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The Case of the Vanishing Herpes Simplex Virus

The Case of the Vanishing Herpes Simplex Virus

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
       Stoughton, Mass
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 was positive.

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