Can shingles affect HSV tests?

[Joyful_Blues]

1) Are there cases of shingles showing up as positive HSV swab test results?

2) After a positive Real-Time PCR swab test, why might I test HSV1 negative via IgG test 12 weeks post-symptoms?

3) Is bloodwork or actual antibody formation being affected by my being on antivirals since BEFORE exposure and outbreak?

4) What follow-up test(s) would you recommend to get to a definitive answer?

5) Will the expense of a Western Blot give better answers for HSV1?

6) Is anyone other than UW (Yale?) offering WB tests?

BACKGROUND: I tested “Non-Reactive” for HSV1 and HSV2 in July 2022 (IgG test). I have never had a positive STI test or any symptoms of outbreak, oral or genital.

I was visually diagnosed with shingles in early November 2022 and treated with Valtrex 3g daily for 7 days. Shingles outbreak was mild, presumably due to shingles vaccine.

Four (4) days after I ended Valtrex, I was possibly exposed to HSV through oral sex.

Four (4) days after exposure, I had genital symptoms of pressure and burning but no external lesions. I saw OB-GYN Nurse Practitioner (NP) 5 days after symptoms started, was visually diagnosed with HSV, and started on 2g Valtrex daily for 10 days while waiting for swab test results. NP counted 15-20 internal lesions and commented all were on left side of vagina; there were ZERO external lesions. (Shingles lesions had been on left side of neck/shoulder.) **Could this have been shingles and not HSV?**

Real-Time PCR swab test was POSITIVE for HSV1, negative for HSV2.

Continued discomfort led to different OB-GYN doing a second swab test 3 weeks after initial symptoms presented. SURESWAB HSV Type 1 and 2 came back “Your Value Not Detected” for both types.

Follow-up IgG blood tests for HSV were done:

*Nov 2022 Results (day after initial diagnosis): Your Value Non-Reactive Index
*Feb 2023 Results (12 weeks from first symptoms): Your Value <0.90 Index (negative)

I have continued 500mg to 1g Valtrex daily since the end of the 10-day 2g daily treatment.

• This topic was modified 1 month, 1 week ago by Joyful_Blues. Reason: Spacing for easier reading

[Terri Warren]

1) Are there cases of shingles showing up as positive HSV swab test results?
no, the swabs look for two different viruses

2) After a positive Real-Time PCR swab test, why might I test HSV1 negative via IgG test 12 weeks post-symptoms?
Because 1) the IgG test misses 30% of HSV 1 infections compared to the western blot anyway and 2) because you’ve been on suppression

3) Is bloodwork or actual antibody formation being affected by my being on antivirals since BEFORE exposure and outbreak?
YES!

4) What follow-up test(s) would you recommend to get to a definitive answer?
You have a definitive answer – a positive swab test. You don’t need anything else.

5) Will the expense of a Western Blot give better answers for HSV1?
Not until you are off suppression for 3 months. At that point, you could try to do the IgG test again, but I’m confused about why you don’t believe the swab test which is definitive?

6) Is anyone other than UW (Yale?) offering WB tests?
No

Terri

[Joyful_Blues]

Thanks for answering my questions.

3) Is bloodwork or actual antibody formation being affected by my being on antivirals since BEFORE exposure and outbreak? YES!

Is my actual antibody formation being affected by being on valacyclovir since before the exposure and outbreak? Does this matter in any way, like being infected in my mouth because I don’t have sufficient antibodies against someone with HSV1 kissing me?

NEW QUESTIONS:

1) The PCR swab test was conducted by a OBGYN Nurse Practitioner who had given me bad information about a condition I had prior to the HSV outbreak. After the swab test came back positive, the Nurse Practitioner said:

“You’re positive for HSV1. This is great news! This means you’ll never have another outbreak and will never test positive for herpes again! It will be like you never had it.” (Seriously. I wrote it down and read it back to her, and she said I got it right.)

I went over this and over this with her on the phone to be 100% certain of what she was saying–because it didn’t seem right after the reading I’d done on the CDC site and your site.

She’s incorrect about this, yes? While I *might* never have another outbreak, I *do* have HSV1 in the genitals and can infect others when the virus is shedding. Which means I need to guard against it every time there’s any sexual contact, yes?

2) Finally–the swab test came back “Positive.” Should there have been a number metric? The lab won’t talk directly to me, the Nurse Practitioner won’t request them to provided any detail, and my general practitioner didn’t get good answers.

I guess I’m hoping the swab test wasn’t a false positive because of the shingles and valacyclovir days before the exposure and outbreak. Do you have any idea how likely a false positive is on the swab test?

I really appreciate your providing this forum to ask questions my doctors can’t answer.

[Terri Warren]

1) The PCR swab test was conducted by a OBGYN Nurse Practitioner who had given me bad information about a condition I had prior to the HSV outbreak. After the swab test came back positive, the Nurse Practitioner said:

“You’re positive for HSV1. This is great news! This means you’ll never have another outbreak and will never test positive for herpes again! It will be like you never had it.” (Seriously. I wrote it down and read it back to her, and she said I got it right.)

I went over this and over this with her on the phone to be 100% certain of what she was saying–because it didn’t seem right after the reading I’d done on the CDC site and your site.

She’s incorrect about this, yes? While I *might* never have another outbreak, I *do* have HSV1 in the genitals and can infect others when the virus is shedding. Which means I need to guard against it every time there’s any sexual contact, yes?

Yes, although HSV 1 recurs very infrequently and some people don’t ever have another outbreak. The shedding is far less than HSV 2, but when first infected, you are shedding on about 13 out of 100 days, the transmission rate is higher when first infection.

2) Finally–the swab test came back “Positive.” Should there have been a number metric? The lab won’t talk directly to me, the Nurse Practitioner won’t request them to provided any detail, and my general practitioner didn’t get good answers.
No, no numbers associated with a positive

I guess I’m hoping the swab test wasn’t a false positive because of the shingles and valacyclovir days before the exposure and outbreak. Do you have any idea how likely a false positive is on the swab test?

I really appreciate your providing this forum to ask questions my doctors can’t answer.

A false positive is highly unlikely with a swab test.

terri

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