Negative HSV Culture.....but????

[female26]

i have recently been tested for HSV after the last time I had sex with my ex-boyfriend on Nov 11 (we started having unprotected sex after being tested in August and we both tested Negative and at that time we started having unprotected sex), i felt a lot of pain in my vagina and had a bit of blood. it hurt when i would sit. This pain started immediately after sex. In the passed I have been swollen and my vagina had been swore after having sex when they was not enough lubrication, or the sex has been rough. After the pain did not go away after a day or so, i looked at myself with a mirror and spreading my vaginal lips, noticing two small paper-cut-like cuts just above the opening of my vagina, below my urethra opening on either side. there were just cuts; did not look like a blister, no small cluster of red bumps, no itching, nor did any scab form. i went to my doctor concerned i had a yeast inflection and also herpes. After a visual exam he said he thought it was defiantly herpes. He did a culture, gave me Valtrex and the oral medication for a yeast inflection. I asked why a blood test was never given whenever i saw him for full STD work ups; he said there is really not a blood test for herpes. After seeing my doctor the cuts were almost gone in 2 days.
herpes was a concern because i had heard recently that a past partner gave herpes to another girl. I have recently spoken with this partner and he has said that he does not have it, that this other girl was lying.
I have received the culture test back; it was negative (no sign at all of HSV), which my doctor was surprised to see. my doctor now wants to do some follow up testing. i know with the culture test there can be a false negative, it is standard procedure to have follow up testing when a culture is negative? It has now almost been two months and i have not had any other symptoms.
What are the chances the negative culture is a false negative?

[Edward W Hook, MD]

In your situation the chances that this was a herpes and that the culture was false negative are very low.  As I understand it the laboratory data and your own history suggest that this is not herpes.

First, when you have sex with someone how does not have herpes, you cannot get herpes.  If you and your BF both had tests and they were negative for both HSV-1 and 2, then there is no herpes in the relationship, therefore no risk.  The negative culture confirms this.

Second, you have another explanation.  The lack of lubrication can cause fissures of splits in the genital area that can be quite uncomfortable, can look like herpes lesions and which also tend to heal quickly.  If this had been your first episode of herpes, typically it takes a week to 10 days for the lesions to heal.

With all due respect to your doctor, there is good blood test for herpes, the HerpeSelect. In addition, recent studies indicate that even experts misidentify herpes lesions in both directions-calling lesions that are not herpes herpes and saying things are not herpes when they are.

Hope this information is helpful.  EWH

[female26]

thank you for taking the time to answer my questions. I have also posted my comments in the Herpes forum and i am very confused about culture tests.

one person commented that culture tests are 70% false negatives, is this correct?

i guess the best thing, if the blood work comes back negative, is to ask my doctor to include in my STD work ups the blood test for herpes going forward. In the past it has not been included i guess. And as for my bf (who i am no longer with) had told me he was clean. And i have not reason not to belive him.

I see my doctor tomorrow for a follow-up, almost 2 months after seeing him with the cuts.

[Edward W Hook, MD]

Many factors can effect how likely a herpes culture is to be positive or negative.  The proportion of tests which are false negative is higher in recurrent herpes than initial episodes and higher as the amount of time the lesion has been present increases. Other lab factors like time of specimen transport and specimen handling also can cause false negative cultures.  I think the, in general 70% is far too high a figure for false negatives in most settings but as discussed above, there are many factors which can contribute to this phenomenon ( I only mentioned a few).

You are correct that most doctors do not routinely include herpes blood tests in routine STD testing.  

Even the the additional information and discussion above, I still doubt that you had herpes as the cause of your lesions.  Good luck.  EWH

[female26]

again many thanks for taking the time to review my comments. i must admit i have been very stressed about this. thank you for the second opinion.

i will now have HSV blood work as part of my STD testing on a regualr basis.

[female26]

so i went to see my doctor and he seems to be very, and i mean very, surprised at the negative HSV culture. and as we talked about things more her thinks there are some signs that maybe it is not herpes. like the fact that the person that i thought might have herpes does not in fact have it (the partner that said he have it to her, was telling a lot of lies and timelines were not adding up. And I and my former partner dont even know if this other women has herpes). also the fact that my cuts did not form any scabs or crust over. And as i mentioned i have been swollen, swore and had small cuts before some rough sex or when there was not enough lubrication.

going for blood work. however, he suggests that i wait 12 weeks from when the cuts appeared. Should i wait that long? I would like to have a 100% answer on this matter.

Also, over the last couple days I have noticed a red area on the side of my urethra. It is the side were one of the cuts were, but more on the urethra it self. From what i can see and feel there is no cut. I have no pain, no pain during urinating and no itching. the red area seems to be where a small flap of skin is. I also had my period last week, could this be causing this? I can’t remember if i have had this redness before.

Am i just obsessing over this and trying to find things????

[Edward W Hook, MD]

As you recall, my initial impression was that you did not have herpes.  Your doctor and I agree on this and now, the additional information you've provided points us in that direction.  At 12 weeks 80-95% of people with herpes will have antibodies.  On the other hand, if your antibody test is positive, it does not mean that the lesions you had were herpes.

Hope this helps to clarify things.  EWH

[female26]

thank you for your reply. my doctor is still not 100% that is it not. He was very suprised at the "-" culture. Even with the information about this red area that i described, you still feel that it is not herpes? could this red area just be an irritation from me always examining myself or from havng my period? Or am i just looking at every little thing to find something?

It has been 9 weeks since i noticed the lesions, it is best to wait the 12 weeks to get a firm "-" or "+"? or can i go now for the blood work? I really have no concern to think i have herpes, aside from these lesions i had 9 weeks ago.

[Edward W Hook, MD]

My bias is that this is unlikel to be herpes.  Your blood test results will help to sort this out with greater finality.  At 12 weeks about 90% of HSV blood tests that are going to be positive will be.  I think it is to your advantage to wait till then.  EWH