[Question #1221] Confused about test results

84 months ago
I have been in a monogamous relationship for a year, but had 3 relationships over the past 4 years in which I had unprotected sex.  One month ago (September 6th) I noticed a small ulcerated area where my leg and pelvic area join.  It was not painful, and I would not have noticed it was there except for my underwear line would rub the area and it felt irritating.  I am a nurse and under a lot of stress at this current moment; therefore, given my current stress level and the ulceration I went to my doctor in fear that my body had suppressed HSV infection manifesting itself now due to emotional stress.  My MD did a culture of the ulcer (unsure of how long I had it as I was asymptomatic), and the culture was negative. He also did blood work HSV Type 2 IGG-negative.  HSV Type 1 IGG-negative.  HSV Ab screen IGM-negative.  HSV by PCR-negative (Im not sure which one was the culture of the ulcerated area.  However, this week I have had a horrible "yeast" infection, which has been chronic for me for the past couple years with my period.  I also developed a "pimple" on the same side as the ulceration but now on the outside of my vulva.  It is not painful at all, but was noticeable, and has since decreased in size.  My fiancĂ© thinks that I shouldn't worry because of my blood work results and wants me to have sex as soon as my yeast infection clears (i just took my 3rd dose of fluconazole yesterday with some by not complete relief).  I saw my primary care again and she cultured the area, and states that I am not experiencing the clinical symptoms but the "pimple" could possibly be concerning, especially since it is on the same side as the ulceration I had a month ago.  I am waiting for the test results next week, but am sooooo worried about spreading this to my partner.  
Terri Warren, RN, Nurse Practitioner
84 months ago
Hi Kristen,
When did you last have sex with anyone else?  Was it a year ago?  I guess I'm trying to be certain that the timing of you HSV testing is adequate to have picked up any recent acquisitions that might not be reflected in the HSV testing that you've had done.  By the way, the "culture" is the PCR - a far more sensitive test than the culture, so very good that you had that done.  Let's see how this test turns out, but so far, so good, with the lab testing.  BTW, the IgM is useless, has many false positives and should never be done in adults to try to sort out herpes infection.  Thankfully, you didn't get a positive on the IgM because that can be very confusing.   I think if this swab test of the pimple is negative that you can then believe that these lesions are not herpes.  It is possible for the IgG test to miss an HSV 1 infection (about 30% of the time), but if you end up with two negative swab tests (your first one and this most recent one), I would move beyond this worry).  Let me know about the results of your most recent swab test, OK?