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STDs (Expert Forum)
Accuracy of older HSV2 tests, HSV2 vs. VZV
Answered by
University of Washington
Seattle - WA
This forum is for questions and support regarding STD issues such as: Chlamydia, Crabs (pubic lice scabies), Gonorrhea, Hepatitis (viral), Herpes, HPV, Molluscum Contagiosum, PID, Rectal Infections, Syphilis, Trichomoniasis, Warts, Yeast Infection.All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.
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Accuracy of older HSV2 tests, HSV2 vs. VZV
by pearl2, Feb 16, 2006 12:00AM
Thank you, Doctor, for helping me with your answer to my previous question about HSV, Zoster, and PHN. I have a follow-up visit with my neurologist coming up. He and I have been working together for a long time, trying to control the chronic pain and attempting to resolve some of the diagnostic issues (more mysterious to me than to him, no doubt). I believe that "fresh eyes" are helpful, which is why I'm asking you this question. My diagnosis of HSV2 was made 15 years ago, by an infectious disease specialist in hospital. A large lesion was scraped, and they also had CSF and blood at their disposal for testing. I've had several doctors recently ask if it was cultured. I had meningitis at the time, and was pretty out of it. I do recall that the test results were given to me within one to three days. My question is, is it likely that the test given was accurate by today's standards? I am unclear as to what changes have been made, only that the questions asked by my new team are different than what has been asked before. I understand that IgG results are more accurate, and IgM results are inaccurate -I'm not clear which tests were commonly used in the late 80's to early 90's.
Also, now that my docs have suggested, but not proven, zoster as a diagnosis, I have been told to have my next lesion cultured. Generally, I have frequent outbreaks. Now that I am waiting for one, it's been three months since I've had one (that's a record!). Is culturing a lesion the only way to diagnose VZV?
Also, now that my docs have suggested, but not proven, zoster as a diagnosis, I have been told to have my next lesion cultured. Generally, I have frequent outbreaks. Now that I am waiting for one, it's been three months since I've had one (that's a record!). Is culturing a lesion the only way to diagnose VZV?
Doctor's Answer
by H. Hunter Handsfield, M.D., Feb 16, 2006 12:00AM
, Feb 16, 2006 12:00AM
I really cannot help very much. Your term "fresh eyes" implies you might be looking to me for a diagnosis or specific diagnostic advice, but that's much too close to practicing medicine from a distance, which I cannot do. I will just say that older HSV serological tests indeed were less accurate than those now available; and that "frequent outbreaks" is not consistent with herpes zoster. I have never heard of a patient with more than 3 total episodes of VZV (although I suppose it can occur)--but this is well outside my expertise.
If your diagnosis is uncertain and you are having recurrent genital (or other) skin lesions, and if your provider recommends re-testing for HSV and/or VZV, or having a modern HSV blood test, then I suggest following that advice.
Good luck-- HHH, MD
If your diagnosis is uncertain and you are having recurrent genital (or other) skin lesions, and if your provider recommends re-testing for HSV and/or VZV, or having a modern HSV blood test, then I suggest following that advice.
Good luck-- HHH, MD
My other question, which was not addressed, is whether testing for VZV requires culturing of an active lesion, or are there other tests?
HHH, MD
I read your original post and wanted to let you know that I have had phn from the start. In fact, that has been the only real symptom of my hsv2, other than minor lymph swelling. The phn and swelling were what brought me to the doctor. Due to my description of the nerve pain which I described as radiating down my left leg, the doctor immediately suspected hsv and did a type-specific blood test to confirm the diagnosis. I have no other complicating illnesses, and I am a young, otherwise healthy person with no history of other std's. My immune system is in good shape and I do not have hiv. I take acyclovir daily, and when I do not take my pills on time, the pain comes back. My partner was tested after I tested positive, and he also had hsv2, but was apparently asymptomatic. Based on my doctor's anecdotal experience with hsv2, as well as my own, and the relative similarity between zoster and hsv2, I'm wondering why anyone would doubt that both might cause phn. It seems kind of silly. I doubt anyone has done an empirical study on the issue. Okay, I'm fairly positive they haven't. I've checked several databases. Anyone seeking grant funding out there want this one? Of course, I already know the answer, but I think it's time it was documented.