1. The PCR swab of my genital lesions came back neg for HSV DNA. I noticed the sores/burning in the evening on my labia minora and the next day in the afternoon it was swabbed in less than 24 hours of me noticing any symptoms/redness. At the time of swab the sores were open, red, and raw and oozing fluid a hurting/burning. The provider swabbed all of the red sore/open cut areas and it did hurt during the swab procedure so I figured she scraped a good amount and got a decent sample. The result came back the next day. Do you think that this could be a false negative? What are the rates of false negatives on genital PCR swabs for HSV-1?
I think it is very unlikely that this is a false negative. Given there is no better and accurate test than PCR swabs, we have no data on false negatives.
2. I had been taking valtrex 500 mg BID for at least a week or more prior to the PCR swab for treatment/prevention of the oral HSV-1. Is it possible that the valacyclovir made this result a false negative despite the sore being fresh (nonhealed)? I think the timing on the swab was good as my ulcer/sore became less painful and started improving after following day and was swabbed at it’s worst. It took about 4-5 days to heal. No crust or scabbing but it was itchy when it was healing.
It is possible but unlikely.
3. Yes, I have had oral sex done to me at the age of 20 (I started having classic cold sores on my lip when I was 13 or 14 years old (probably got it from my mother who had cold sores) but didn’t have anyone do oral sex on me until I was 20 years old. I was focused on school and did not really kiss or have sex with anyone until 18 years old. So, my HSV-1 oral infection was definitely well established by the time I had any oral sex or sex in general. Is it possible I could have gotten gHSV1 from the oral sex in my early 20s and just never had an OB until now… 15 years later?
No. I didn’t realize you had had cold sores for so long.
3. Do you think I could have infected myself as a teenager by autoinoculation (carelessly touched my cold sore and then my genitals) in the 4 month span after my primary HSV-1 oral outbreak? I was not careful and I didn’t understand anything about HSV at that young of an age
I think that is extremely unlikely…
4. If that is possible, then how likely would it be that I had HSV1 genitally and orally all these years (since age of 14 ) and never had a genital occurrence until now 20 years later? To me, if I had genital HSV-1 for 20 years and never had an OB, why all of a sudden now? Especially since I’m taking Valtrex (never took suppression antivirals until this year due to the frequent intraoral sores). I am very confused.
I think that is extremely unlikely
5. What should I do next to figure this out? So far the 1 genital HSV swab was negative while on valcyclovir supression. My biggest question and concern is do I have HSV genitally and it is consuming my thoughts. I am afraid to have sex with my husband as I don’t know what’s truly going on and his risk for transmission.
HSV 1 genital infection is rarely active and is rarely shed. Once someone has had HSV 1 genitally for two years, they shed virus on about 4 days out of an entire year. Given the very unlikely possibility that you have genital infection and the low number of recurrences if you did, I think your concern about infecting your husband is not realistic. Is he as worried as you are about all of this?
6. My husband and I have been together for about 15 years, married for about 11. Like I said, he and I don’t kiss and I don’t give him oral, or share food/drinks/utensils. I have been very particular about doing what I can to not infect him or my kids with HSV. He tested neg for HSV-1 on igG test and I would be willing to do a western blot test for him if I have genital HSV just to get more clear idea of our circumstance and risk but i am primarily focused on what I need to do next. IF i have another genital sore, I will plan to go and get it swabbed again, maybe I should get it biopsied if I had a negative PCR? I thought for a second I might have bequette’s given my intraoral sores and genital sores but that is super rare and my oral sores do not look like aphthous ulcers.
Biopsy is not the method to diagnose HSV. PCR swabbing is.
Again, you don’t kiss and you don’t give him oral sex all because of your oral HSV 1 infection? How does he feel about all of that?
7. It is very frustrating because I think I need to assume i have genital HSV until I rule it out by more negative testing or finding out the sores are something else. I realize there are very few things that can cause ulcers/sores on labia so that is why I have to assume it is HSV. What is your opinion on everything I have described about my lesions, symptom, and history…what would you assume and recommend I do at this point? I value your input greatly. TY!
People approach things differently. I would take a very different approach of I were in your situation. And it also depends upon how your husband feels about all of this. If he is the one that is so scared of getting HSV 1 that he is OK with never kissing his wife or receiving oral sex, then that is a decision for the two of you to make. Given that half the population has HSV 1 anyway, given effective treatments are available, given how infrequently HSV 1 reactivates in the genital area, I know my husband wouldn’t give it a second thought – he’d take the risk in a heartbeat to have a fuller loving and sexual relationship. But as I said earlier, everyone is different and their priorities are different.
Terri