Accuracy of older HSV2 tests, HSV2 vs. VZV

[pearl2]

Thank you, Doctor, for helping me with your answer to my previous question about HSV, Zoster, and PHN.  I have a follow-up visit with my neurologist coming up. He and I have been working together for a long time, trying to control the chronic pain and attempting to resolve some of the diagnostic issues (more mysterious to me than to him, no doubt). I believe that "fresh eyes" are helpful, which is why I'm asking you this question.  My diagnosis of HSV2 was made 15 years ago, by an infectious disease specialist in hospital. A large lesion was scraped, and they also had CSF and blood at their disposal for testing.  I've had several doctors recently ask if it was cultured.  I had meningitis at the time, and was pretty out of it. I do recall that the test results were given to me within one to three days.   My question is, is it likely that the test given was accurate by today's standards?  I am unclear as to what changes have been made, only that the questions asked by my new team are different than what has been asked before. I understand that IgG results are more accurate, and IgM results are inaccurate -I'm not clear which tests were commonly used in the late 80's to early 90's.

Also, now that my docs have suggested, but not proven,  zoster as a diagnosis, I have been told to have my next lesion cultured.  Generally, I have frequent outbreaks. Now that I am waiting for one, it's been three months since I've had one (that's a record!). Is culturing a lesion the only way to diagnose VZV?

[H. Hunter Handsfield, M.D.]

I really cannot help very much.  Your term "fresh eyes" implies you might be looking to me for a diagnosis or specific diagnostic advice, but that's much too close to practicing medicine from a distance, which I cannot do.  I will just say that older HSV serological tests indeed were less accurate than those now available; and that "frequent outbreaks" is not consistent with herpes zoster. I have never heard of a patient with more than 3 total episodes of VZV (although I suppose it can occur)--but this is well outside my expertise.

If your diagnosis is uncertain and you are having recurrent genital (or other) skin lesions, and if your provider recommends re-testing for HSV and/or VZV, or having a modern HSV blood test, then I suggest following that advice.

Good luck--  HHH, MD

[pearl2]

Thank you for your response.  No, I am not requesting a diagnosis; I have a complex medical history, atypical presentations, and unusual responses to medications (this has been true -literally- since birth).  I do want unbiased, well-informed answers to my questions.  I am sometimes uncertain of the expertise of some of the M.D.'s I've seen. It's hard also to get answers to questions when you're one of 40 patients being seen that day. That's why I'm writing. You answered one of my questions - and re-testing for HSV is of course, no problem - But no, none of my M.D.'s have suggested it. They have suggested culturing my next lesion - which all of the sudden, is long in coming.

My other question, which was not addressed, is whether testing for VZV requires culturing of an active lesion, or are there other tests?

[H. Hunter Handsfield, M.D.]

Sorry, I missed that part of your questions.  It's just like HSV:  there is a blood test (an antibody test) that tells whether someone carries the virus, but it doesn't tell whether a particular outbreak is due to VZV.  Over 90% of the population has antibody to VZV, dating to the near-universal chickenpox).  The only way to know whether a particular lesion is due to VZV is to test for the virus.  The technology isn't culture, but immunochemical detection of the virus--but it's the same idea.

HHH, MD

[pearl2]

Bummer. One of the few things I remember about that hospital stay 15 years ago, is what it felt like when they scraped the lesion to culture it.  Oh, well.  But you see, doctor, the phrase "fresh eyes" does apply to this exchange.  None of my docs (and I have a team of them) have suggested a blood test for HSV2 - even though the only test I had for it was 15 years ago.  I hadn't considered that the technology for testing might be substantially different until I read this forum.  I've been coping with this for so long - my treatment has been on auto-pilot for 10 years. My health has taken a downward turn lately, so my doctors and I are back to looking for answers and exploring options.  I'll take good information wherever I can get it.  Thank you so much!

[phn]

Hello-
I read your original post and wanted to let you know that I have had phn from the start. In fact, that has been the only real symptom of my hsv2, other than minor lymph swelling.  The phn and swelling were what brought me to the doctor.  Due to my description of the nerve pain which I described as radiating down my left leg, the doctor immediately suspected hsv and did a type-specific blood test to confirm the diagnosis.  I have no other complicating illnesses, and I am a young, otherwise healthy person with no history of other std's.  My immune system is in good shape and I do not have hiv.  I take acyclovir daily, and when I do not take my pills on time, the pain comes back.  My partner was tested after I tested positive, and he also had hsv2, but was apparently asymptomatic.  Based on my doctor's anecdotal experience with hsv2, as well as my own, and the relative similarity between zoster and hsv2, I'm wondering why anyone would doubt that both might cause phn.  It seems kind of silly.  I doubt anyone has done an empirical study on the issue.  Okay, I'm fairly positive they haven't.  I've checked several databases.  Anyone seeking grant funding out there want this one?  Of course, I already know the answer, but I think it's time it was documented.