Usually herpes doesn't have pus in the lesions, far more often, clear or slightly cloudy fluid.  Pus is more likely a zit.  The hand sanitizer might well influence a PCR swab if taken close to the time of application of the sanitizer.  If there is visible pus that can be swabbed, then I think this is not as much of an issue at all.

Terri
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Thank you. Unfortunately my regular doc's office was closed, so I went to an urgent care where I had been previously. The MD declined to swab the lesion bc he said it was a zit and that in a case like this clinical observation was sufficient and why waste a $200 test. I am not very assertive in these types of situations, and I did not insist, which of course I now regret. 

I would say that 99% of my patients get zits on the bottoms from time to time.  Herpes lesions truly are different from zits in that they are water filled and usually tender.  They usually come in groups on the buttocks and are very noticeable and uncomfortable.  I doubt that you would mix them up.  it's good the doc in the urgent care clinic felt strongly it was a zit - then it probably was.

Terri
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Thank you. I don't want to seem as though I can't accept good news - in fact I would be so happy to be done with all this. I really don't want to sound like a negative person. It's just that it's hard to make sense of these docs. This urgent care doc, for example, was one of the original providers who told me back in 2015 that his clinical exam was totally sufficient and that my mouth lesion WAS HSV. He did a swab in 2015 just to appease me, but he was very emphatic when he told me that even if it came back negative, that was probably just because the lesion was too small. Well the swab in 2015 did come back negative (it was a NAAT), but I didn't put too much stock in that result since the doc had seemed so down on it. So now I guess it's just hard for me to trust him when I went back this last time and he's telling me how sensitive the swab in 2015 was, and that there's no need to do a swab this time because his clinical exam is sufficient. I just... I don't know how to make sense of this. At least one of his clinical exams clearly was incorrect, and he's told me both that the NAAT is not super sensitive for a small lesion and then again that it is. I don't know...

I honestly don't know what that particular gel would do to a PCR swab - it isn't antiviral, that's correct, but what impact it might have anyway isn't completely clear to me.  I would suggest that if you are having lip lesions that you want to have swabbed next time don't get that gel anywhere near them so you can get the most accurate results possible.
in terms of what the urgent are doctor said to you and your struggle with this:  The CDC clearly states that physical exam alone is insufficient to diagnose herpes as many mistakes are make when using physical exam only as a diagnostic tool.  I know that his words are sticking with you and I certainly don't know if he's right or not but I guess your only option now is to continue to try and have lesions swabbed as they come up.   

Terri
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Thank you. Yes, I agree at this point all I can do is try to get the lesions swabbed as they come up. I wish I hadn't put the acne gel on that last one, but I was feeling indecisive - wanting to believe the urgent care doc that it was just a zit, wanting to be optimistic, etc. Yet still not entirely convinced. Live and learn, I suppose. At any rate, the PCR that my regular doc's office did did come back negative. So that's good news. I don't know if the acne gel influenced that result, but either way I supposed it's good to have a negative result. 

P.S. I meant to mention that I've taken your advice/expertise to heart in regards to not worrying so much about laundry and pillows and the like. I'm much more comfortable with sharing pillows with the kids once again and also with sticking to the basics in terms of washing the laundry. It's nice to be able to let go of those concerns, and I look forward to your reply in regards to what I realize are probably silly concerns regarding tooth-brushing, so that I may let go of those as well and move on with life as usual. 

The things you describe around oral hygiene are NOT a concern for transmission of oral herpes to your family members, no.
Yes, hand sanitizer is what we professional use between patients unless there is visual contamination (blood, stool, etc) in which case we wash hands of course. 
I'm so very very pleased to hear that you are doing better with the laundry, that's a big step forward for you, I think.   And glad you are going to do the western blot.  Now the trick will be letting the results be the final word on your worries, if you can.  You sound much much better already, though.  Great job getting on top of some of those worries.

Terri
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