Herpes is a common viral infection. While healthcare professionals typically diagnose herpes based on specific symptoms and laboratory tests, misdiagnosis can occur, leading to confusion for individuals.
How Herpes is Typically Diagnosed
Diagnosing herpes often begins with a healthcare provider visually examining any suspected sores or blisters. During an active outbreak, the appearance of small, fluid-filled blisters that later crust over can suggest a herpes infection.
Laboratory tests confirm a herpes diagnosis. A common method involves a viral culture, where a swab is taken directly from a lesion and sent to a lab to grow the virus. The Polymerase Chain Reaction (PCR) test detects the genetic material (DNA) of the herpes simplex virus (HSV) from a lesion sample.
Blood tests detect antibodies produced by the immune system in response to an HSV infection. These tests identify IgG antibodies, indicating a past or chronic infection, and IgM antibodies, suggesting a more recent infection. Type-specific IgG tests differentiate between HSV-1 and HSV-2, offering precise viral typing.
Reasons for Misdiagnosis
Misdiagnosis can lead to a false positive. Older or less specific blood tests might cross-react with antibodies from other common herpesviruses, like varicella-zoster or Epstein-Barr virus, leading to incorrect results. Using type-specific IgG blood tests for HSV-1 and HSV-2 is crucial to prevent these false positives.
Another misdiagnosis scenario involves detecting asymptomatic viral shedding. Highly sensitive PCR tests can detect small amounts of dormant viral DNA even without active lesions or symptoms. Without careful clinical interpretation, this could be misinterpreted as an active infection, leading to over-diagnosis. Laboratory errors, such as sample contamination or mislabeling, can also contribute to inaccurate results.
Conversely, a false negative can occur. This can happen in early infection stages if antibody levels are not yet detectable for blood tests. Improper lesion sample collection, or swabbing old or healing lesions, can also result in false negatives on culture or PCR tests.
Conditions Often Mistaken for Herpes
Several conditions present with symptoms similar to herpes. In the genital area, folliculitis or ingrown hairs can cause red, painful bumps mistaken for herpes lesions. Yeast infections can cause itching, redness, and irritation.
Contact dermatitis, an inflammatory skin reaction, can produce rashes or sores resembling herpes. Syphilis can manifest as chancres, painless sores that may be confused with herpes, requiring specific testing. Genital warts, caused by human papillomavirus (HPV), can also be mistaken for herpes.
Around the mouth, where oral herpes (cold sores) commonly appears, other conditions can mimic its presentation. Canker sores are painful sores inside the mouth. Angular cheilitis, with cracks and inflammation at the mouth corners, can also be confused with herpes.
Steps to Take if You Suspect Misdiagnosis
If you suspect a herpes misdiagnosis, first communicate openly with your healthcare provider. Discuss concerns, clarify test results, and inquire about alternative diagnoses.
Seeking a second opinion from another healthcare provider, especially an infectious disease or dermatology specialist, offers a fresh perspective. These specialists have extensive experience diagnosing and managing conditions resembling herpes and can provide an independent assessment of previous results.
Request specific and confirmatory testing. If initial blood tests were not type-specific, request type-specific IgG blood tests for HSV-1 and HSV-2 for a more accurate picture of past exposure. If active lesions are present, a PCR test or viral culture from the lesion can confirm the virus. Retesting may be necessary if initial tests were too early for antibody development.