[Question #2469] Waiting on hsv swab results
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97 months ago
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So glad to find this site-i really need to stop googling this stuff
Timeline of partners/symptoms:
7/6-unprotected vaginal sex with A
7/8-sex with condom and receptive oral with B
7/9-vaginal and oral sex with C
7/14-noticed a painful spot on my outer labia near the cleft. It felt a large raised bump. Looked initially and thought I saw the classic cluster of tiny blisters. Poked and prodded and it got more painful. (A, B, and C were my only partners in the previous 12 days)
7/15-very painful, looked red and inflamed.
7/16-less painful, starting to heal. No crust like in pictures
7/17-barely painful, largely healed. Mild vaginal irritation. The PA I saw said it "might be" a herpes lesion and swabbed. She did a pelvic and didn't see anything; said my vag looked frothy and swabbed to test for BV, etc. She was surprised by how quickly the spot was healing.
Questions:
1-i don't think there was fluid under the skin when I had the exam-she punctured the spot to swab. Did this affect reliability of the test?
2-A and C told me they haven't had symptoms. Does that make it less likely they or I have hsv?
3-if I'm positive, should I have an IGG now? The speedy recovery makes me think it might not be the first outbreak.
4-if I'm positive, should I tell B? Others I was with earlier this year?
5-i didn't see any pictures with outbreaks in the same place as mine. Does that mean anything?
We're also testing for other STIs. And my therapist and I have a lot to work on.
Many thanks.
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Terri Warren, RN, Nurse Practitioner
97 months ago
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The painful spot is of course quite worrisome for herpes for me as I can see it is for you as well. And I would agree that it is unlikely a first infection, due to the very short duration of the lesion. If this is established herpes, something you've had for a while now, the IgG may well be positive now. But the herpes tests are very far from perfect - in a study we did recently through my practice, the IgG for HSV 2 missed 8% of infection and the IgG for HSV 1 missed 30% of infections. In addition, if you test positive for HSV 1 by IgG, it could be oral or genital infection. Have you ever had a cold sore on your lip or in your nose? If yes, then a positive IgG for HSV 1 could be explained by the history of cold sores.
The lack of symptoms in your partners is not very important - 80% of those infected with HSV 2, identified by antibody test, say that they don't have herpes symptoms. I'm less concerned about your contracting HSV 2 from partner B because it was condom protected. You don't mention whether condoms were used or not with partner C. Condoms are very effective at reducing transmission from infected males to uninfected females.
If the IgG is positive for HSV 2, and you did not use condoms with partner C, I do think that you need to talk to him about this. Less worried about partner B.
The fact that pictures don't show lesions in the place where yours was is not important at all.
If there was not fluid when the swab test was done, it is somewhat less accurate than if there was fluid, but a good swab, PCR, can pick up very small amounts of virus and if positive, can still be accurate. It's the negative swabs that aren't definitive.
and yes, if only a swab was done and it was positive, doing an IgG will give your more information about whether this was new or old infection.
Terri
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The lack of symptoms in your partners is not very important - 80% of those infected with HSV 2, identified by antibody test, say that they don't have herpes symptoms. I'm less concerned about your contracting HSV 2 from partner B because it was condom protected. You don't mention whether condoms were used or not with partner C. Condoms are very effective at reducing transmission from infected males to uninfected females.
If the IgG is positive for HSV 2, and you did not use condoms with partner C, I do think that you need to talk to him about this. Less worried about partner B.
The fact that pictures don't show lesions in the place where yours was is not important at all.
If there was not fluid when the swab test was done, it is somewhat less accurate than if there was fluid, but a good swab, PCR, can pick up very small amounts of virus and if positive, can still be accurate. It's the negative swabs that aren't definitive.
and yes, if only a swab was done and it was positive, doing an IgG will give your more information about whether this was new or old infection.
Terri
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97 months ago
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C was unprotected sex as well. I realize how irresponsible that is.
I'm not sure if I've ever had a cold sore - I possibly had one earlier this year.
I've told A and C that I found a spot in my pubic area and am waiting on STI test results. C and I talked more in depth - he's a regular partner. More questions...
Is anything known about how long hsv2 can incubate before symptoms appear?
The PA took 2 swabs for hsv-any guesses why, and if that might improve reliability of test results?
Is it meaningful that I haven't had any other classic symptoms (except mild vaginal irritation)?
I've had 2 yeast infections this year that needed 2-3 doses of diflucan to clear. Is that meaningful re: possible hsv?
I understand that female to male transmission is somewhat less likely-can you tell me specifics?
Regardless of swab results, should I have the IGG or Western Blot test anyway? I've had a large number of partners over the years. (I do get the standard STI and HIV tests at least yearly.)
I'm mentally preparing for a positive result, but a little hopeful.
Again, thanks. If it's ok, can this stay open until I get swab results? Hoping it'll be soon.
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Terri Warren, RN, Nurse Practitioner
97 months ago
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The usual incubation between new infection and symptoms IF symptoms are going to show up with new infection, is 2-10 days.
I don't know why they would gather two swabs - perhaps you should ask them?
It isn't really meaningful, no, the presentation of herpes can vary so much and if you've had HSV 1 in the past, which it sounds like you have with the cold sore,then new HSV 2 infection can be very mild or without any symptoms at all.
What was thought to be yeast could have been herpes, yes. The two get mixed up frequently
with sex about twice per week, female taking antivirals daily, male using a condom the transmission rate of HSV 2 is about 1-2% per year
Yes, I think you should. The symptom is just too classic for herpes not to pursue this further, in my opinion
I will definitely leave this open
Terri
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I don't know why they would gather two swabs - perhaps you should ask them?
It isn't really meaningful, no, the presentation of herpes can vary so much and if you've had HSV 1 in the past, which it sounds like you have with the cold sore,then new HSV 2 infection can be very mild or without any symptoms at all.
What was thought to be yeast could have been herpes, yes. The two get mixed up frequently
with sex about twice per week, female taking antivirals daily, male using a condom the transmission rate of HSV 2 is about 1-2% per year
Yes, I think you should. The symptom is just too classic for herpes not to pursue this further, in my opinion
I will definitely leave this open
Terri
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97 months ago
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Negative on the viral culture. I had specifically asked for a pcr swab, so pretty angry the PA didn't order that. Last round of questions.
1-what's the false negative rate on the viral swab?
2-since the lesion(?) had been there for more 2 days and was healing (the PA punctured it to take the swab), how much does that increase the chance of a false negative?
3-I understand the viral culture can take up to 10 days to grow. But it was sent to the lab Monday evening and came back today. Is that even enough time? I feel like the test is almost useless.
4-I'm planning to have an IGG now and again in 3 months. Re: any sex in that period, I feel I should disclose. I understand taking acocylivir and using condoms lowers the risk of transmission. But the IGG is more likely to be a false negative if I'm acocylivir? Thoughts? Does taking acocylivir affect the Western Blot results as well? (Though at the moment I'm not at all interested in sex)
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97 months ago
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Adding a few more questions, if it's okay. I just heard back from the PA - I had contacted them to ask why they didn't do the PCR swab as I had asked. They're checking with the lab to see if the lab can do that one as well. I also tested positive for BV - the PA said the spot could be due to BV "causing irritation to the surrounding tissues." However, the vaginal irritation didn't start until Monday, 3 days after the spot, and the spot is nowhere near my vagina. Based on the test results and how fast the spot went away, she's "confident" it's "likely" not hsv. I'm confident she's not well informed about hsv.
Continuing the last question list:
5-is it too late for the lab to do a reliable PCR test, if they even have something to test? It seems like the sample may have degraded.
6-does the BV diagnosis change your opinion on the symptoms?
7-it's really hot and humid here. Could the spot be some sort of heat irritation?
Again, thank you!
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Terri Warren, RN, Nurse Practitioner
97 months ago
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1. We can't determine the false negative rate in general on a swab but the PCR is about 3-4 times more sensitive than a culture.
2. The culture sensitivity does decrease over time because in that test, vs. the PCR, the lab is trying to grow something and there is less virus as the lesion ages.
3. That's very typical timing for the culture and it isn't worthless, it is just not as good as the PCR by a long shot.
4. Antivirals, taken right after new infection, for more than a week or two, definitely can impact the results of the antibody test. Best to hold off if you can.
5. It might not be too late for the PCR if they still have the original vial of transport media that the PA gathered. The PCR is looking for genetic material, degrading doesn't happen with that.
6. Not all all. BV is not an inflammatory response, thus the "osis", not and "Itis" - bacterial vaginosis
7. I supposed it could be but that seems somewhat unlikely to me.
Terri
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2. The culture sensitivity does decrease over time because in that test, vs. the PCR, the lab is trying to grow something and there is less virus as the lesion ages.
3. That's very typical timing for the culture and it isn't worthless, it is just not as good as the PCR by a long shot.
4. Antivirals, taken right after new infection, for more than a week or two, definitely can impact the results of the antibody test. Best to hold off if you can.
5. It might not be too late for the PCR if they still have the original vial of transport media that the PA gathered. The PCR is looking for genetic material, degrading doesn't happen with that.
6. Not all all. BV is not an inflammatory response, thus the "osis", not and "Itis" - bacterial vaginosis
7. I supposed it could be but that seems somewhat unlikely to me.
Terri
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