Herpes culture positive, blood test negative 3 years later

[Person473]

In January of 2017 I had a pretty bad outbreak and got a culture swab that came back positive for both herpes type 1 AND 2. My doctor at the time told me she was concerned that maybe there had been a mix up because she hadn’t seen positive results for both on one swab so she had me get a blood test. The blood test came back positive for both so she confirmed that I had both. (Side note: the antibodies were at a very low level for type 2 but still positive).

Fast forward to February of 2020. I haven’t had an outbreak since. I have a new doctor and I was going in for an initial check up and told her about my herpes. She asked me if I wanted another swab (to check for a symptomatic shedding I guess ?) and blood test. I said why not. The swab came back negative for type 1 and type 2 and the blood test came back positive for type 1 and negative for type 2. (Both blood tests in 2017 and 2020 were IgG).

So my question is - did I always only have type 1? Do I still have type 2 as well because that initial swab came back positive for both? My doctor seemed perplexed and I am as well.

[auntiejessi]

First - the blood test. Do you remember how low the low positive was? My guess, and it's only a guess without knowing how low it was, is that that was a false positive. Anything under a 3.5 needs to be confirmed, and the lower the number, the higher the chance that it's a false positive.

Can you get a copy of your original culture results? I'd have to wonder if your doctor didn't know how to read it, or it wasn't typed, and it said something like "HSV1&2 isolated" which means it could be 1 OR 2 OR both.

When you had the most recent swab, did she do a PCR swab or a regular culture? A regular culture isn't very sensitive, and wouldn't pick up on shedding. A PCR swab would, but if you've had ghsv1 for this long, you might be shedding about 4 days per year, so it's not surprising that even a PCR swab wouldn't find it on that particular day.

If you have anything genitally, my guess is that it's ghsv1, but I can't say that for sure without seeing the results. Even if you can't get the original results, having ghsv1 won't change much for you. At this point, like I said, you're probably only shedding about 4 days a year, you aren't getting outbreaks (which isn't uncommon - many with ghsv1 only get the 1st outbreak and never get another), so with the infrequent shedding, and infrequent outbreaks, you're not likely to ever transmit. Most experts haven't ever seen anyone transmit ghsv1 from their genitals.