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STDs (Expert Forum)
VZV vs HSV symptoms
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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VZV vs HSV symptoms
by igotstoknow, Feb 15, 2007 12:00AM
My wife and I have been together for couple of years now. I didn’t have any symptoms but she developed some sores around her genitals. She had lesions on her vagina and what looked like blisters or boils – bumps with red base, like round inflamed pimples and some had tiny scabs on them. It appeared on her genitals as well as her inner thighs and skin around the anus/butt area and has been very painful for her. We went to her Ob/Gyn and she said it’s probably VZV and not HSV but I think she was basing this diagnosis on the fact that I had no symptoms. I had an STD test few years ago but don’t know if they tested for HSV unless it’s standard. I do get cold sores about once a year. They took a culture and put her on valtrex. We both had chicken pox as children. She is in her 30’s now and she has been diagnosed with having a very low immune system by her docs for the past few years. She also had mono for a long period of time when she was in her teens that went untreated due to misdiagnosis by her GP at the time if this info helps. My questions are:
1)How long does the culture yield results?
2)How accurate are these vs blood tests?
3)How can you tell the difference between vzv and hsv from their symptoms?
Very worried.
1)How long does the culture yield results?
2)How accurate are these vs blood tests?
3)How can you tell the difference between vzv and hsv from their symptoms?
Very worried.
Doctor's Answer
by H. Hunter Handsfield, M.D., Feb 15, 2007 12:00AM
, Feb 15, 2007 12:00AM
I agree this sounds more like genital herpes due to herpes simplex virus (HSV) than shingles. Your description suggests your wife's lesions are bilateral, i.e. on both thighs and both sides of her genitals. If so, this cannot be shingles, which always is unilateral--lesions may extend up to or barely beyond teh body's midline, but no further. (The virus reactivates in a nerve ganglion and causes lesion's in that nerve's skin distribution--and no nerves cross the body's midline.)
On the other hand, this might be neither one of those problems; perhaps a bacterial infection. The first genital herpes infection usually is limited to the genitals and anal area and does not extend onto the thighs. So on balance, my guess is that this is neither HSV or VZV. To your specific questions:
1) HSV culture results take anywhere from 3 days to 3 weeks. The longer it takes, the less likely the result will be positive. VZV isn't tested by culture, but by a fluorescent antibody test or PCR, either of which takes the lab only a few hours and should have results in a day or two.
2) Culture (or FA for VZV) are 100% reliable if positive, but either test can be negative; the tests themselves aren't perfect. But with fresh, new lesions--which your wife apparently had--a negative result will be pretty good evidence against HSV and VZV, respectively. The HSV-1 and -2 blood test takes up to 3 months to become positive; if your wife's test is negative and becomes positive later, that will be solid evidence of the cause.
3) See above about clinical differences between HSV and shingles. The latter is almost impossible, in view of the apparent bilateral lesions.
If things remain unclear, consider a 2nd opinion, e.g. from a dermatologist. I hope this helps. Best wishes-- HHH, MD
On the other hand, this might be neither one of those problems; perhaps a bacterial infection. The first genital herpes infection usually is limited to the genitals and anal area and does not extend onto the thighs. So on balance, my guess is that this is neither HSV or VZV. To your specific questions:
1) HSV culture results take anywhere from 3 days to 3 weeks. The longer it takes, the less likely the result will be positive. VZV isn't tested by culture, but by a fluorescent antibody test or PCR, either of which takes the lab only a few hours and should have results in a day or two.
2) Culture (or FA for VZV) are 100% reliable if positive, but either test can be negative; the tests themselves aren't perfect. But with fresh, new lesions--which your wife apparently had--a negative result will be pretty good evidence against HSV and VZV, respectively. The HSV-1 and -2 blood test takes up to 3 months to become positive; if your wife's test is negative and becomes positive later, that will be solid evidence of the cause.
3) See above about clinical differences between HSV and shingles. The latter is almost impossible, in view of the apparent bilateral lesions.
If things remain unclear, consider a 2nd opinion, e.g. from a dermatologist. I hope this helps. Best wishes-- HHH, MD
Does the fact that the symptoms have subsided after taking 3g of valtrex per day for over a week indicate one way or another - even for baterial infection?