Visual Diagnosis Negative PCR

I will try to make this as short as possible. My doctor had been giving me the runaround for three weeks and I'm tired of this nonsense. I'm also medical student and if you have any reference material to suggest, I would greatly appreciate it. Let me begin by saying I've tested negative for every other STD.

On May 19th, after an abnormal pap smear, I was given a colposcopy. Thursday the 21st, I had an extremely strange discharge. I reasoned this was the "discharge" my doctor had warned me about, but it was almost solid, yellow, quarter sized, and completely foreign to me. Friday I came down with extreme lethargy, a mild to high fever, muscle aches, more yellow discharge, and went straight to the emergency room in case I had an infection. The ER doctor and pelvic exam concluded that I had cervicitis. I was placed on hydrocodone and antibiotics. Saturday, red bumps appear around my entire genital area. Sunday, the bumps fill and burst in a HSV fashion and are so painful I throw up several times throughout the day. They appear dime sized, almost ragged, and relatively spread out with little to no cluster formation. Memorial Day Monday, I get ahold of the on call nurse and she prescribes Valtrex for herpes symptoms. My doctor visually diagnosed me on Wednesday the 27th, and took a culture (this is within 72 hours and my first outbreak). He also stated, and I quote, "This is a textbook case of herpes. If I were writing a book I would take your picture." He assured me that it was my first outbreak and that my fiance had knowingly given it to me (which I now know is completely presumptuous).

Well, my PCR results are negative and I'm scheduled to have blood tests on Monday. Thing is, I do not trust the accuracy of the blood tests as much as the PCR. I've read studies on the error between visual diagnosis and PCR testing, but have yet to find anything conclusive. Isn't the test supposedly the "gold standard" of hsv cultures? Are false negatives common in PCR testing? Is there a possibility of another type of infection cured through my antibiotic treatment? The symptoms were similiar to a first outbreak, and the flu-like aches, fever, and cervicitis are present in a primary episode, but the PCR is hanging over my head. Also, visually, I've found nothing to confirm my outbreak looked like genital herpes. The ulcers were quite large, never crusted over, and slightly ragged. It feels like I won't get an accurate diagnosis until I have another outbreak (if I do).

Thank you for your time and I appreciate your response. I've also scheduled an exam with another doctor for a second opinion.

[crossing_the_bridge]

a culture is supposed to be done within 48 hours.  there is a high rate of false positives, especially if performed beyond that point.  this is because there may no longer be active virus in the lesion. (an additional factor may be swabbing technique.)  in this scenario, it doesn't matter if it's a regular, old culture, or a pcr - if there's no active virus, it simply won't be detected.  the detection rate of culture w/ recurrences is only about 30%.

read this:
http://www.ashastd.org/herpes/herpes_learn_testing.cfm

so, at this point, you are going to need type specific blood testing.  suggest fiance get tested now.  your results will be most accurate if you get tested at 12-14 weeks from symptoms, but you could get a test now, for baseline (and, some 50% will develop antibodies within 2 weeks).

try reading the herpes handbook.
http://www.westoverheights.com/genital_herpes/handbook.html

[gracefromHHP]

You had been on valtrex for 24-48 hours prior to the lesion culture correct?

At this point both you and your bf getting type specific herpes igg blood tests is in your best interest to see who has what.  

I take it they didn't do any bacterial cultures correct?

Are your symptoms healing up?

grace

[brightyoungthing]

crossing - PCR does not work the same way a viral culture does. It is highly sensitive and the "gold standard" for culturing HSV lesions. Type does matter as pointed out by Dr. Hook in the professionals forum. He is highly doubtful of a false negative on my culture because the time frame is so short. PCR also detects recurrences with 300% more accuracy than viral cultures.

Grace - I had taken 4 Valtrex pills in total, less than 48 hours from the first does was my culture. The outbreak was within 72 hours. My bf recently took a blood test and his IgG was <.91 Negative for HSV-2. Since his last sexual encounter prior to me was 3 months ago exactly, he will return in a month for another IgG. They didn't do bacterial cultures because my doctor was visually certain it was herpes. But as Dr. Hook pointed out 20% of those are wrong. My symptoms are completely gone aside from what appears to be 2 cyst-like formations. Does herpes often leave scar tissue? Is it common to do so with the first outbreak? The  real problem here is that I was also taking antibiotics for my cervicitis. If it was bacterial or fungal (like a staph infection or impetigo) the antibiotics would have crushed it. I was taking more antibiotics than Valtrex at the time of the outbreak and before I was prescribed Valtrex. Sooo confusing.

I declined a blood test at my follow-up visit today. The only thing that would be worthwhile is the IgG and since it was my first outbreak, the results would most likely produce a false negative. I will wait three months and send blood. Also, I am stopping my Valtrex suppressive therapy to see if symptoms return and to re-culture the lesions if they appear. Sure it will be uncomfortable if it happens, but I cannot wait around for a potential yes or no.

I just hope that if I do get an outbreak, the second one is significantly less horrible. I am going to Greece in two weeks! Would an outbreak occur before then if I've stopped taking my Valtrex yesterday?

Thanks so much!
-Lynne

[gracefromHHP]

Honestly if I had known you were also being helped by Dr Hook, I would've never responded. It's our policy not to knowingly step on each other's toes here.

I really can't add any more than what Dr Hook has told you. At this point you really don't have many answers yet.  I disagree with your reasoning behind why you defered a blood test until later on - you are assuming this would have to be a newly acquired infection when it really could be just your first obvious reccurence.  Have you ever had a herpes blood test before?

grace

[crossing_the_bridge]

thanks, but i know how pcr works.  the point you are missing is that it all starts with the swab.  if there's no active virus in the lesion, there won't be any on the swab.  no matter what you do with it after that (plate it on agar, or multiply it w/ pcr), "nothing" will be the result (ie, negative).  you can double check this with your microbiology professor.