Can I get False Negative For Herpeselect I and II ?

[feedrightwolf]

Five years ago I was diagnosed with Genital Herpes via visual examination only, but the blood test came out negative. I do not know the type of blood test used.

I had few occurrences of dry skin or redness on top of my penis that would usually go away fast. A year ago I got a red circle about half of inch in diameter, that would not go away with my usual over the counter treatment. I went to see a doctor, but by the time I was seen it already healed, and diagnosis could not have been made.

A month ago I once again had this circle appear. I made a dumb mistake and instead of seeking the doctors advice, treated it with lamisil for about a week or so(I have nail fungus and assumed that I might have transmitted it over to my genitals since it kind of looked like little ring worm), causing it to scale over with dry skin, which I was able to scrape off. At this point it began to look very much like a healing herpes outbreak and I got scared again and went to see a doctor. Once again I was told via visual examination that it looked like herpes, and was told to come back when the next outbreak occurred to get culture sample.

The problem is that I never get a pimple like growth filled with fluid, so I don't know when to come back. I still have the redness now, and I called my doctor but she ignored me and didn't get back to me.

I went out and got Herpeselect I and II blood test for both myself and my GF (5 years monogamous relationship) and both of our tests came back negative.

Now I have 2 very much herpes looking pimples on my lips. But I was tested false for both types of herpes, so either what I have is not herpes, or I had a false negative?

Is it possible that I had a false negative? And what can I do now to find out what exactly is it that I have?

Thank you!

[Edward W Hook, MD]

I would first rephrase the question.  Do you have oral HSV?  A positive culture of PCR test is the only way to  prove this. Antibody tests like the HerpeSelect do not detect all infections.  Precisely how many they miss is not totally clear but the investigators who have performed the very difficult studies needed to determine this estimate that they detect antibodies in about 95% of persons who get HSV-2 and perhaps a somewhat smaller number in persons with HSV-1.  The presence of HSV-1 antibodies seems to be associated with a somewhat decreased sensitivity for detection of HSV-2.

It is for these reasons that, short of making a definitive culture or PCR-based diagnosis, the diagnosis is best made by an experienced, expert clinician who can "put all the pieces" together.  From what you tell me above and integrating the information and test results you have given me on both your and your GF, my suspicion is that you do not have herpes virus infection, either on your mouth and even less likely on your genitals. EWH

[feedrightwolf]

Thank you for getting back to me so fast. The question I guess that I really have now, is how accurate is herpeselect test is, since if I do have oral herpes, it failed to detect it.

And do you know of any condition that can make a small pimple on the edge of my lip, which (after I shaved and cut it) looks very much like a small herpes outbreak?

[Edward W Hook, MD]

Welcome to our Forum.  I suspect that you do not have herpes.  There are many dermatological processes that can be mistaken for HSV.  The clinical (visual) diagnosis of herpes is incorrect over 25 % of the time that STD experts make the diagnosis.  It is for this reason that we recommend that all cases of HSV be confirmed by tests.  In your case, the tests show that you do not have infection and the lesions you describe sound more like a fungal infection than anything else.

Given the fact that you have a negative blood test and that your GF does as well, I really doubt that this is HSV.  Furthermore it sounds as the first lesions that concern you were genital in location and now you are worried about lesion on your lips.  HSV almost never causes infection at two places (i.e. genital and lips) in the same person.  As to what it might be, that is more difficult to say.  My advice is not to worry about this.  If however you are worried, my recommendation would be to see a dermatologist who can help you sort this out.

Hope this comment is helpful.  EWH  .