired it without knowing in the past or because they misidentified their herpes as something else.  An excellent source of further information about herpes can be obtained by accessing excellent informational web sites such as the one run by the American Social Health Association (disclosure, Dr. Handsfield and I are both on the Board of Directors of ASHA).  EWH

[jwnyc]

Thank you, Doctor.

I will get retested using an IgG test with my PCP.  Two follow-up questions:  

1) Longshot:  The test was administed at a NYC Health Clinic.  Are you aware if the Tzanck test was commonly used by Public Health Clinics four years ago, specifically in NYC.

2) Were I to get a negative result using the IgG test, could I consider that a definitive negative result.

Again,  Thank you for your help.   I've been researching the subject for some time and this is the first I have heard of the Tzanck test!

[Edward W Hook, MD]

Sorry,I don't know what testig was done at the NYC helath Departments.  

If your IgG is negative I would presume that the original diagnosis was an error.  EWH