How improbably is an HSV-2 positive test to be caused by an 'ear infection'?

Question

For reasons different then you would likely presume I had a women come to me to ask about an STD test a man had provided her. His tests show positive for HSV-2 (a 2.15 result where >1.09 is positive). He claimed that it was not genital warts, but instead caused by an 'ear infection'.

Before I gave her the obvious answer I researched HSV some more to be certain I was being fair and accurate. While HSV-2 is generally associated with genital and rectal herpes it can be caught on the face, usually orally for obvious reasons. Thus in theory I believe one could have an HSV-2 that was contracted on or near the ear; though I don't want to think about exactly what process would lead to one contracting it there... I have not found any actual reference to HSV-2 on or around the ears.

Now I don't believe that is what's happened in this case, for plenty of reasons. Beyond the obvious fact that HSV-2 is far more common genital, and that I still wouldn't call it an 'ear infection' if he had HSV-2 around the ears, there are other warning signs and it's just not worth the risk. I've already advised her to walk away quickly.

However, I am curious now. Just for the sake of completeness and my own knowledge (I get asked questions about STDs more then I ever expected, and while I'm not a medical expert but I would like to be informed enough to give accurate answers where I can), I was hoping someone could help confirm just how probable, or improbable, having HSV-2 on the ear really is?

Answer 1

Herpes simplex virus (HSV)

Herpes simplex virus (HSV) is a common infection that causes painful blisters or ulcers. It primarily spreads by skin-to-skin contact. It is treatable but not curable.

There are two types of herpes simplex virus:

• Type 1 (HSV-1) mostly spreads by oral contact and causes infections in or around the mouth (oral herpes or cold sores). It can also cause genital herpes. Most adults are infected with HSV-1.

• Type 2 (HSV-2) spreads by sexual contact and causes genital herpes.

Most people have no symptoms or only mild symptoms. The infection can cause painful blisters or ulcers that can recur over time. Medicines can reduce symptoms but can’t cure the infection.

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HSV-1 more commonly causes facial herpes (including Bell’s palsy), while HSV-2 more commonly causes genital herpes. However, both can cause infection in the other area as well, although less commonly.

There is also varicella zoster virus, which is in the same family of alphaherpesviruses but is responsible for chickenpox, shingles and Ramsay-Hunt syndrome (an infection of the ear and facial nerves causing painful vesicles in the ear and a facial paralysis similar to Bell’s palsy).

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I found a case report discussing HSV-2 causing an infection similar to Ramsay-Hunt syndrome. This is unusual, though the authors note HSV-2 has been known to causes facial herpes.

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Summary

While much less common than genital infections, HSV-2 can cause herpes infections in other areas, including the ear.

Given all types of HSV spread by skin to skin contact, this would still be a risk for transmission and may cause genital herpes in a contact.

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Sources

A Case of Ramsay Hunt–Like Syndrome Caused by Herpes Simplex Virus Type 2

Herpes Simplex Virus (World Health Organisation)

A comparison of herpes simplex virus type 1 and varicella-zoster virus latency and reactivation