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I was hoping that someone could help me sort out some conflicting test results, and figure out the likelihood of a lab error vs.
Most (90 in one study) of these people have positive blood tests for HSV with no history of symptoms or outbreaks. Psychological Stress As A Trigger For Herpes Zoster: Might The Conventional Wisdom Be Wrong?
A PCR test can be done on cells or fluid from a sore or on blood or on other fluid, such as spinal fluid. A positive herpes IgG test only tells you that at some point in time you acquired the herpes virus (1 or 2 or both depending on your results).
Antibody tests are sometimes done but are not as accurate as a viral culture at finding the cause of a specific sore or ulcer. Herpes is not a blood borne infection so therefore using pcr testing for routine testing of herpes is pretty much useless. Given the severity of the illness and the availability of effective therapy, there is a need for a rapid and accurate diagnostic test for HSV encephalitis (HSE).
HSV PCR detection from CSF is a sensitive and specific alternative for detection of disease involving the CNS, as well as oral, genital, ocular, and other sites. If a viral culture taken at a clinic from an active herpes lesion is positive for herpes simplex, then this makes the diagnosis. Polymerase chain reaction (PCR) can be used to detect VZV DNA rapidly and sensitively in properly collected skin lesion specimens; however, PCR testing for VZV is not available in all settings. With both detection methods, lesion duration and morphology were associated with HSV detection.

This is a qualitative assay; results are reported either as negative or positive for herpes simplex virus (HSV) type 1 or HSV type 2, or HSV indeterminate. Wald et al showed in their 1997 paper that the PCR test was almost 300 more sensitive in picking up actual viral material from vaginal specimens than was the viral culture.
In these instances, a history of VZV exposure or of a rash that began with a dermatomal pattern, along with results of VZV antibody testing at or before the time of rash onset may help guide the diagnosis.
This test can be used to diagnose genital infection with herpes simplex virus type 1 or type 2.
Cell culture or PCR test may give a false-negative result if the sores have begun healing or if you are recently infected.
Using these experiments, we more accurately computed the test sensitivity, specificity, and misclassification rates. The most important fact to know in terms of Herpes testing is that blood testing with an IgG test is the BEST test for diagnosing the disease. In the past, type-specific blood tests were not always accurate because they confused other herpes virus antibodies such as varicella zoster (chicken pox) , Epstein Barr, or mononucleosis for herpes simplex (Types 1 and 2) antibodies. Know that having an accurate sexual history as well as a description of your symptoms is very important as your health care provider evaluates you.
The PCR test locates the DNA of the herpes virus; hence, this common way of testing for the herpes simplex virus offers highly accurate results.
There is a new test, dubbed the silver pap that includes a herpes PCR swab test in addition to the GC (gonorrhea and Chlamydia) tests that are performed at this time. Whereas the culture requires quick access to the lesions, PCR does not require as many virus particles for accurate testing.

This allows more time between lesion outbreak and sample collection with a lower false negative rate.
One study found that herpes cultures give FALSE NEGATIVE results 76 of the time when compared to the more accurate PCR test described below.
The detection of Herpes Simplex (HSV) from ocular specimens is essential for prompt and accurate therapy. In our laboratory, all clinical ocular samples suspected of possible HSV infection are tested with standard cell culture, ELVIS, and PCR.
Both Herpes simplex type 1 (HSV 1) and Herpes simplex type 2 (HSV 2) can infect the genital area.
Yes, there are blood tests for Herpes Simplex Virus 1 and 2 (HSV1 and HSV2) but they are not recommended in adolescents or adults who are asymptomatic. If a PCR test from a swab of a sore is positive, you can be pretty sure herpes is the cause. Other accurate tests for HSV-2 may also be available through your local healthcare provider.

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