HSV 2Blood tests Neg/HSV 2 Culture Positve

[healed007]

I was tested for all STDs including HSV1 and HSV2- (HerpeSelect)  My 10/2012 results were positive for HSV1 (4.71 igg)  and negative for HSV 2 (0.11 igg). I originally found out that I was HSV1 positive (3.34 igg)  in 06/2009 and I was negative for HSV 2 (0.08 igg). I had a one time fever blister outbreak when I was under 10 years old. I never had any fever blisters/cold sore outbreaks in my teenage years and as an adult.  In 2010, I was tested again for HSV1 which was positive (3.33 igg)  and HSV 2 (0.00 igg or 0.01 igg). (Three negative hsv2 blood tests in three years).

Since 10/2012, I have been dating by boyfriend. I tested negative for  HSV2 (0.11 igg) in  10/2012.  This past month (11/ 2013), I was tested positive for hsv 2 from a culture.  Three days after having intercourse, I noticed a bump on my perineum. I did not have a bump during or before my current relationship. I visited my gyn right away. My culture results can back positive which I do have a copy of  my results. My boyfriend will be tested for hsv2-awaiting results.  Based on my previous negative blood tests, can you please share your opinion about my complicated situation?  I am baffled...

How soon should I get  a hsv2 blood test now that my culture is positive? Would you recommend that my blood tests are  sent to Western Blot?

Thanks,

[H. Hunter Handsfield, M.D.]

Welcome to the forum and thanks for your question.  I have reviewed your discussion a couple of weeks ago with Terri Warren on the herpes professional forum.  I agree with Terri that there are some peculiar and complicated issues here.

Terri asked you to get a written copy of the culture test that was positive for HSV-2.  Have you done that?

As discussed by Terri, your genital symptoms are not at all typical for herpes.  And a new genital herpes infection, from intercourse 3 days earlier, would not normally occur on the perineum.  The usual sites are the places that receive maximum friction during sex: in women, that usually means the vaginal opening, labia minor, etc.

Most people with positive blood tests for HSV-1 have oral herpes, as you have suspected yourself.  However, it is possible you have genital HSV-1.  I have to wonder whether your positive culture in fact was HSV-1.  Or maybe it was positive for herpes, but your doctor or the lab assume HSV-2 because of its genital location, without actually testing the virus type.

So my best judgment is that your apparently positive culture for HSV-2 was false -- either it was entirely negative and mistakenly reported, or might have been positive but for HSV-1.

So my advice remains the same as Terri's:  get the written test report from the lab.  However, if you cannot do that, a Western blot blood test might be helpful.  I would predict it would be negative.

Best regards--  HHH, MD

[H. Hunter Handsfield, M.D.]

There are two basic kinds of HSV testing:  blood tests look for antibody, i.e. the immune system's response to the virus; and there are tests to look for the virus itself.  The latter include both culture and PCR.  PCR is better, for the most part, as discussed above.  A doctor may request a culture, but if the lab only offers PCR, that is the test that will be done.

[healed007]

My original response to you on 11/22/13, I informed you that my hsv2 was PCR tested which you indicated not a culture. I am a little confuse.  My gyn bursted my bump , swabbed, and sent to the lab-not Lab Corp. or Quest. My culture was sent to a lab that specifically performs PCR only.  I did not have blood drawn. I thought that PCR was testing for cultures  on  a swab not blood.

Can you explain PCR? I know that my blood will be drawn for HerpeSelect and Western Blot to check  for hsv 2 antibodies.

Thanks

[healed007]

Thanks again for the quick response. I will take another HerpeSelect  blood test and a new Western Blot blood test. I will follow-up with you when I get both results.

Thanks

[H. Hunter Handsfield, M.D.]

Ah--  you had a PCR, not culture.  The PCR tests are superb, and generally an improvement over culture because they pick up more positives and can be more helpful in diagnosing some patients.  However, that excellent performance comes at a cost:  they are almost too sensitive, and sometimes give false positive results.  Given all the available information, I think that's what's going on here -- i.e. that you don't have HSV-2 at all.

The other problem sounds like folliculitis, i.e. hair follicle inflammation/infection, which is often triggered by shaving.  It's a bacterial infection, often with staph or strep.  I cannot be certain that wasn't a herpes episode, but I doubt it.  I'm sure your gynecologist is correct about the vaginal cyst diagnosis.

Given the PCR result, I would recommend you have one more blood test -- and make it both a standard IgG test, like HerpeSelect, and a Western blot by the University of Washington clinical laboratory.  I predict both will be negative.  I'll be happy to give you my final thoughts if you get tested and post the results.

[healed007]

Thanks for following-up with me so quickly. I picked-up my culture results on 11/18/13 and I reviewed them again tonight- Negative HSV1 and Positive HSV2 - PCR Real Time. I did not have a bump within  the labia minor or the vagina opening. I just reviewed some pictures online regarding the female anatomy to make sure that I know where the perineum is located. Actually, the one  bump  was on the  perineal  body central tendon/posterior fornix- new medical term I learned tonight. Yes, the one bump appeared three days after I had intercourse, I visited my gyn two days later for a culture.

This evening, the bump can back in same the location (very/very small) So, I started Valtrex again.  

A Different Issue:

After shaving this past summer in 7/2013,  I noticed three-five small bumps on my labia majora where I shaved .  Gyn bursted and swab them.  The culture results can back negative hsv1 and hsv2 and I have a copy of the results. However, the bumps come and go.  In 10/2013, gyn and dermatologist ruled out folliculitis and said I have vaginal cysts. I am not sure about that.  Last month Nov., I put Nystatin  and Triamcinolone Acetonide on them and they went away. Hopefully, they do not returned. I was advised by both specialists not to every shave again.  

Once again, can you please share your opinion on both of my complicated issues?   Should I  wait three months to take the Western blot to see if antibodies develop for hsv 2?

Thank you