[Question #2335] Herpes vs. Shingles

45 months ago

My wife recently experienced an outbreak of appx 10 small bumps on the right side of her anus.  They looked like razor bumps but had some associated itching.  She visited her MD and her GYNO.  Both suggested either shingles (she did have chicken pox) or herpes2.  Within 3 days of the initial outbreak, she had tests done at her MD.  She tested negative on both IGG tests.  She was then pointed to her GYNO.  Appx 6 days after the outbreak, they tested for both IGG tests AND the IGM test.  Her IGG tests came back negative once again.  Her IGM test came back positive.  The nurse from the GYNO practice called and told her that indicated a positive result for herpes2.  But reading online, it looks like the IGM test could indicate both herpes2 and shingles.  I guess my question(s) are:

1.  Are there specific IGM tests that could distinguish between shingles and herpes 2?  If so, this positive result would then indicate herpes 2 correct?  If there aren't two distinguishable results, wouldn't this result be inconclusive between herpes2 and shingles?

2.  Does IGG start to show up after initial EXPOSURE to herpes OR after the first initial outbreak? 

Thank you for your assistance with this.

Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
45 months ago
Was any swab testing done of the lesions?  It should have been - that would be excellent at defining what is going on here.  I think shingles around the anus alone is unlikely but not impossible.  Have you had an antibody test to determine your HSV 1 or 2 status?  If not, that would be beneficial here.  The IgM test is very poor and has many false positive but not every positive is a false positive so it is possible she has new herpes infection and thus a negative IgG which will later become positive.  The IgG builds over weeks after new infection, but likely is not going to be positive until a few weeks after infection up until a few months after infection - it varies greatly.  Also, the IgG test misses about 8% of HSV 2  infections and 30% of HSV 1 infections, so it's also possible that she has HSV 1 or 2 and the test missed it.  Does she get cold sores?

What we haven't discussed here is the possibility that she has HSV 1 genitally - very very common and is usually a result of someone who has HSV 1 orally in the form of cold sores at some point in life giving oral sex to someone who does not have HSV 1 infection already.  That's also why the swab test would be beneficial because it can type the virus. 

Your thoughts?

Terri

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45 months ago

Hello, and thank you for the fast reply.  I guess some additional info would help you.  The outbreak was on a single nerve line on the right side only.  The doctor said that the location presented as herpes, but that the straight nerve line presence, with no cross over to the other side made her think shingles.  They did an immediate culture, but the doctor also said it would be the smallest initial outbreak she'd ever seen and that there was very little to collect on the swab.  She was not confident that there would be enough for a conclusive result.  We had a baby in April, and have only had one sexual encounter since then in early May.  I myself have never been tested for herpes.  So I guess we're still confused by the timing of everything.


Could I have had herpes for 10+ years with no clear outbreaks.  Not known that I had it.  And then just now passed it on to her from our encounter in May?

Could she have had it for 10+ years and just now had her first outbreak?

And I guess I'm still confused on the IGG vs. IGM results. 

IF she has had the virus for 10+ years and is just now having her first outbreak, would her IGG levels be "negative" at the first outbreak (current) and THEN go up?  Or would she have elevated IGG levels because the virus would have been in her for so long?

And as far as the IGM question from before, is there a distinguishable test for herpes IGM vs. Shingles IGM?  From my online reading, I have found that a new shingles outbreak would also elevate the IGM results.  So, if there's only one IGM test, can it distinguish between herpes and shingles?  Or is there a separate IGM test for singles and a different IGM test for herpes?

And then same line of questions for me. 

I guess first question, is it possible for me to have had the virus in me for an extended period, never have know, never have shown any signs of an outbreak, and JUST NOW pass it on to my wife?

And if that's the case, I MUST have had an outbreak at some point without knowing it, so my IGG levels would already be increased, correct?

Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
45 months ago
1. Yes you could have had herpes for 10 years with no clear outbreaks - so could she, yes, or she could have missed an earlier outbreak or confused it with something else such as a yeast infection or UTI, but this is far less likely since her IgG for HSV 2 is negative now.
2.  They would only be negative IF the IgG test missed the infection entirely, which does happen.
3.  I don't know if VZV (shingles) has an IgM test -probably.  It's not something I have ever ordered so I'm not certain about that.  The IgM test for HSV can cross react with other things so it's not a good test at all in my opinion and the CDC says it should never be done due to it's poor performance.

Outbreaks don't make IgG tests positive, infection even without symptoms does.

I know you guys are focused on HSV 2 due to the IgM test but I still think HSV 1 is in the running for these lesions.  Was HSV 1 testing done? 
Have you ever had a cold sore?  Has she?

How did the swab test turn out, do you know?  Do you know if the swab test was a culture or a PCR?

Having lesions on a single side of the body is also characteristic of HSV recurrences so she could have had HSV 1 genital infection for years, missed the first outbreak and any subsequent recurrences and is now having one.  This is a possibility - not only shingles can be one sided.  Has it resolved now?


Terri
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45 months ago

Terri,  Thank you again for the thoughtful reply.  I'm sure at some point each of us has had a cold sore, so I don't want to discount the HSV1 Possibility.  The only thing there is that she had both IGG 1AND 2 tests done and has been negative on both tests both times.  So IF we had cold sores / HSV1 for years at this point, wouldn't she have tested positive for IGG1 in both of those tests?

They do have an IGM test for shingles.  And I read that the IGM test for herpes can cross react from the shingles virus, so I'm going to discount the IGM result for now.

The bumps have scabbed over (minimal scabbing, but much less red) and the MD said are almost completely inactive.  Minor itching remains, but no spreading or newly active spots.

Based on your line here:  "Outbreaks don't make IgG tests positive, infection even without symptoms does."...  So are you saying that in order for my wife to have two negative IGG tests AND have these bumps be the HSV2 virus, she would have HAD to actually contract the virus from our one sexual encounter in May?  Prior to that, she was having a rough pregnancy and we hadn't had sex for over 4 months.  So IF she had contracted the virus from a previous encounter (meaning more than 5 months ago) her IGG levels would already be elevated at this point.  IF hypothetically that were the case, how rare would it be for me to have had the virus for an extended period and NOT passed it onto my wife for more that 10 years?  That seems like a very low probability in my mind.  Am I thinking about that correctly?  Just to be clear, IF she had the virus for 10+ and only now had her first outbreak, you're saying her IGG levels would already be elevated from having the virus for that long correct?  Regardless of previous outbreaks?

And to answer your final question, the swab was a culture.  We have not received any results back yet through our MD.  At this point, we have two IGG results (both 1 and 2) in; both negative.  And one IGM result that came back probable positive.

If I'm thinking about all of this correctly, I see our options as:

1.  Herpes HSV2 that she'd have had to contract from me from our last sexual encounter in May.  OR

2.  Shingles which caused the IGM positive result from the last test.

Because of her two negative IGG results, it doesn't seem like she could have had the virus for the last 10+ years with only her first outbreak coming right now?

Thank you again for all of your help!


Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
45 months ago
she could have contracted it from you in May (yes, you could have had it for 10 years and didn't know and didn't pass it to her) OR she's had it a long time and the IgG test missed it - it misses about 8% of HSV 2 infections  OR she has HSV 1 genitally and has not previously had a cold sore and got it genitally from you OR it's not herpes and it's shingles instead.  There are many possibilities here - too bad a culture was done - the PCR is way more sensitive and hopefully most clinicians are now using PCR vs. culture.  Let me know how the swab test comes out.  If it happens to be positive for HSV be certain they also do typing of the virus. You have used up all your posts but I'll leave this open so you can tell me the culture results.

Terri
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45 months ago
Thank you again for all of your help! Quick update: my wife's igg tests from both ob and General md are all negative. There was a positive igm test, which made the nurse at the ob tell her was positive for herpes. However, we read (and you advised) that the igm test is very poor and can cross react from something like shingles. The md's cultures came back and were NEG for herpes and POS for shingles. So our md is somewhat confident that it's shingles. However, the ob, who stated that IF it were herpes it would be the smallest initial outbreak she's ever seen, is still concerned it's herpes based solely on the igm positive result. The ob contacted the md and consulted and are now bringing in an infectious disease specialist. The outbreak was very small. The igg tests have all been negative. The cultures back bag neg for herpes and POS for shingles. Are we reading too much into the igm result by letting this continue to an infectious disease specialist. Thanks again for all of your help!
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
45 months ago
Yes, I think you are reading too much into the IgM.  So the swab test was positive for varicella zoster virus?  If that's correct, then you can put the herpes issue behind you.  It's either VZV or it isn't - if it is that, then it isn't herpes.  It can't be both.  Great news!

Terri
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