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 patienthas had no recurrences, and recent blood tests for antibodies to HSV types 1 and 2are negative. How is this possible?
---- Diana Rodriguez, MD
       Stoughton, MassAlthough many patients with primary HSV-1 infection have no clinicalrecurrences, the failure to seroconvert occurs very seldom--inno more than 1% of patients. Failure to seroconvert happens morefrequently following antiviral therapy of first-episode disease. Withtime--usually 6 months--seroconversion will occur.Because of the compatible clinical findings, I doubt that a laboratory erroroccurred 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 wasno 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
       BirminghamEditor's note: Dr Rodriguez reported that a recent blood test for HSV antibodieswas positive.