False Positive HSV2 Culture?

[Pato747]

A couple of months ago I noticed some scabs on the underside tip of penis. Went to a clinic just after I did a full STD make-up. All came back negative. The doc said maybe I had some aggressive masturbation or it also looked like molluscum contagiosum. I ordered another Herpes 1-2 IgG blood test which came back negative. Shortly after a few blisters and small red bumps appeared on top of tip of Penis. Of course I freaked out, went back to my doc and he cultured it saying it looked "viral". I then went to a dermatologist and he said it was  molluscum contagiosum. The blisters weren't really clustered and the bumps looked like molluscum. I finally calmed down and then the other doctors office called said my culture tested positive for HSV 2 after 2 weeks of waiting. I'm frankly scared. Sounds for sure now. I'm off to the dermatologist again today (everything is healing and going away) and i guess a third blood test. Any Thoughts?. I doubt the culture is false positive although that would be gladly accepted

Pato

[H. Hunter Handsfield, M.D.]

A dermatologist's diagnosis of molluscum contagiosum is highly reliable, ans same for an STD clinic -- so that diagnosis is solid.  However, it seems you had both problems, an initial genital herpes infection along with the molluscum.  False positive cultures for HSV can occur but are rare.  It takes 5-6 weeks for the HSV blood test to become positive, sometimes as long as 3-4 months -- so it is quite common to have initial gential herpes with a negative blood test.  You should have another test after 6 weeks and, if that's still negative, yet another one after 3-4 months.  You can expect it to become positive for HSV-2.  Since most dermatologists are herpes experts, your doctor will be able to advise you about what to expect in terms of possible recurrent outbreaks, risks for transmission to sex partners, and possible treatment to lessen viral shedding and the risk of transmission.

And of course you need to speak with anyone you have had sex with in the past few weeks.  Whoever gave you the infection might not know that s/he is infected with herpes, molluscum, or both, and should see his or her health care provider about it.

Finally, you should educate yourself about genital herpes.  Some excellent online sources are CDC (www.cdc.gov/std), the American Social Health Association (www.ashastd.org), and the Westover Heights Clinic of Portland, OR (www.westoverheights.com).  (Full disclosure:  Dr. Hook and I are on ASHA's Board of Directors, and we are friends and colleagues of the Westover Heights director.)

Good luck-- HHH, MD

[H. Hunter Handsfield, M.D.]

You don't need to start a new thread to ask a follow-up question; it should have been posted as a "Comment" in this thread.  I deleted the new thread.  You can use the Contact link to ask MedHelp administration for a refund of your $15 (but no guarantees; it's up to them, not me).

You asked "I also had a question about the IgG test. Do you have to have an outbreak for the blood test to detect the antibodies? Can a test show positive without having an initial outbreak. Like I had mentioned, 2 negative blood tests and then a recent positive culture for HSV-2. So it obviously is a sure thing. Hard to deal with and accept but I'm coping. Do people go on to live normal lives with this?"

You do not need symptoms to have a positive IgG antibody test.  Many infected people with positive antibody tests have no symptoms at all.  As far as living "normal lives" with genital herpes, absolutely yes -- but you do need to take precautions to protect future sex partners.  Read the information on the websites I suggested; and you also can telephone ASHA for personal discussion with an experienced counselor.  Finally, consider asking that question on the MedHelp herpes community forum, where the moderators are expert herpes counselors.

[Pato747]

Dr. Handsfield,

Just wanted to thank you for your responses to my questions. Also couple new questions if I may about outbreak triggers.

1) Can working out(weight training) cause stress to the body to the point of triggering an outbreak?

2) Can masturbation trigger an outbreak as well?

3) What are the common triggers?

Regards,
Pato

[H. Hunter Handsfield, M.D.]

First to your general question, no. 3.  For oral herpes due to HSV-1, several triggers are well established, such as injury to the lips or face, including surgery and sunburn, and various other infections.  The names "fever blister" and "cold sore" for oral herpes reflect the tendency of other infections to trigger outbreaks.

For genital herpes due to HSV-2, no definite triggers have been confirmed.  There are common beliefs about stress, mestruation, having sex, getting too little sleep, and eating certain foods.  However, there has been very little actual research and none of these has been scientifically confirmed to trigger symptomatic outbreaks.  It makes sense that, like oral herpes, various systemic illnesses (e.g., having influenza) might trigger outbreaks.  But the large majority of genital herpes recurrences seem to be entirely random, and usually it is a waste of an infected person's time and energy to try to identify and avoid specific triggers.

As for questions 1 and 2, the answers almost certainly are no:  there is no reason to suspect that either masturbation or weight training would trigger recurrent herpes episodes.