False positive culture?

[Rara7]

My husband and I have been married for two years. In those two years, I have never had bumps or ulcers or lesions and neither has he. In fact, neither of us has had anything like that all our lives. Last week he and I had sex and he sucked both my nipples really hard. So hard it hurt when he did it. The very next day my breasts were in pain. Two days after that I noticed my left breast was larger and red. I also noticed small blisters on my areola and 1 on my upper breast skin. It was burning and tingling; like a sharp pain that made my nipples unbearable to touch. I went to urgent care and the doc did a quick swab of my nipple (literally took 10 seconds) and sent me away with Bactrium. The next day the pain got so bad I went to the emergency room. By this time my right breast was also swollen and also had some blisters, although a lot fewer than the left. They gave me clindamycin through IV and both the redness and swelling went down dramatically within 45 minutes. But my culture from the urgent care finally came back and it was positive for herpes--no typing. I developed a low fever and also a sore throat with a white ulcer in the back of my throat. I went to my primary care and he said it looked like cellulitis and I needed antibiotics through IV immediately as it was now on my right breast as well. When I went to the emergency room the doctor there said he thought it was herpes and gave me valtrex and clyndamicin. The PCR blood test the ER doc did came back negative for both type 1 and type 2 HSV. It has now been a week and I no longer have a fever and all the blisters have turned into yellow crusts that are falling off. I never had anything ooze out of my nipples. Just those yellow crusts now that it is healing. I also had an ultrasound and everything looks good. Could the culture be a false positive?? How many people get herpes on their nipples?? Why would the PCR blood test be negative for both?

[Terri Warren, RN, Adult Nurse Practitioner]

Which is very consistent with what sounds like a first infection.  

Terri

[Rara7]

I got my IGM and IGG back and they are both negative for Herpes.

[Terri Warren, RN, Adult Nurse Practitioner]

But it was cultured at urgent care and was positive for herpes right>
Couples go many years without transmitting either oral or genital herpes to their partner.  I think in your case, the very rough biting of the nipples probably combined with viral shedding from his mouth resulted in in infection where other contacts had not.  
If the culture from urgent care was positive, the blisters are herpetic not impetigo.  I suppose your could have gotten a secondary infection from impetigo, but I seriously doubt it.  
This does not need to be a big issue for you and your husband.  You should have antiviral therapy on hand so that if you feel another one coming, you can treat.  Speak with your doctor about the dose, etc.  I really think you will be fine!

Terri

[Rara7]

Shouldn't I have antibodies in my blood by now if my husband has had it all along? What are the chances we have been having unprotected sex and I didn't get it until 2 1/2 years into our marriage? That's a lot of unprotected sex and kissing and rubbing and everything else without ever getting it until now...don't you think? Could it be possible that I have impetigo instead of Herpes?

[Rara7]

They didn't touch my blisters at the ER. It was definitely blood.

[Terri Warren, RN, Adult Nurse Practitioner]

It doesn't say if the PCR is from the lesion or the blood.  Or does it?  I think some clinicians are confused about the use of the PCR test.  It should be from lesions only, not blood.

Terri

[Rara7]

My husband has never seen anything on him and neither have I. The test result literally says,

HSV I DNA PCR Result Negative, Reference Negative
HSV II DNA PCR Result Negative, Reference Negative


Tomorrow I get the results of my IGM and IGG blood tests.  

[Terri Warren, RN, Adult Nurse Practitioner]

Your symptoms sound classically like herpes of the nipple to me.  The culture was positive because it is herpes (very likely HSV 1) and the PCR is not a test for herpes in the blood and I have no idea why it was done.  Are you sure it wasn't an antibody test from the blood?  I would expect, since this sounds like your first infection, that this was an antibody test, not a PCR test from the blood, and that it is negative for HSV 1 and 2 because this was your first infection with HSV.  The severity of your symptoms sound consistent with first infection also.  Generally speaking,  a positive culture combined with a negative antibody test indicates first infection.  There is virus present on the skin sufficient to yield a positive culture but not enough time has passed to have made antibody to the virus.  

Herpes on the nipple is not that uncommon, and acquired just the way you are describing it happening.  Has your husband had visible cold sores in the past?

Terri