Accuracy of PCR swab testing

[Rockytj]

Hello,

I have a question regarding the accuracy of PCR swabs on scabs.

A brief history of my situation, on 09/10/2023 I had a new partner and received unprotected oral sex, I did not see any sores or lesions on my partners mouth, and they had been recently tested. I have sensitive skin, and aside from some discomfort going from a humid to dry climate, I did not experience any blisters or lesions. I am always vigilant after being with a new partner, and the dryness I experienced was consistent with skin issues I’ve experienced before.

Fast forward to 09/26/2023 and I had a new partner, there was protected penetrative anal sex, and lots of manual stimulation. Today on 09/28/2023 I noticed two pinprick scabs on my penis. Thinking they might be something else I washed them off in the shower. After realizing what they were I made an appointment with my primary care provider and was able to get a PCR test done on the red skin. The clinician looked at the area, swabbed it, and asked questions about my symptoms and sexual history, noting that it didn’t look like HSV she’d seen before, and may have been the result of manual stimulation and dryness.

My question is, would it be odd to experience only scabbing with an initial outbreak? And how confident should I be in the results of the PCR based on the timeline of my potential exposure (either 18 days or 2 days?

Thanks in advance

[Terri Warren]

It may have been too late in an outbreak for an accurate swab test. OR it wasn’t HSV. The appearance of the sores 18 days after the oral sex also seems too long for a true primary with only two little scabs present. When you say she tested negative, was that for HSV 1 and 2? I suppose a lot of manual stimulation could be aggressive enough to cause breaks in the skin from the woman from the 26th?

Terri

[Rockytj]

Yes I had a negative IGG prior to these partners in August (type 1 and type 2). The most recent PCR of the scab was also negative for both type 1 and type 2.

Unfortunately if there were systemic symptoms immediately after it would be hard to know as I had COVID and was ill with fever, congestion and sore throat immediately after. I think that likely would be masked any initial symptoms.

I will retest after 12 weeks, and follow up on any lesions that do pop up.

I also do continue to experience seasonal dryness and discomfort in the same location, even through the scabs are fully healed. So either the outbreak is continuing to hurt for weeks afterwards, or I’m thinking it could be some mild dermatitis. I do have a history of eczema and skin sensitivity.

Would it be unusual to have no vesicles and lesions to directly to scabbing on a primary outbreak?

I know you don’t do images here but I did cross post here if you want to take a look: https://honeycomb.click/topic/83069-atypical-initial-ob-questions/

[Rockytj]

Also, I’m assuming my exposure likely would’ve been oral to genital (HSV1). Doesn’t GHSV1 usually have a more sever initial outbreak?

[Rockytj]

Sorry to spam, but I reached out to the partner from 09/10/2023 and told him I’d had something unusual going on on my penis and asked if he’d tested recently, specifically for HSV, and he had! Still could be a missed or new infection, but it did make me feel much better. As the second encounter was mostly manual stimulation and protected sex, do you think that would be sufficient exposure to see scabs in two days?

Thanks again

[Terri Warren]

That is good news that this partner tested negative. Genital HSV 1 can cause mild or severe symptoms. Both happen. I’m sorry, but I don’t view pictures on this website. To have symptoms of a brand new infection 18 days after a concerning encounter seems really unlikely to me.

Terri

[Rockytj]

Going back to my first question, would it be unusual for an outbreak to present only with scabs and no visible lesions or redness in the area?

I know there’s all sorts of variation but looking at lesions in pictures it seems like there’s usually a certain degree of redness and a more crater like appearance.

Thanks

[Terri Warren]

sometimes the earlier stages of an outbreak can be missed but most often there is some sensation prior to the scabbing stage, but not every time. The crater phase happens before the scabbing phase.

Terri

[Rockytj]

Following up, I did have a negative igg test at 8 weeks post my concerning encounter. And will retest next time I get my std testing done.

I’ve continued to experience dryness in the region, no more scabs but the same ongoing discomfort and some small white, flaky spots, visibly dry. There is no redness, blisters, or ulcers.

Does HSV ever present as just dry skin? Am I overthinking this?

Thanks again

[Rockytj]

I did get the flaky skin swabbed and PCR tested it again came back negative. There is still continued dryness and discomfort a week later.

No other symptoms besides dryness and discomfort. If the pain were some sort of prodome it wouldn’t last a week correct? And if the dryness was anything healing, it wouldn’t continue to hurt afterwards right?

[Terri Warren]

Does HSV ever present as just dry skin? Am I overthinking this?
I think you probably are. HSV does not present as dry skin.
Symptoms like pain that happen this far out from a concerning encounter are very unlikely to be related to HSV especially with a negative IgG test.
Terri

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