Positive Culture, Negative IgG years later

[101me]

     About 2-3 years ago I noticed a bump in my vaginal area.  I tried to pop it which only made matters worse.  Still, it was just that one small area.  I had a herpes culture done immediately, which came back positive.  I have had no signs or symptoms since then.  Two months ago I had bloodwork done,a package deal including several other tests as well as The Herpes Simplex Type 1/2 -- described as HSV types I and II Specific Antibodies, IgG (AT)-- which came back NEGATIVE.  The HSV-1 aB IgG came back negatice with less than 0.90 and the HSV-2 aB IgG came back negative with less than 0.90.  
     I read you have to wait around three months before IgG testing, but this has been well over two years.  I plan to have the bloodwork repeated as I cannot repeat a culture because there are/have not been symptoms since.  Current OBGYN (did not perform the culture) says it is still certain I have Herpes because of the positive culture even though there are no symptoms and the blood tests are negative. "Cultures are the gold standard and rarely give false positives."  I read once you have HSV-2 it stays in your bloodstream for life, yet I have never tested positive.  What about western blot?
     Is it possible to have a false positive on the culture?  How can that be proven? If the blood work (IgG) comes back negative again, do I go with the blood work or the culture? Confused and just need to know either way.

[H. Hunter Handsfield, M.D.]

It is true that cultures rarely give false positive results.  But it is also true that the vast majority of people with HSV develop positive blood tests. Your description of your genital lesion is somewhat atypical for herpes; which usually does not cause a bump you would be tempted to pop.  (Herpes lesions are superficial; think of them as being on the surface of the skin, whereas pimples are deeper--think of them as being 'in' the skin.)  But the botttom line is that I cannot predict with certainty.  Two approaches:  1) Ask your current doc to directly contact the lab that gave the positive culture result and confirm that there wasn't a mix-up in your test results.  False reports always can occur because of simple clerical errors, for example.  2) Have a repeat blood test, specifically a Western blot at the University of Washington clinical laboratory in Seattle.  If that is also negative, I would lean toward believing the culture report was wrong.

Good luck--  HHH, MD

[101me]

I am not sure if you can even respond now.  If not, maybe someone else will.

I appreciate your advice.  However, your answer seems a little vague.  You say "lean towards."  Is there any way other than the lab admitting they goofed (not likely especially 3 years later) to prove 100% that I do not have herpes?  

You would think if there is a test that can say you CERTAINLY have it, there would be a test that will say you CERTAINLY do not have it.  Are you saying the Western Blot is that test?  Or does a test like that even exist at this point?

Thank you very much for your time.

[H. Hunter Handsfield, M.D.]

Sorry, no tests exist that will give you the certain answers you seek.  If no lab error can be identified, you can never be 100% positive you don't have HSV.  But if WB is negative, you can be pretty certain you don't have a genital HSV infection that can be transmitted to a partner.  But until or unless some new testing method comes along, nobody will ever be able to take that advice to any stronger level than "pretty certain".  I understand your desire for certainty and the anxiet you feel, but it just isn't going to happen.

[101me]

Thank you, again.

If you cannot answer this, I understand.  But I am still confused as to where I go from here.

IF Western Blot and second IgG do come back negative, am I ethically obligated to disclose the results of the positive culture three years ago or do I go on the diagnoses of the three recent tests that I do not have herpes?

[monkeyflower]

I personally think it's up to you. If it were me, and the risk might be particularly great for my partner and his/her partners--i.e. someone who is immunocompromised (I have a partner with cancer), or someone in an otherwise monogamous relationship--then I'd probably say that I'd had a positive culture for herpes and subsequent negative blood tests, and let them decide for themselves.

But I actually do have herpes, and except for one person, it's really never been an issue at all. So either way, I don't think it's worth all this stress and worry.

[101me]

I really appreciate your input.  I guess the doctor is done with follow-ups.

I have been through the initial reaction and all that comes with that when I had the positive culture.  So I am really not stressing so much about that now.

I realize it is a small chance that the culture was wrong, however, it is also a small chance that the blood tests are wrong.  So I will have that repeated and ask about the western blot.

My mom works in a lab and she said I was kidding myself if I expected to call up this lab and have them say "Oh, yeah, my bad."  That just is not going to happen especially three years after a test.

It is just an issue I do not want to have to deal with if I don't have to.  And I would really like to know one way or the other.

Thank you again.

[soxfan28]

I recently saw my PCP to have a complete STD screening. I told him that I wanted to be checked for HSV-2 and he told me that I needed to have an active lesion to have the test performed. I felt that that info was not correct so I did some checking online. I quickly found out about the Herpes Select blood test. When I went to have my blood drawn today, I asked the phlebotemist about the test and she told me that they perform that test all the time. She did say that they have never performed that test for a male however. Is the test only for women?

[101me]

I really wouldn't understand why the blood test could not be performed on a man, but could be performed on a woman.  Then again, there is A LOT about this that does not make sense to me and there are very, very few people, doctors included, that can/will give you specific definite answers.

Try calling other offices that perform routine screenings and ask them.  Sorry I couldn't be of more help.  Good Luck.