[Question #6008] HSV 2 Blood Test

17 months ago
Hello,
About six months ago I had been dating a new guy. I’d asked about sexual history and we’d both had clear general screenings. (No HSV testing) After getting on the pill, we had unprotected sex. We had only had sex a handful of times (I’d estimate 6), when I noticed a small ulcer. I made an appointment with my gynecologist who said it definitely wasn’t herpes. (Just did a visual exam) 

Since then, the same spot has returned three times. It never looks like the typical “herpes” sores. Also, I’ve developed other symptoms that are pretty non-typical of herpes (I think) - persistent vulvar pain and swelling, not burning or itching but almost like severe soreness and a low grade temperature. I’ve been hurting for almost a month with fever off and on. Interestingly, the ulcer always precedes the pain and is never there when it hurts. I’ve also had some urethral swelling but the urologist ran some tests and did an exam and wasn’t quite sure why. 

My doctor isn’t sure what is going on, but she doesn’t seem to think it’s herpes. 

For my own sanity, because what else causes a recurring ulcer, I had an HSV blood test done. 
It was positive for HSV 2 at 1.102 and negative for HSV 1- I’ve read that this is a very low positive. 

At six months post exposure with “recurring” symptoms, wouldn’t this be higher? 

How likely is it that the test is wrong?

If I don’t have HSV one, which is out of the ordinary but not surprising since I can’t ever remember a fever blister, wouldn’t my primary outbreak had likely been more severe than one ulcer?

I guess I’d just like some reassurance. It took six months to find the courage to test the first time and now I’m terrified to test again. 


Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
17 months ago
Well, there is an excellent chance that your HSV 2 is a false positive but we can't promise that. I would say a 90-95% chance of this being a false positive.  But I have also seen some true positives (western blot positive) at 1.1.   Also, the IgG test misses 30% of HSV 1 infection, compared to the gold standard western blot,  so we can't honestly count on that one being negative either.  If you had the resources or inclination to do the western blot, that would be your best bet to clarify your situation.  Have you had the actual ulcer swab tested?  And the best swab test is a PCR.  I would suggest having it swab tested again, the first day it comes up.  The general soreness is probably not related to herpes.

Terri
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17 months ago
Hi Terri,
Are the index values typically different for samples collected with dried blood samples? I went ahead and went to the clinic to have actual blood drawn today. In the case that the results are similar, I will certainly look into the Western Blot. 

Thank you for your help!
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
17 months ago
I personally think the dried blood spot herpes testing is still a bit uncertain as to it's accuracy.  Good you did some other testing, I think.  I have seen conflicting results for dried blood spot results and regularly drawn IgG and western blot results

Terri
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