[Question #3886] HSV-2 Positive PCR Culture

33 months ago

Good evening doctors,

 

Thank you for taking the time to help me out. Here is some background info to give you a sense of how I got where I am at:

 

I’m a 38 year old healthy female who has never been diagnosed with any STDs or serious health problems. I have no children.

 

Last week (on Thursday 6/15/18) about 7 days after having unprotected sexual intercourse as well as oral sex with a new partner, I discovered a tiny and very slightly itchy bump right above my labia minora right next to my clitoris. It was very small and therefore relatively difficult to see) and was just a small bump maybe the size of a pinhead. I let it be for about a day until I just could not help myself while inspecting it and gave it a little squeeze. I believe it had a tiny bit of weeping fluid on it before squeezing it and once I did it instantly turned into a perfectly round red “crater” type wound. Almost like a little blood blister and still relatively small. Like perhaps a pin head with the round ball tip. No pus or anything came out really other than the weeping fluid that looked yellowish/clear.

 

By the next morning the red spot I caused by squeezing was totally gone as if it was never there and just a slight, mostly flat and small wound remained (clearly having been made worse by my squeeze but unremarkable looking nonetheless) and it still had very slight weeping. Over the next couple of days it continued to heal almost to the point of not being visible. No pain...just a slight slight sore sensation/over awareness of a slightly open sore being there.

 

Again, I first noticed this bump on Thursday evening 6/15/18 and on Monday morning 6/18/18 I saw my women’s health provider in person who took one look and said it absolutely did not look like herpes at all. I gave her detailed info about what it looked like from start to current and also showed her very detailed, up close photos I took of the bump each day starting from day 1 to the current morning I was seeing her. She stated it looked like it was likely caused from shaving or just one of the bumps on the delicate labia skin getting clogged. This seemed reasonable and highly likely given I have been doing a lot more full shaving recently. She also said if it was herpes I would definitely know it—especially if this was an initial outbreak as it has a very obvious look to it and is very painful. I have never had a cold sore or genital sores but I imagine I’ve been exposed to HSV1 as a child because both of my parents have it.

 

Even though the doc felt it was nothing I asked her to please do a PCR HSV culture just to calm my nerves—especially since I just started having sex with a new person (unprotected due to both thinking we were clear of diseases). My partner was married before me and was with the same woman for about 15+ years. He does have HSV1 orally as he gets occasional cold sores but reports he has never been diagnosed with HSV2, nor has he ever had a genital outbreak of any kind.

 

For what it’s worth, the last time I had intercourses was 4.5 years ago and the last time I received oral sex was 1.5 years ago. Never had any symptoms after these previous encounters.

 

One day after the doctor took the PCR culture (6/19/18) I got the following lab results sent to my phone:

 

Genital specimen-Swab:

HSV-1 DNA, QI, PCR=NEGATIVE

HSV-2 DNA, PCR=POSITIVE

 

I am absolutely reeling from this even though I know “technically” herpes is a minor inconvenience. Given such, I could really use some additional guidance on next steps-here are my questions:

 

  1. Is there any way at all that the PCR culture could be a false positive? I ask because the doctor was so sure it was not herpes and the symptoms came and went so quickly and I’ve never had oral or genital outbreaks before. My doctor appears to believe this is possible and told me she is “shocked” that the result was positive and suggested we do an IgG blood test to see what’s going on.
  2. I asked my doctor to call in an IgG blood test and I had my blood drawn earlier today for that test. I requested this test as I would like to try to figure out if I already have antibodies built up (suggesting that this is an old asymptomatic infection that is just popping up) or if it comes up negative which might suggest I got it from my new partner because we first had sex just under two weeks ago. Of course I understand there is no way to be 100% certain about anything in life except death and taxes but I feel this test might help me a little. I was going to ask my partner to take one too. Depending on what is found with the IgG I would be interested eventually in a Western Blot test—thoughts on my decision to do either of these tests and what to expect?
  3. Is there anything else you recommend I do at this point to address this awful news? Perhaps I’m just in denial but I can’t help but feel like there has to be some sort of mistake given how much my doctor felt it was fine/nothing and given the incredibly mild, almost nonexistent nature of the symptoms. Nobody in their right mind would EVER think what I had was herpes and I was so convinced that I was just letting my anxious mind get to me that I literally moved on thinking it was fine and then opened my email last night and got this devastating blow.

 

Thank you so very much for your time—I cannot tell you how much it is appreciated.

 

Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
33 months ago
I think you should certainly rely on the PCR swab - it came from a lesion and was also able to be typed.  I don't think this is a false positive.  Many clinicians do not realize how minor a herpes outbreak can be.  
If your IgG is negative now, this indicates new infection.  But remember that by 3 weeks after new infection, half the people who are going to become positive, will be positive.  So if the timing is that, a positive may not indicate old infection.  You should pay attention to the index value (the number associated with the positive result).  You can write to me about this.  Your timing is actually quite good to do this IgG test and I think lots of people  forget that they have a limited amount of time to do this after new infection. 
Yes, I would recommend that you revise the term "awful news".  As you think, so shall you feel.  If you feel like this is terrible news, you are going to be emotionally upset.  But if you try to revise this to thinking about this as inconvenient and unfortunate but manageable.  you are probably  thinking I'm out of my mind about this, but in time, it will be best of you can work on thinking less negatively about this - it will take time, I know. 
I am here for you.

Terri
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33 months ago
Hello,
Thank you so much for the fast reply. That all makes sense. I should have the results of the IgG blood test later this evening or tomorrow and I will be sure to follow up on this thread with the specifics. Thank you again for your help-
33 months ago

Hello again Dr.,


I just received the news that my IgG blood test was negative for both HSV1 and HSV2. Unfortunately the results did not indicate the actual values for each. I just called my provider and asked for this information and while the lab did not give specific values for HSV1 and HSV2 they clarified that “0.90 IV or less equals a negative result” so I think we can safely assume I was under that number for both. Let me know if you see that differently or need more information. 


This is somewhat what I imagined as my hunch is that this is a new infection as my first sexual encounter in a very long time occurred exactly 2 weeks ago today and the symptoms popped up very soon after. I know this cannot be known for sure but it sure seems likely. 


At this point my plan is to have another IgG test in the future and I am curious if you can recommend how long to wait from today to do that so that I can feel confident in the results? 16 weeks?


Also, I totally took your reassurance to heart about the positive PCR not being a mistake and have accepted that HSV2 is now part of my reality but I happened to find a separate post by Dr. Handsfield which stated that while PCR is amazing and awesome it can sometimes be too sensitive and can create a false positive. Do you have additional thoughts about that? I just want to understand as much as I can because this is one of the most confusing things I’ve been through and the conflicting information makes it even more tricky.


Also, should I begin any antiviral medicines at this point? I asked the doctor who is in today to please call in an Rx of Valtrex

for me and that’s in process. I just want to do everything I can to keep from shedding this and am happy to take the medicine every day if necessary. 


Thank you again so much—your kind answer the other day meant a lot to me and I look forward to connecting again soon. 

Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
33 months ago
While false positives have happened with PCR testing, the entirety of your situation with the itchy bump and the positive PCR, I don't think you have a false positive here.  Also, the majority of herpes in relationships happens in the first 3 months so that timing fits too.
You can certainly do another antibody test down the road at say 12 weeks from the encounter and look for seroconversion to confirm the PCR if you wish, but remember that taking daily antiviral medicine will interfere with the testing.  If you are having sex with someone who is also infected, this won't matter.  But if you are having sex with someone who is infected, taking daily medicine will reduce transmission.

Terri
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33 months ago

Hi,


That all makes a lot of sense—thank you. Yes, I will do another test in 3-4 months just for my own curiosity but I am certainly treating this as if I have it because that appears most likely. 


With that said, you stated the following: 


“...If you are having sex with someone who is also infected, this won't matter.  But if you are having sex with someone who is infected, taking daily medicine will reduce transmission.” Did you mean “having sex with someone who is NOT infected, taking daily medicine will reduce transmission”? I am so sorry but just want to be sure I fully understand that part and don’t want to make assumptions. 


Last questions as I believe there are only two follow-ups allowed (but certainly let me know if I need to buy another round as I am happy to do so—unfortunately, I am getting next to zero support from my current healthcare provider):


  1. Assuming my current partner is the one who had this all along asymptomatically and assuming it is genital, what are the odds of his getting the HSV2 virus from me orally from me now that I have it genitally? I’ve heard this is unlikely since he already has the virus in his body but I am just curious what you think. 
  2. On a related note, my current partner does have a history of HSV1 orally. I am aware I can get this genitally in addition to the HSV2. Are dental dams seriously the only way to try to prevent asymptomatic transmission of HSV1? This sounds crazy but should I just resign myself to the fact that I have HSV2 genitally and not really worry about getting the HSV1 genitally?
  3. When I get another outbreak of HSV2 will it occur in the same location or does it move around the genital area? What is the likelihood autoinoculating myself and getting it orally or somewhere else? Somewhat worried about it spreading to other parts of my body...


That should be it—thank you again for being a wonderful resource during a challenging time. 


Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
33 months ago
If you and a partner both have HSV 2 infection, it is not going to helpful for you to take antiviral medicne, except to reduce recurrences should you have them.
If he has well established HSV 2 infection, he is extremely unlikely to ever get it in a new location
Once a person has HSV 2, they likelihood of subsequently acquiring HSV 1 is about 1 in 55,000.  I wouldn't worry about it.  And the IgG test misses 30% of HSV 1.  The outbreaks in the future could show up anywhere in the boxer shorts area but shedding only occurs from the genital and anal area, not other places.
I would simply wash your hands after touching the genital area for three or four months and you should be fine.  No more than 15 second, with warm water and soap

Terri
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33 months ago
Thank you so much, you have been incredibly helpful. Take care-
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
33 months ago
You are most welcome.  If you have more questions, feel free to come back

Terri
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