[Question #7814] Negative PCR/serologies with classic presentation
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52 months ago
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Hello experts!
Hoping for some insight. I am a 26 year old female. 2.5 years ago, I entered a relationship with a male with oral HSV1 (since infancy). We both took 10 panel STD screens, including hsv type specific IgG, after 5+ months since our last intercourses, prior to becoming intimate (I did see his results, so no room for deception here). Everything was negative for us both, except for his hsv type 1. He started taking 1 g of Valtrex daily for multiple months prior to us ever engaging in oral sex (which we did infrequently). One night, we had unprotected intercourse for about 60 min (no oral). I was very dry (not unusual for me due to my oral BC). I was in pain immediately afterwards, with scant bleeding, generalized vulvovaginitis and dysuria. Again, not uncommon for me. After a stubborn confirmed yeast infection for 5 years, well before my sexual debut (have to love daily tetracyclines for acne and 13 y.o girls too shy to ask for sexual health help), I have very sensitive genital mucosa and diagnosed vaginismus and vulvodynia. Anyways, the day following intercourse, I noted redness and swelling, bilateral labia minora around my introitus. The following day, I noted one larger aphthous ulceration on one labia minora and two smaller ones on the other, presenting as kissing lesions, where . I immediately went to my GYN who performed sureswab HSV PCR and ordered serologies. The PCR was done at exactly 40 hours after the intercourse. I then took Valtrex for 5 days only. Ulcers went away within a week. The PCR came back negative. I tested with Quest herpes select type specific IgG at 2 weeks, 3.5 months and 8 months after the symptoms, all negative. My GYN thinks it was simply aphthous ulcers due to mucosal trauma. This made sense, as I get canker sores frequently and I accepted my results, however I’ve been reading about false negatives and how rare non-STD ulcers are. Can I rely on my test results? Have any of you seen this in practice? Thank you for your help!
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52 months ago
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I also was taking oral spironolactone 100 mg once daily for acne in addition to the oral contraceptive in case that is important ! Thank you again for your help, I apologize for the novel!
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Terri Warren, RN, Nurse Practitioner
52 months ago
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Interesting case. These could be apthous ulcers, though they are not common in the genitalia area - they do happen
Another possibility is that you already had HSV 1 genital infection and the IgG test missed a positive HSV 1 - is misses 30% compared to the IgG test. I am assuming you've had no cold sores in your lifetime?
What did the doc think who swabbed you? Were the lesions tender?
Terri
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52 months ago
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Wow, thank you so much for the fast reply. I have never had a cold sore to my knowledge, which further complicates the situation. The ulcers were very tender to the touch- the swab was very painful, but my Dr. said he needed to ensure that he takes a good sample for accurate test. Upon inspection, my Dr. said, that he suspected herpes, but that ‘he’s been wrong before and testing was needed to confirm. After I tested negative, he said that it’s very unlikely I’d have both a false negative PCR of a fresh lesion and negative blood tests (although he seems to think serologies are way more sensitive than what’s reported on the forum). I took his word for it and moved on, but I should also add, about 1 year later, I had the same situation occur. Same partner, same exact sexual position for 1-2 hours with dryness. Pain, swelling, bleeding afterwards. Exact same ulcerations 1-2 days later with same size, number, severity, in the exact same location (which is what concerns me for hsv). No other symptoms. The ulcers went away in the same time as before. 5-7 days, but this time without any medication. I didn’t think to get it swabbed since my tests had been negative and I hadn’t switched partners. I would be comforted if my only risk is gHSV1, as I know that’s much less likely to reoccur/infect others, but I wasn’t sure if I should be concerned with type 2? Or is possible this is some hyper- or auto-immune response to mucosal damage causing aphthosis? Could this realistically be anything else that I’m missing? How often do PCRs give false negatives on fresh ulcers? Please let me know if I need to renew as I know that I just bombarded you with questions. Thank you so much for your help, I really appreciate it.
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Terri Warren, RN, Nurse Practitioner
51 months ago
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Since we have no better swab test than PCR, we don't know the exact sensitivity. This is concerning for HSV infection, by your presentation. If you want to know for certain if this is HSV, I would advise the herpes western blot from the University of Washington. Your regular provider can order this for you or I can at westovereheights.com. I doubt that this is some weird autoimmune thing going on.
Terri
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51 months ago
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Thank you for your time and insight, Terri. I know I wrote a lot and I appreciate you taking the time to go through it all. I’ve actually considered doing the blot myself before. Sadly, I won’t be able to afford the it for another year, after I finish grad school. I suppose I could live as if I have gHSV1 until I can confirm it- there are worse things anyways. Better safe than sorry. Take care.
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Terri Warren, RN, Nurse Practitioner
51 months ago
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Sounds like a good plan. When you are ready, I'm here.
Terri
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