Hi Doctor: I have a very confusing situation for a friend of mine. 10 years ago she was in a relationship and felt vaginal burning. Went to a planned parenthood clinic to seek medical attention for that condition and vaginal swab came back "positive for HSV". I'm a physician and she stated to me that she gets "yearly outbreaks". I referred her to an STD clinic to get evaluated. She goes to a reputable clinic and lo and behold she tests negative with the biokit! She doubted the validity and asked for me to perform a HerpesSelect test from Quest Diagnostics. That test came back very positive for HSV2 (>5) and HSV1. Needless to say she was devastated. I advised her to be reevaluated at that same clinic and show that MD the results of the HerpesSelect. It so happens she returns at the time when she was having her usual "OB". Well, she tests negative again with the biokit, is examined thoroughly by that MD, told her she did not have any lesions, did a KOH smear and was + mildly for fungus and given Fluconazole. Does she have HSV2? This is so confusing for her.
Welcome to the Forum. I'll be pleased to comment. The situation you describe is not common but it also is far from unique. Your friend's history is perfectly compatible with HSV-2 - an initial outbreak and periodic outbreaks since that time. Her positive culture test at the time of the initial outbreak likewise strengthens the diagnosis. Serological verification of infection can sometimes be difficult- for recent infections this may be because of the time it takes for antibodies to form and this is not relevant to your friend's situation. What is relevant however is that none of the current serological tests for HSV antibodies is perfect- they all miss a small proportion of persons who do have infection but do not have antibodies to the specific antigens targeted by the test. In our own research we have found that both the HerpeSelect and the Biokit do rarely (less than 3% of the time) fail to be positive in persons found to be HSV infected by other means (i.e. either positive tests for the virus itself or multiple other positive blood tests). I suspect this is what is going on. If she (or you) really feel the need to prove that HSV is present, the best approach would be to wait until the next recurrence and then ASAP perform a PCR test on the lesion (it does not have to be in the blister form but the tests should be done ASAP). An alternate approach would be to test with the Western Blot at the University of Washington.
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