Herpes or Shingles

[worried_mom66]

I posted the following for my child the forums section:  

I am not sexually active. I recently exhibited symptoms similar to vaginal herpes.  The initial blood test for antibodies was negative.  The direct culture of the lesions was negative.  The doctor was stumped.  As I had done some of my own research, I suggested that it might actually have been shingles, not herpes.  She agreed this was possible, and since the lesions followed the pattern of shingles (they were only on the left side), this was a more likely diagnosis than Herpes simplex.  She still wanted a follow up blood test in a month.  

The lesions were extremely painful, and cleared in less than a week.  In the meantime, I became ill again, this time diagnosed with Mononucleosis.  The swollen and sore glands cleared up fairly quickly, but the fatique remains a month later.  I went for the 2nd blood test on Mon and Tues night I  became violently ill with a stomach virus.  A week after the blood test, the doctor called with the results, slightly elevated IgM (I think she said 1.6), but no change in IgG levels.  She believes that the original outbreak was indeed shingles, and that possibly the EBV or another virus created a positive reaction.  She is contacting someone in ID to confirm.  Just to be sure, she wants yet another blood test when I am healthy to rule out the false positive.

I don't take care of myself, possibly not meeting my nutritional needs.  In early October, I hit a low point, and was lethargic and weak and highly stressed.  I was busy with school and so many obligations.  It was just as I was getting things caught up that this happened.

I think I might have some sort of immune deficiency.  I haven't been well since September!  I keep getting different viral infections, I am worried what might be next.

I guess I just want some feedback.  It is possible that this was shingles?  I haven't had sex (in any way shape or form), it has to be shingles!   Help!

[Edward W Hook, MD]

Your daughter had a rash which suggested a herpes (simplex or zoster) infection to a physician who saw her.  The cultures of the lesions were negative which would be VERY unusual for either HSV or zoster infection.  In addition, there is nothing in your note to suggest that valacyclovir therapy, which would help  both zoster and HSV helped.  The only diagnosis that you have for your daughter that is solid is mononuc\leosis which in fact can also be associated with rashes.

My assessment. This is probably not zoster or HSV but a rash associated with her mono.  In addition however, you have too many health care providers involved, all of whom are making suggestions which don't necessarily agree woith each other.  My advice is to work with a single doctor whom you trust and who can evaluate the tests and time course of your daughter's difficulties.  That person should coordinate all testing and be the conduit for all information.  

As far as another HSV blood test, if you choose to do this, I would wait until at least the end of January to obtin a test, at which time the results, positive or negative will be most reliable.  Beyond this, I have little more to offer.  Good luck.  EWH

[worried_mom66]

It is difficult to list all pertinent details with text character limits on these posts.  My daugther is 17, and the initial diagnosis is frustrating and embarrassing for her.  We have been conferring with our regular doctor, but as a GP (my daughter hasn't seen an OBGYN because she is not sexually active), she doesn't have all the answers.  She has an ID specialist friend who is on maternity leave until sometime in January, we are awaiting more information from her.  In the meantime, I was investigating vaginal shingles, although rare, it is a more plausible diagnosis than herpes in a non-sexually active individual.  Here is the timeline:
Nov 1 achy and tired
Nov 3 some pain during urination
Nov 4 very painful urination. Went to after hours office. Urine test positive for blood, administered AntiB injection, and prescribed AntiB for UTI. Also ordered blood work for HSV because of observed lesions
Nov 5 blood work at hospital. Visited regular Dr, stop antiB, did culture of lesions, presc. Valtrex and Hydrocodone.
Nov 6 Difficulty urinating
Nov 7 Unable to urinate, back to Dr, then to hospital for Foley Catheter
Nov 10 back to Dr.Blood test and culture negative, did not remove Foley (lesions almost cleared)
Nov 12 back to Dr, removed Foley.  Lesions completely cleared.  We discussed my research on shingles.  She noted that the lesions had been only on one side, which fit with shingles, and that is was possible.
Nov 14 beginning sore throat, to Dr, prescribed AntiB for strep
Nov 17 Dr for Mono blood test - which was positive
early Dec for follow-up blood test, which was the marginal positive IGM result (neg IGG).  I didn't see that report, she called, so I don't even know if I got the antibody names right.  She was to discuss the potiential for cross reaction from the recent EBV from Mono with this test.  She believes it was shingles.  She had also discussed the case with HER OBGYN who said he had seen vaginal shingles before, so it is possible.  But, just to be sure, they want ONE MORE blood test, when my daughter is completely healthy.  She seems to be well, not terribly fatigued from Mono, and recovered from the stomach virus right before Thanksgiving.  Should I request a specific HSV test, so that we are not questioning the results, based on potential false positive readings?  We want a definitive result.  

[Edward W Hook, MD]

I will try to help with your question but it is difficult and I find myself wondering why your daughter is not corresponding.

It would help to know a bit more about the time course - when was the genital outbreak?  how long did it last?  Were the cultures taken before therapy was given?  Has your daughter had chicken pox or the chicken pox vaccine?


Herpes zoster may occur in the genital area but it is uncommon.  The pain could be is consistent with either herpes zoster or genital herpes and for either zoster or a first episode genital herpes to clear without therapy in less than a week is rather unusual. Furthermore, if untreated and cultures are taken in the first couple of days, the viral cultures are usually positive.  This in turn raises the possibility of other processes such as another infection or a dermatological process.

Poor diet would not be expected to modify the course of the illness unless she is truly malnourished and here in North America that is most uncommon.

The question of immune deficiency is hard to assess and with a single infectious process is somewhat unlikely.  it is more likely that what she has experienced is just bad luck.

I will entertain a follow-up question or two but, to be honest, this  and these questions are really something that should be investigated directly between the patient and their doctor, not through an intermediary.  I realize you are concerned but much really does get lost in translation.  EWH