Genital Herpes Virus in Spinal Fluid

Dear Dr. Rob:

I’m a nurse and a close female friend of mine is also a nurse. Two weeks ago she went to the ER with a severe headache, nausea, vomiting, the works. After much testing and a spinal tap she was found to have the genital herpes virus in her spinal fluid causing meningitis. While the meningitis diagnosis explained the symptoms she was having, the doctors seemed puzzled by how she had the genital herpes virus in her spinal fluid, but had never had a genital outbreak. Apparently they have never seen anything like this. A gynecologist examined her and failed to find any genital/cervical lesions. We haven’t received much explanation from the physicians at the hospital. Have you ever heard of a case like this?
Thank you for your help,
Confused Nurse

Dr. Rob’s Response:

Dear Confused Nurse:

I am somewhat confused too. Although it is quite likely to have genital herpes without having any typical outbreak, it is unlikely to transmit that to the spinal fluid. The nerves that are typically infected with the virus or where the virus lays dormant are in the Perineal area. So one could say there was a disruption in the dural sac or the spinal cord sac that you could, in fact, infect the CNS. It is far more common to infect the spinal canal with Herpes Type 1 Herpes Simplex Encephalitis, and that being a Type 1 infection, I would wonder about the specificity of the diagnosis and if they did an HSV1 culture to find out whether, in fact, we are talking about that. Please keep me informed, as I find this very interesting.   


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