Conflicting Herpes Diagnosis

[captain777]

Hello,

In Sept 2008 I noticed some red bumps and tiny blistering on my scrotum area.  I shave in that region but was concerned so I went to a dermatologist.  The doctor proceeded to diagnose me with herpes by means of a viral culture.  She also said I had a staph infection.

I've not had outbreaks since.  Three months after that diagnoses I had a IgG type specific antibody test for both HSV 1 and HSV 2.  Both were negative.  I repeated the blood test at 6 months.  Again negative.  I repeated the blood testing again at 12 months at a infectious disease specialist MD.  Again, both negative.

The original dermatologist told me she doesn't care what the blood tests say because viral cultures are the "gold standard" and never wrong.  After a year from original diagnoses, wouldn't one of these blood tests show a positive result though?  I just want to know one way or the other.  I was expecting to get a positive result in some of the blood work and was upset with finding the results of the original culture.  I just want to know if I am a contagious risk to someone.

Thank you for your help.  It is hard to get answers sometimes...

[Edward W Hook, MD]

Follicultis lesions are the ones that typically have hairs groing out of them and HSV lesions typically do not.  EWH

[captain777]

Thank you for your expert advice.  I appreciate it.

Is it true that herpes lesions do not have hair growing out of them?  In the past, prior to any of this starting,  I have had what I believe to be sebaceous cysts caused by ingrown hairs as I've always seen a hair come out of the affected area.

[Edward W Hook, MD]

You are correct, in published studies less than 3% of persons with proven HSV fail to develop positive blood tests by 6 months.  Your situation is a little more likely for this to be the case since you were expeditously started on valacyclovir and have been on it since.  EWH

[captain777]

Thank you Dr. Hook

I will most likely talk to my doctor about a Western Blot.  Out of curiousity, how rare is it to show no antibodies on an IgG test at 3, 6, and now 12 months?  It seems like the vast majority of people online post that there is seroconversion around 3-4 months, and almost always within 6-12 months.

[Edward W Hook, MD]

That has been known to alter antibody responses, delaying their development and sometimes even preventing development of antibodies (very, very uncommonly).  What this means biologically in terms of your infectivity for future partners is unclear and unstudied.

There are several options for you.  You could continue to take valacyclovir indefinitely. In this situation I think your infectivity for future partners would be, at most, low.  Alternatively, you is that it would be helpful for you to stop taking your daily valacyclovir at this time.  The outcomes of this include that you could have a recurrence, thereby verifying that you are infectious and answering your question, or your Western blot assay could become positive even without a recurrence, also verifying your infection and potential infectivity for future partners or you would not have a recurrence and not develop a positive blood test which, in my mind would diminish the likelihood that your will be infectious to future partners.  There are no studies to guide our thinking in this situation.  EWH

[captain777]

Dr. Hook,

Thank you for your quick response.  I was treated with Valtrex and have taken it daily since Sept 2008.

[Edward W Hook, MD]

Welcome to the Forum.  Your situation is a difficult one.  I agree with your dermatologist that culture of virus from lesions is the "gold standard" for diagnosis of herpes infections unless your specimen was mixed up in processing or at the lab (this would be most unusual).  Having said that, and acknowledging that there is a small proportion (about 5-10%) of persons who get genital HSV and then never have a recurrence, it is really rather unusual for HSB serological tests to not be positive.  The HerpeSelect has a high sensitivity but is occasionally negative in someone with herpes.  

Your situation raises two important questions- do you have HSV and are you infectious to others.  For the first question further testing with a Western Blot assay from the University of Washington may be helpful.  This was the test that the HerpeSelect was compared to in development and it did pick up a small number of infections that were not picked up by the HerpeSelect.  

If your Western Blot is negative, the next question becomes are you infectious to future partners, given that there is no evidence of infection in terms of recurrences or blood tests.  There is no definitive answer to this.

I realize this is not a definitive yes or no question.  I would start with the Western blot.   If that is negative there is a chance that you are not infectious to future partners as there is no evidence of ongoing infection.  EWH

p.s.  Were you treated for your initial infection?  Do you continue to take antiviral therapy?  EWH