PCR swab timing and Acyclovir antiviral

[Hopingforanswers123]

Hi Terri,

I had a 2mm whitish blister/pimple on my inner labia, with nerve pain as well, for about 11 days. On the 9th day, the lesion had a little dimple where it seemed to have opened, and that same day I went to the clinic where they performed an HSV NAA swab test (they told me that is a PCR test). Over the next couple of days, the lesion seemed to dry up and disappear, and there was no scar or any sign left behind. I was on Acyclovir for the entire outbreak, 800mg 3x per day (I already have a prescription handy, due to cold sores).

The swab test came back negative for HSV 1/2. I also got IGG blood work negative for HSV2. Though, it has only been 6 weeks since my potential exposure. This is my second blister like this (the first one appeared 12 days post-exposure, and I took acyclovir during that whole period as well).

I’m wondering what your thoughts are about the accuracy of a PCR swab on day 9 of lesion formation?

Also, I’m aware that Acyclovir can delay seroconversion on bloodwork. Does Acyclovir affect the accuracy of a PCR swab test as well?

What is the likelihood of a single blister/pimple being a herpes outbreak, especially if Acyclovir is involved?

Thanks for your help!

[Hopingforanswers123]

Hi Terri,

After reading thru the forum I’ve discovered that I need to be off antivirals for 5 days otherwise the PCR test will be inaccurate. So, I will discontinue them today.

So I guess if I could change my question… I find it tricky to line up my doctor appointments with an outbreak, and I really don’t want to miss my chance and be stuck off of antivirals for too long if I really need them. Is there anyway I can purchase PCR swabs for at-home testing?

And then my other question would be what day is the ideal timing to perform the swab? First signs of prodrome/nerve pain? First eruption of a blister? A few days into the outbreak?

Thanks again for your help!

Ps- I purchased three more questions, just in case I’m not allowed to change the ones I previously asked.

[Hopingforanswers123]

And my third question remains the same… what is the likelihood of a single blister/pimple being herpes, if I’m actively taking Acyclovir?

Sorry for the confusion!

[Terri Warren]

Sounds like molluscum contagiosum to me, honestly. Few things have a little dimple in the middle but that does. Herpes does not.
But let’s say it is herpes, as a possibility. The acyclovir that you took prior to a swab test would definitely influence not only the swab test but also the antibody test.
The best time to take a swab is when there is very clearly something to swab.
You could obtain swabs from 24/7 Labs and do it at home if you have difficulty lining up an appointment with your provider or you could go to urgent care if you get it again.

Terri

[Hopingforanswers123]

Hi Terri,

Thanks so much for your reply. I just ordered a swab and I’m waiting on delivery.

Well, it’s hard to say… It could have been a dimple, or it could have been a hole where fluid leaked from. But the sores seem to change pretty rapidly. One might show up for a day and disappear, another sticks around for a week or so. I’ve had only 2 bumps that really stuck around for a week and did this dimple/hole thing. So I’m mostly ignoring the smaller ones and hoping they are just clogged pores or something.

The 2 sores were definitely opaque and white, sort of like they are pus-filled. The tiny ones seem to be flat. It does not burn when I pee. All of my skin is sensitive when I rub the area, but I wouldn’t say the sores themselves are painful, not any worse than the surrounding skin.

I’m having tons of nerve pain, going on 6 weeks now since initial potential exposure. I realize that’s not typical for herpes, but I wonder is it possible that I have a sore underneath my clitoral hood which is causing all that pain? I’ve been checking and I see quite a bit of redness and some rough skin inside of there.

Would it be possible to privately share some photos with you so you can take a look? If there is a separate consultation fee please let me know, I am happy to pay for your time.

Thanks again for your help!

[Hopingforanswers123]

The swab is now in the mail and I am coming off acyclovir so I can get an accurate test.

Do you believe it is necessary to stop all natural antivirals and remedies as well? Like raw garlic, lysine, Reishi mushroom, oil of oregano, etc… Will those affect the test?

Thanks again!

[Terri Warren]

No, I don’t belive those substances would impact the swab test. Good for you for getting the swab test done.

Terri

[Hopingforanswers123]

Hi Terri,

Thanks again for your help.

I regret to admit that I haven’t had the guts to come off the antivirals yet. I see spots on my clitoris, and I’m terrified of the pain and spreading of sores that might happen if I stop taking the meds before the spots are gone.

Is there any chance we can have a consultation and I can show you photos? I know it’s really hard to diagnose by photo alone, but I really need some sound advice and peace of mind, prior to taking this leap.

I also wonder what harm might be done if I just continue taking the antivirals from now on, if it’s keeping the sores to a minimum (they seem to show up one every week or two, but they are so tiny they go away pretty fast without causing a lot of pain).

Thanks again for all of your help.

[Terri Warren]

What was the result of the swab?
There is no harm in continuing the antivirals, except that you won’t get a clear picture of what’s going on with a swab test while taking them.
You are welcome to set up a video consult with me and attach photos to the evisit chart, yes.

Terri

[Hopingforanswers123]

Thank you, Terri.

I received the swab in the mail, but haven’t used it yet since I haven’t come off the antivirals.

I had two lesion swabs done at the urgent care clinic in the past few weeks (while on antivirals), both negative.

I tried to book an evisit, but the calendar had no open spots. I checked every month thru to 2024. Maybe it’s an issue with my browser? (Safari mobile)

I’m still trying to wrap my head around how a lesion could be present without viral DNA, thus causing a false negative PCR. Do antivirals really render the test completely useless, or is there some chance that they are accurate when a lesion is present? (As opposed to just swabbing skin for general “shedding”)

And the fact that these lesions just keep coming… my goodness. I’ve just increased my acyclovir dose to 800mg 4x/day, and I still have lots of prodrome tingling which comes and goes for hours every day, and tiny white blisters that come and go… some lasting a day at most, and others lasting a few days or up to a week. I also considered I’m taking too much acyclovir… so I dialed it back to 400mg 3x/day and the symptoms seemed to be worse. So I quickly increase dosage again. I’ve been trying to assume these dots are clogged pores, but I think I’m in denial. Lots of red inflamed skin around labia and anus that flares for a day or two, and feels okay for a day or two, then starts again. This has been going on for nearly 2 months now. It’s maddening 🙁

Is it possible for an initial outbreak to present this way, for this long? Even when taking antivirals from Day 1?

Thanks again for your help.

[Terri Warren]

To me, these lesions do not sound like herpes. But because you insist on staying on the antiviral medicine it’s very difficult to know for sure and I don’t think that you will know for sure until you come off of this medicine. These could also be lesions associated with some bacteria and I think it would be worth having bacterial cultures done of this area as well. This could be a staph or strep infection and that should be evaluated.

The nature and duration of your symptoms does not really suggest herpes to me.

Terri

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