Herpes 2 vs Shingles?
November 5, 2014 6:14 AM   Subscribe

After being celibate for a couple years, I decided to get a full sexual screening before starting a relationship with a new partner, i.e. good practices. I tested negative for everything-- except Herpes 2 (HSV-2.) (I had the blood test, not a swab test, and I've never had anything remotely approaching symptoms.) I realize most people are asymptomatic, but my question is: I had a massive outbreak of what was visually diagnosed as shingle blisters on my neck last year (Shingles = Herpes Zoster.) Googling shows that sometimes Zoster can be confused with Herpes-2. Is this actually true, or just wishful thinking? What can I do to find out more or get a better test?

I know you are not my doctor, and I know enough not to have sexual relations until I know more and can adequately inform my partner.

Just to be clear: my doctor said I had antibodies in my blood for HSV-2, but I've seen some articles online saying that Zoster can be confused for Herpes 2 and I would really, REALLY like to rule out any alternative possibilities. Thanks!
posted by anonymous to Health & Fitness (14 answers total) 1 user marked this as a favorite
PCR test is not possible, as you are asymptomatic. You might be looking for a type-specific serologic test.
posted by xiix at 8:13 AM on November 5, 2014

Herpes simplex 2 is genital herpes - it doesn't appear on your neck. Zoster and herpes 2 are both blistering rashes but zoster appears along the part of your body that is innervated by one nerve - herpes simplex affects mucous membranes of the oral and genital areas or the adjacent skin.
posted by treehorn+bunny at 8:15 AM on November 5, 2014 [2 favorites]

Also can you clarify what you're trying to figure out? The confusion between zoster and simplex are in how they appear - having HSV antibodies is not related, because zoster comes from varicella (chickenpox), not HSV.
posted by treehorn+bunny at 8:20 AM on November 5, 2014 [1 favorite]

Treehorn, I think anonymous is saying the testing can confuse zoster with HSV-2.

Here is a bit of information on false positives of HSV-2 tests.

One of the most common brands of type-specific serology is the HerpesSelect brand. It is a very good test, but there are issues with false positive results with one form called the HerpesSelect ELISA. (Other forms are the HerpesSelect Immunoblot and the HerpesSelect Express.) That is, some people who have a positive test result for the virus are not actually infected.

The Herpes Select ELISA is reported back as an index value. A value greater than 1.1 is considered positive. If you have no history of genital herpes outbreaks, did not have a positive culture or PCR test for HSV, or have no risk factors for genital herpes, you should know the index value. False positives have been reported with values less than 3.5. If your value is less than 3.5, ask to be tested again with a different test, preferably with another antibody test called the Western blot.

And here:

Why have false positive tests been used as an argument against routine testing for genital herpes but not for other STDs, which can also have false positives?

False positive tests can occur with many diagnostic tests, including STD tests, and the chance of a false positive test result increases as the likelihood of the infection decreases in the person being tested. False positive HSV type 2 results can occur, especially in persons with a low likelihood of HSV infection. It is not clear whether knowledge of a herpes diagnosis improves the health of people taking the tests and reduces spread of HSV in the population. Thus, the harm of possible false positive tests may be a greater consideration

Bottom line: you may want a repeat test, more so depending on what type of test you had. Did they score the results or just give you a positive or negative?
posted by dances_with_sneetches at 8:35 AM on November 5, 2014 [1 favorite]

Herpes simplex 2 is genital herpes - it doesn't appear on your neck

That just isn't true. . HSV-2 "prefers" the genital area but is not limited to it. HSV-1 = cold sores and HSV-2 causes genital sores is the most common presentation but they can both be either.
posted by missmagenta at 8:39 AM on November 5, 2014 [2 favorites]

Herpes simplex 2 is genital herpes - it doesn't appear on your neck

That just isn't true. . HSV-2 "prefers" the genital area but is not limited to it. HSV-1 = cold sores and HSV-2 causes genital sores is the most common presentation but they can both be either.

This is true. That said, I'm unaware of HSV outbreaks that don't initiate from mucous membranes. So if your neck blisters didn't start around your mouth, it's hard to imagine that being HSV.
posted by deludingmyself at 9:13 AM on November 5, 2014

I've had coldsores on my cheek, so it is possible. I've never known anyone to have it on their neck but most people have never heard of someone getting it on their cheek either.

But yeah, get retested, could be a false positive.
posted by missmagenta at 9:16 AM on November 5, 2014

I should caveat the above: normal HSV outbreaks in non-immunocompromised people, and even more so first HSV outbreaks, occur predominantly at mucous membranes. In rare cases you can get things like acute eczema sufferers who have latent HSV that breaks out at eczema sites. You can also have HSV outbreak #1 occur at the mouth, and subsequent outbreaks kind of spread outwards along the same nerve path, because the virus hangs out in a latent state in the nerve ganglia and then occasionally will erupt and make its way back towards the skin, resulting in an outbreak at the edge of the mouth, on the chin/cheek, farther away from the genitals, etc.

Anyhow, my perspective as someone who's not a doctor, is HSV-negative, and has had a clear-cut set of shingles outbreaks as a teenager, and once worked in a virology lab:

The highest odds here are that you do have latent HSV-2 right now, because, well, 20% of the adult U.S. population does. MeFi has some great threads with advice on dealing with finding out about and sharing a positive HSV-2 status, including for people just getting back into dating.

If I were in your shoes, I might be really bothered by not knowing what the neck outbreak was, but after searching PubMed for 5 minutes, I don't see anything about cross-reactivity between V. zoster and HSV glycoproteins in the HSV ELISA tests. So I might get re-tested, just because of the false positive rate, but after that I'd go ahead and assume I was HSV-2+. If you have another outbreak of any kind, hie thee to a doctor to get it swabbed and tested. (Ideally a doctor you've talked to about this before, who has the willingness & capability to do this testing.)

But yes, a full range of possibilities exist. You may have shingles & HSV-2. You may have shingles and not-HSV2. You may have HSV2 and not shingles. You may never get another outbreak of either. But probabilistically, you most likely do have HSV-2, so it's worth thinking about how you move forward from that point.
posted by deludingmyself at 9:51 AM on November 5, 2014 [2 favorites]

I've tested (dunno which test) positive for HSV 2 antibodies, but have never experienced anything that looks like (or seemingly feels like) what others experience. So I went off to my doctor today, without an appointment (the scandal, the horror) when I realised something that maybe was herpes and maybe was not had reappeared.

The nice receptionist tried to schedule me for tomorrow and I explained how the doctor had told me it had to be cultured before the sore broke, blah, blah, blah and the heavens opened up and the single dermatologist in the office that day took a culture after saying, "that really doesn't look like herpes to me." But who knows? This may well be something else entirely and I still have HSV 2. Which is how I plan to proceed because I may never know for sure and it's only fair to warn my potential partners.
posted by Bella Donna at 5:28 PM on November 5, 2014

Then there's herpetic whitlow (HSV-1 or -2), which I get on my thumb from time to time and herpes simplex gladiatorum, which happens especially to youth in contact sports like wrestling and can appear on the head, extremities or trunk and is caused by HSV-1.

I've had outbreaks of HSV-1 on my lips and nose for years, haven't ever had the genital form, which is another thing to be grateful for. When my thumb began to "buzz" and then itch like crazy and then popped up with blisters, it acted just like the lip sores, but I couldn't imagine it. Doctor scraped a blister and tested it and yep, HSV-1, called herpetic whitlow. I rarely get the mouth sores any more, but the thumb quite often and each outbreak covers a broader area with more blisters.

There's also an ocular version which is absolutely excruciatingly painful, I guess. My MIL's sister was an old lady when she got it and she was in terrible pain - she actually wanted to die, but that was before all the antivirals available now; I assume and hope they do a better job than the nothing treatment that was the norm back then.

Herpes is a nasty damn thing, but it's common now in one form or another. Still, I hope your test was a false positive.
posted by aryma at 7:31 PM on November 5, 2014

Herpes simplex 2 is genital herpes - it doesn't appear on your neck

That just isn't true.

I still stand by my statements. :-) I'm not the OP's doctor, by any means, but I am a doctor - and I did mention that herpes simplex (1 or 2) affects mucous membranes or the adjacent skin. Neck doesn't count as adjacent to either the mouth or genitals. It is possible to get HSV2 on oral mucous membranes and possible to get HSV1 on the genitals, but HSV2 is still the main cause of genital herpes, and to argue that it's only 'mainly genital' seems like splitting hairs.

It also doesn't help the OP to suggest that the test result could mean that they have HSV2 infection orally, instead of a genital HSV2 infection, because they don't have symptoms in either location. To presume that their infection is not genital herpes and implying that thus they don't need to inform future partners would be unfair to the partners/bad medical advice, given that it is not likely to be true.

If you don't believe me (some random stranger on the internet claiming I'm a doctor, after all), I'll quote a source for you as well (the same one quoted by dances_with_sneetches, some doctor doing a column for the NYT on herpes diagnosis).

"The presence of antibodies for HSV-2, the most common cause of genital herpes, almost always indicates genital herpes infection with the type 2 virus."

Treehorn, I think anonymous is saying the testing can confuse zoster with HSV-2.

I am not aware of the testing confusing zoster with HSV2. I have heard of cross reactivity with HSV1 with some types of tests but not with VZV, not seeing much online if I try to search for it either. Given how common VZV is amongst adults, any test for HSV that was cross-reactive with it would be problematic. If you're concerned about the likelihood of false positive test (regardless of what the reason for it), I suggest asking your doctor what type of test was used and what the specificity of the test is.
posted by treehorn+bunny at 8:41 PM on November 6, 2014

I realized I didn't address the mention of other types of herpes on the skin, like whitlow and gladiatorum - these are generally caused by HSV1, because most people don't touch or rub against other people's genitals when they have an active outbreak of herpes there (fun article on the subject here, with gross photos). It is possible that herpes gladiatorum could be misdiagnosed as shingles (whitlow should not be, really, since it characteristically is on your fingertip or maybe a toe), but gladiatorum should look different than shingles (i.e. shingles generally crops up along the span of a nerve, sort of in a straight or curved line, while a gladiatorum infection would crop up over a general area where skin had rubbed up against you - you can see an example in the photo of the wrestler's face from that article).

As deludingmyself alludes to, I don't think this unlikely possibility being possible would help you anyway, because even if you did happen to have HSV2 on your neck because you wrestled someone, that would still mean you could have recurrent outbreaks and infect others you might be rubbing up against intimately, so trying to prove that your prior infection wasn't zoster would be in opposition to what I presume is your goal here, to prove you don't have an infection you need to tell your sexual partners about - it does seem that you're likely asking this question hoping that you don't actually have HSV2 antibodies rather than asking whether your neck infection could have been HSV2. I hope after taking all the time to write all this that it is helpful to you. I do applaud you for wanting to be transparent with your future partners and getting thoroughly tested, and hope that your future partners will appreciate you for it!
posted by treehorn+bunny at 9:31 PM on November 6, 2014

I read somewhere that IgM tests cross-react with chickenpox/shingles, but not IgG or Western Blot tests. Best to find out what kind of test it was.
posted by MrHalfwit at 6:42 AM on November 7, 2014

Here is a useful-seeming link
posted by mai at 8:50 AM on November 7, 2014

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