Herpes Blood Test Reliability - Very Nervous

[ash_b]

I have vulvodynia with pudendal neuralgia. I have also had several herpes blood tests that screen for both HSV1/HSV2 and distinguish between the two. All blood tests have come back negative for both types. I have not had sex since or for over a year before the last test. Here's the problem. Often with my period I get really red and inflamed in the vulvar area along with massive pins and needle or tingling type sensations. I have had this for a long time, since before having negative blood tests. A few days ago I had the problem and went to a walk-in clinic, thinking perhaps it was an allergy to my panty liner. The only different thing this time was a very small pin-head size red spot in the lower pubic hair, just above the vulva. That kind of freaked me out, because I thought maybe it was a sore, which made me think of herpes. Rationally, I thought it was probably an infected hair follicle. Anyway, the doctor took a look and said that she wanted to do a herpes culture, even though she did not see any vessicles (I don't think she saw the small red area either). She said that sometimes herpes shows up as redness without blisters. She said she thought perhaps it was fungal but wanted to make sure. I stopped wearing the pantyliner and in a day or so felt much better. I have not gotten the culture results back but am panicking over it, mainly because of the tingling part. Also, I have heard that cultures often give false negatives. In addition, someone on this board posted that some people with herpes never have positive blood test results. So, I am wondering about the reliablility of the blood tests and whether I should do anything further if the culture comes back negative. Should I still be worried because of redness, pain, and tingling, or is it possible that these symptoms were the result of an allergic reaction possibly combined with the pudendal neuralgia. Any help would be greatly appreciated as this is causing a great amount of anxiety. Thanks.

[H. Hunter Handsfield, M.D.]

You're welcome.  If you can't get beyond your "what if" questions about it, have a frank discussion with your doctor.  I'm sure she will agree with me about herpes.

[ash_b]

Thank you so much for the reply! In fact, I just got off the phone with the clinic while I was waiting for a reply from you and the culture result did in fact come back negative. I still feel some anxiety about it because I have a tendency to "what-if" over things, but everything you said makes sense. So, I will do my best to stop worrying. Thanks so very much for the quck response!

[H. Hunter Handsfield, M.D.]

Please accept my best wishes for eventual resolution of your vulvodynia.  It can be a very frustrating problem.

As for herpes, it is very unlikely have it and I expect the culture to be negative -- and I'll bet that's what your doctor expects as well.  It is true that cultures can miss the virus, even when herpes is present, especially if the lesion is healing when the specimen is collected.  It is also true that the blood tests aren't perfect and occasionally miss an infection with HSV-1 or HSV-2.  It is also true that symptoms of herpes can be atypical.  However, the odds of all those things happening in the same person -- atypical symptoms, negative culture, negative antibody -- are virtually zero.

As implied above, your symptoms are not at all typical for herpes, and it seems clear your doctor did the culture as a precaution, not because she seriously suspected herpes.  It is true that non-blistering lesions can occur, but most do turn into blisters then pustules then scabs.  Herpes lesions almost always occur in clusters that are strictly limited to one side of the body; that generally recur in more or less the same spot every time; uncommonly are in the pubic area; and generally don't surround hair follicles.  Herpes doesn't cause diffuse redness of the sort caused by yeasts and other fungi.  I'm not in a good position to speculate about other causes of your symptoms; you list some reasonable possibilities, to be discussed with your provider.  From your description, she seems very knowledgeable, both in general and about your own genital health.  I'm sure you can rely on her judgment on this.

I hope this helps.  Best wishes--  HHH, MD