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Positive HSV-2 swab test from blister on ear?
My husband presented with headache, earache, sore throat, swollen lymph nodes, and scalp sensitivity all on the right side of his head 7 days ago. We noticed a small bump in the crease where his right ear meets his face shortly after that we first assumed was a spider bite. Over the next two days, it turned into a blister which broke open and his original symptoms persisted. He had the blister swabbed at urgent care 2 days ago where the nurse practitioner insisted on testing for HSV-1/2 as well as shingles (not sure why the HSV tests were necessary).
Yesterday, the results were negative for shingles and HSV-1 but positive for HSV-2. The nurse practitioner followed up with a phone call and seemed surprised by the results as well but mentioned it could be something like "mat herpes" that wrestlers can get. It's my understanding "mat herpes" is caused by HSV-1. We have followed up with his PCP for another round of lab work to confirm the diagnosis or clarify a misdiagnosis. As a side note, we have been together 10 years and neither of us has ever had anything like this before.
Today, the scalp sensitivity has intensified and new sensitivity has spread across his cheekbone toward his eye socket. Questions for the community:
1. Can HSV-2 present on the ear in general? I have read online about rare cases of HSV-1 on or near the ear but nothing about HSV-2.
2. Does HSV-2 present the symptoms described above such as scalp/face sensitivity?
3. Are these symptoms more likely to be shingles than HSV-2?
Yesterday, the results were negative for shingles and HSV-1 but positive for HSV-2. The nurse practitioner followed up with a phone call and seemed surprised by the results as well but mentioned it could be something like "mat herpes" that wrestlers can get. It's my understanding "mat herpes" is caused by HSV-1. We have followed up with his PCP for another round of lab work to confirm the diagnosis or clarify a misdiagnosis. As a side note, we have been together 10 years and neither of us has ever had anything like this before.
Today, the scalp sensitivity has intensified and new sensitivity has spread across his cheekbone toward his eye socket. Questions for the community:
1. Can HSV-2 present on the ear in general? I have read online about rare cases of HSV-1 on or near the ear but nothing about HSV-2.
2. Does HSV-2 present the symptoms described above such as scalp/face sensitivity?
3. Are these symptoms more likely to be shingles than HSV-2?
COMMUNITY LEADER
When herpes happens, it infects nerve groups. If someone gets oral hsv2, that's the trigeminal nerve group, and that can affect the ear, though it usually sticks to the mouth and nose.
https://en.wikipedia.org/wiki/Trigeminal_nerve
Yes, it's wiki, but it has some decent pics of what areas the trigeminal nerve groups cover.
I do think he should get a type specific IgG blood test to confirm this diagnosis, or even a Western Blot test, which is only performed at the univ of Washington in Seattle. Your doctor can order it after the hsv2 IgG blood test. You should also get an hsv2 IgG blood test.
There are false positives on the hsv2 blood test. If your results come in below a 3.5, get the Western Blot. Just do it.
Mat herpes is most often hsv1, but I just talked to someone last week who had hsv2 confirmed as his cause of his mat herpes on his upper back. (That's knows as herpes gladiatorum.)
It's important to get this confirmed for lots of reasos - transmission, the chances of post-herpetic neuralgia, treatment, etc.
If it is hsv2, he could have had this for decades, or long before you met him, and is just now getting outbreaks. Unless he's had negativ hsv2 testing in the past, you might not ever know. If it's oral hsv2, the chances of him transmitting are very, very low.
Right now, your concerns are getting this confirmed, though cultures are not often wrong. Just get the blood tests. Let me know.
If you need help getting the blood tests, you can go to STDcheck.com, Letsgetchecked.com, Healthlabs.com or ultahealthlabs.com. They are all similar, and all run specials, and offer online coupons, just search Google.
Let me know.
https://en.wikipedia.org/wiki/Trigeminal_nerve
Yes, it's wiki, but it has some decent pics of what areas the trigeminal nerve groups cover.
I do think he should get a type specific IgG blood test to confirm this diagnosis, or even a Western Blot test, which is only performed at the univ of Washington in Seattle. Your doctor can order it after the hsv2 IgG blood test. You should also get an hsv2 IgG blood test.
There are false positives on the hsv2 blood test. If your results come in below a 3.5, get the Western Blot. Just do it.
Mat herpes is most often hsv1, but I just talked to someone last week who had hsv2 confirmed as his cause of his mat herpes on his upper back. (That's knows as herpes gladiatorum.)
It's important to get this confirmed for lots of reasos - transmission, the chances of post-herpetic neuralgia, treatment, etc.
If it is hsv2, he could have had this for decades, or long before you met him, and is just now getting outbreaks. Unless he's had negativ hsv2 testing in the past, you might not ever know. If it's oral hsv2, the chances of him transmitting are very, very low.
Right now, your concerns are getting this confirmed, though cultures are not often wrong. Just get the blood tests. Let me know.
If you need help getting the blood tests, you can go to STDcheck.com, Letsgetchecked.com, Healthlabs.com or ultahealthlabs.com. They are all similar, and all run specials, and offer online coupons, just search Google.
Let me know.
6 Comments
Thank you so much for your thoughtful response and guidance. He is seeing his primary care doctor later today and I'll take the information you provided with us to the visit. Crazy coincidence...we live in Seattle and go to UW for all of our medical care.
Oh you are in the very best place!
Your doc can find the Western Blot here - https://testguide.labmed.uw.edu/index?query=HSWB&include_components=y
But start with the IgG - you may not even need the WB.
Make sure your doc orders the type specific IgG - that's very, very important. Insist on it. It's in the CDC STI Treatment Guidelines, which any doc doing testing and treating should follow - https://www.cdc.gov/std/treatment-guidelines/herpes.htm
Good luck!
Your doc can find the Western Blot here - https://testguide.labmed.uw.edu/index?query=HSWB&include_components=y
But start with the IgG - you may not even need the WB.
Make sure your doc orders the type specific IgG - that's very, very important. Insist on it. It's in the CDC STI Treatment Guidelines, which any doc doing testing and treating should follow - https://www.cdc.gov/std/treatment-guidelines/herpes.htm
Good luck!
He had another swab test done that also came back positive for HSV-2 so we have confirmed the original diagnosis. We are in a bit of shock to say the least. I've always considered myself to be well educated about sexual health so HSV-2 presenting on the ear was never remotely on my radar, and I was certain there had to be a mistake. Ten years of intimacy and neither of us had any idea.
I plan to get a blood test to confirm if I have it, but do you think he should still get the blood test? I'm sure the chances of two false positive swab tests is virtually zero.
I plan to get a blood test to confirm if I have it, but do you think he should still get the blood test? I'm sure the chances of two false positive swab tests is virtually zero.
The only reason he'd need a blood test is to find out if he has a new infection or not. I'm not sure what that would prove here - he ear cheated? Someone with oral hsv2 kissed his ear?
That is a big stretch, since oral hsv2 rarely transmits.
Although, it is possible to get oral hsv2 from giving someone oral sex, and it could present on the ear. (This is all very uncommon, please know that. This would all be like the 1% chance of everything.)
Unfortunately, an hsv2 IgG blood test can be positive within 2 weeks, so it would be hard to prove anything. If you have no suspicions of this being a new infection or reasons to suspect anything, I wouldn't bother.
I'm not trying to imply anything - I don't know your husband. I'm just trying to answer your questions.
It would also be very possible for you to not have this and for him to have it. Oral hsv2 rarely recurs, rarely sheds, and rarely transmits.
That is a big stretch, since oral hsv2 rarely transmits.
Although, it is possible to get oral hsv2 from giving someone oral sex, and it could present on the ear. (This is all very uncommon, please know that. This would all be like the 1% chance of everything.)
Unfortunately, an hsv2 IgG blood test can be positive within 2 weeks, so it would be hard to prove anything. If you have no suspicions of this being a new infection or reasons to suspect anything, I wouldn't bother.
I'm not trying to imply anything - I don't know your husband. I'm just trying to answer your questions.
It would also be very possible for you to not have this and for him to have it. Oral hsv2 rarely recurs, rarely sheds, and rarely transmits.
I went ahead with the Western Blot test on 1/17 and the results came back negative for both HSV-1 and 2 today (1/19). It has been about 6 weeks since his diagnosis and about 7 or 8 weeks since we were last intimate. Because of the timing of his first outbreak and when we last had sex, I had come to assume that I had it first and gave it to him so I'm very surprised by this negative result.
Is there any possibility that not just one but TWO swabs returned false positives? I'm 100% confident in our marriage so I'm not concerned at all about infidelity. I assumed I would also test positive and that it would just be this unfortunate mystery of who gave it to who but we would move on. My negative result has honestly created more uncertainty for us about his diagnosis so he is considering getting the Western Blot test done for final confirmation.
Every medical professional we've spoken to has said that this presentation of HSV-2 on his ear is extremely odd and they've never seen anything like it before. The tests were supposed to provide us with answers but it has only made us more skeptical. :(
Is there any possibility that not just one but TWO swabs returned false positives? I'm 100% confident in our marriage so I'm not concerned at all about infidelity. I assumed I would also test positive and that it would just be this unfortunate mystery of who gave it to who but we would move on. My negative result has honestly created more uncertainty for us about his diagnosis so he is considering getting the Western Blot test done for final confirmation.
Every medical professional we've spoken to has said that this presentation of HSV-2 on his ear is extremely odd and they've never seen anything like it before. The tests were supposed to provide us with answers but it has only made us more skeptical. :(
My guess - and please know it's only an educated guess - is that he got oral hsv2 before you met, and it's now presenting on his ear. This, of course, assumes he was sexually active before you got married. If he wasn't, this theory can't be true.
Since oral hsv2 rarely recurs, rarely sheds, and rarely transmits, it doesn't surprise me that you don't have it, if this is the case.
I would still get him the WB just to be sure, but two swabs are really unlikely to be false positives.
If he does have oral hsv2 that presented on the ear, this is all very rare. This hits all the 1% chances of everything - oral hsv2 is uncommon, it recurring is uncommon, and it presenting on the ear is extremely uncommon. Even oral hsv1, which is very common, rarely presents on the ear.
The other theory is that someone with oral hsv2 kissed his ear. This would mean he doesn't have it orally.
You may never know.
In either case, it shouldn't affect much for your marriage. If it is oral hsv2, it rarely transmits. If it makes him feel better, he can go on daily suppressive meds (which will also help him prevent future outbreaks), and that will reduce transmission, but I don't think he needs to do that. That's a decision you'll need to make together, though. He's had an outbreak now, which I understand changes things.
I hope he's feeling better now. It sounds incredibly painful.
Since oral hsv2 rarely recurs, rarely sheds, and rarely transmits, it doesn't surprise me that you don't have it, if this is the case.
I would still get him the WB just to be sure, but two swabs are really unlikely to be false positives.
If he does have oral hsv2 that presented on the ear, this is all very rare. This hits all the 1% chances of everything - oral hsv2 is uncommon, it recurring is uncommon, and it presenting on the ear is extremely uncommon. Even oral hsv1, which is very common, rarely presents on the ear.
The other theory is that someone with oral hsv2 kissed his ear. This would mean he doesn't have it orally.
You may never know.
In either case, it shouldn't affect much for your marriage. If it is oral hsv2, it rarely transmits. If it makes him feel better, he can go on daily suppressive meds (which will also help him prevent future outbreaks), and that will reduce transmission, but I don't think he needs to do that. That's a decision you'll need to make together, though. He's had an outbreak now, which I understand changes things.
I hope he's feeling better now. It sounds incredibly painful.
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