[Question #12468] PCR Swab in absence of Genital Sores

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7 months ago
Good morning,

I 41 yo F started a relationship with a new partner, 48 yo M. We tested for all other STIs but not HSV. All is negative. Sex is unprotected, no visible sores on either end.

I noticed that following sex, 1-3 days  after, I start having significant labial/vaginal itching, redness, and my discharge becomes of a different consistency - more watery and sticky. 
I feel very uncomfortable down there, however no visible sores, no malaise, no enlarged lymph nodes, no pain, no fever.

Fluconazole may help with removing symptoms but not always. Vaginal probiotics may help. At present I am trying boric acid but it’s not helping. 
I went to see my MD and he suggested a swab. I self swabbed for mycoplasma, ureaplasma and HSV. The MD suggested it even though there are no visible external sores. 

My question: Based on your experience, have you seen herpes present this way - either an initial breakout or repeated flare-ups? Is it possible/likely for swab to come back positive in absence of sores? If it does, will a positive swab using PCR be conclusive or require a Western Blot for confirmation? 

I am concerned about genital HSV, not sure if I may have picked it up from this encounter or if it’s a long-standing infection. 

Have you seen such presentation for genital HSV before? Can the sores be internal, if not external? Or they would hurt? Can the swab pick up viral shedding if there is one, even though there are no visible sores? 

Please advise and thank you! 


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Terri Warren, RN, Nurse Practitioner
7 months ago
Usually new HSV presents with lesions, not just redness.  Sores are normally external but can also be internal and they would likely be uncomfortable yes,  The swab should pick up viral shedding if there is some to pick up, even without sores.  I agree with MD suggestion about getting a swab, just to be clearer.  Let me know how that went.  And if you do see any sore, go back and have them swab tested.

Terri
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7 months ago
Hi Terri,

Thank you for your help. I’ll advise once results are available. 

Quick f/u question: Are there false positives with PCR swabs for viral DNA or it’s always a true positive which doesn’t require a confirmatory test? I know there are false negatives, but was wondering if it happens in the reverse as well. If you’ve seen anything like that. Thank you. 
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7 months ago
Hi Terri,

Just updating that I saw the doctor today and swab results are all negative. Or at least nothing was detected. I was checked for everything under the sun thus far. I suppose it’s either an undetected issue or perhaps not of viral aetiology. 

I suppose that something like the Western Blot is definitive, but I’m not sure I need it given symptoms that are not per se indicative of HSV. 

Curious to know what you think of this and wondering (sheer curiosity) whether there is such a thing as “false positives” with PCR swabs.

Thank you. 
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Terri Warren, RN, Nurse Practitioner
7 months ago
That's great that all are negative.  Even if there were no sores, if HSV was present, it would get picked up on the swab
There are extremely rarely false positives on swabs.  I have seen it once in my entire career.
I think this suggests that what you have is not due to HSV

Terri
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