Six weeks earlier, my patient had signs and symptoms of herpes simplex virus
(HSV) infection, and results of a culture for HSV type 1 were positive. The patient
has had no recurrences, and recent blood tests for antibodies to HSV types 1 and 2
are negative. How is this possible?
---- Diana Rodriguez, MD
Although many patients with primary HSV-1 infection have no clinical
recurrences, the failure to seroconvert occurs very seldom--in
no more than 1% of patients. Failure to seroconvert happens more
frequently following antiviral therapy of first-episode disease. With
time--usually 6 months--seroconversion will occur.
Because of the compatible clinical findings, I doubt that a laboratory error
occurred in the initial evaluation; however, this possibility must be considered.
It is also possible that the later serologic testing was flawed.
Thus, I would repeat the serologic evaluation to make sure that there was
no laboratory error in the 6-week sample. This would be unusual, but it is possible.
In the meantime, I would consider the patient infected.
---- Richard Whitley, MD
Professor of Pediatrics, Microbiology, and Medicine
The University of Alabama School of Medicine
Editor's note: Dr Rodriguez reported that a recent blood test for HSV antibodies