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STDs (Expert Forum)
Reliability of herpes pap smear test with blood contanimate
Answered by
University of Washington
Seattle - WA
Welcome to the STD Forum, which is intended only for questions and support pertaining to sexually transmitted diseases other than HIV/AIDS, including chlamydia, gonorrhea, syphilis, human papillomavirus, genital warts, trichomonas, other vaginal infections, nongonoccal urethritis (NGU), cervicitis, molluscum contagiosum, chancroid, and pelvic inflammatory disease (PID). All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.
Reliability of herpes pap smear test with blood contanimate
by piratedude, Jul 27, 2007 12:00AM
I have had oral herpes type1 forever.
I just lost my virginity on saturday night. Sunday night I noticed some small, white bumps (like tiny pimples) near the base of my penis and a couple red spots at the tip. I also had a weird, dull pain in the shin and calf of my right leg.
I went to the doctor on tuesday. He said he really didn't think it was herpes because it was incredibly mild and because each bump was separate and had a hair growing out of it. Sounds like folliculitis. He figured the small red spots on the tip were irritation or possibly yeast infection and prescribed some antifungal cream. We did a pap smear test just to be sure, but he said he would be very surprised if it came out positive.
Test came back positive the next day. He mentioned how mild it was and how he really had to scrape to get anything. Then he said: "it was so small that I think I got mostly (or a lot) blood." This particular pap smear does not report type. I ask him if it's possible that if blood got in, the positive was a result of the type1 I already had. He said it was possible, but more or less shrugged it off, saying he didn't want to get my hopes up again. So he prescribed me some Valtrex.
How likely is it that it resulted in positive because of my preexisting type1 in the blood? If I have type1, and blood is in the sample, is it even possible to result in a negative?
After four days I am almost completely healed.
I just lost my virginity on saturday night. Sunday night I noticed some small, white bumps (like tiny pimples) near the base of my penis and a couple red spots at the tip. I also had a weird, dull pain in the shin and calf of my right leg.
I went to the doctor on tuesday. He said he really didn't think it was herpes because it was incredibly mild and because each bump was separate and had a hair growing out of it. Sounds like folliculitis. He figured the small red spots on the tip were irritation or possibly yeast infection and prescribed some antifungal cream. We did a pap smear test just to be sure, but he said he would be very surprised if it came out positive.
Test came back positive the next day. He mentioned how mild it was and how he really had to scrape to get anything. Then he said: "it was so small that I think I got mostly (or a lot) blood." This particular pap smear does not report type. I ask him if it's possible that if blood got in, the positive was a result of the type1 I already had. He said it was possible, but more or less shrugged it off, saying he didn't want to get my hopes up again. So he prescribed me some Valtrex.
How likely is it that it resulted in positive because of my preexisting type1 in the blood? If I have type1, and blood is in the sample, is it even possible to result in a negative?
After four days I am almost completely healed.
Doctor's Answer
by H. Hunter Handsfield, M.D., Jul 27, 2007 12:00AM
, Jul 27, 2007 12:00AM
It sounds like your doctor did a versions of the Tzanck test. Like the pap, it involves looking under the micrcoscope for abnormal cells, in this case cells typical of herpes simplex virus infection.
It is an old fashioned, totally worhthless test. It should not have been done. It misses most cases of herpes; and false positive results are common. (We did our last Tzanck test in my STD clinic over 30 years ago.) Your symptoms do not suggest herpes, and unless you are the unluckiest guy in the world, you weren't exposed. Not that someone couldn't get genital herpes the first time s/he has sex, but the odds are overwhelmingly against it. Your own oral herpes is irrelevant; you cannot catch your own HSV infection at a new body site.
Having had the positive test, even though I believe it is meaningless, you now should have proper testing. Have your provider do a blood test for HSV-1 and HSV-2 antibody. You can expect a positive result for HSV-1 and negative for HSV-2. Then have another test in 3-4 months. If the result is the same, you can be absolutely certain you weren't infected last Saturday. Make sure your doc does NOT send the specimen for IgM antibody testing. (You can search the forum for 'herpes diagnosis' and 'IgM' to see why that test is unreliable.) In the meantime, I believe you can be confident you do not have herpes, despite the reported test result.
Good luck-- HHH, MD
It is an old fashioned, totally worhthless test. It should not have been done. It misses most cases of herpes; and false positive results are common. (We did our last Tzanck test in my STD clinic over 30 years ago.) Your symptoms do not suggest herpes, and unless you are the unluckiest guy in the world, you weren't exposed. Not that someone couldn't get genital herpes the first time s/he has sex, but the odds are overwhelmingly against it. Your own oral herpes is irrelevant; you cannot catch your own HSV infection at a new body site.
Having had the positive test, even though I believe it is meaningless, you now should have proper testing. Have your provider do a blood test for HSV-1 and HSV-2 antibody. You can expect a positive result for HSV-1 and negative for HSV-2. Then have another test in 3-4 months. If the result is the same, you can be absolutely certain you weren't infected last Saturday. Make sure your doc does NOT send the specimen for IgM antibody testing. (You can search the forum for 'herpes diagnosis' and 'IgM' to see why that test is unreliable.) In the meantime, I believe you can be confident you do not have herpes, despite the reported test result.
Good luck-- HHH, MD
I'm just wondering if the fact that my blood (having type1) contaminating the sample can result in a false positive, or if you believe it is false because of my symptoms and the inherent error in the Tzanck test.
I talked to my doctor again today, and while he doubts type2, he thinks I may have been infected by type1 through oral (which I forgot to mention). Just wondering how likely that is. It would seem even less likely than getting type2 and maybe even impossible.
I have already gotten more than my money's worth here, so if you think I should post a new question I am more than willing.