False negative PCR swab? I'm getting different opinions and I'm confused!

[Vinic]

I’ve been on a rollercoaster the last week.

Background – I had sex for the first time in years a couple weeks ago. This was the day after I went on a long, strenuous hike in hot, humid weather and was wearing tight yoga pants the whole time. Within a few days, I felt yeast-infection type symptoms (itchy all over, which progressed over a few days and then I felt raw and itchy). I self-treated with MONISTAT 1, then got in touch with a provider who prescribed fluconazole. Swabs came back negative for chlamydia, gonorrhea, trichomoniasis, BV, and yeast.

A couple days later I went in for a physical exam and was told it was definitely a yeast infection – not in the canal, but on the exterior instead. It was the result of being sweaty and wearing tight yoga pants for 12 hours. I was given anti-fungal cream. The next day I went to the bathroom and as I pat myself dry (carefully, because it was tender) I feel a very painful spot. I look in the mirror and have a single lesion, it looked almost like a cyst, and was firm and tender to the touch (I have photos if needed). I kept using the anti-fungal cream and took my second fluconazole pill. Second swab came back negative, I’m told it’s because I’d already used two anti-fungals.

The next day, the pain was much worse in that location so I went to urgent care. I’m told it looks like herpes. They do a PCR swab on the lesion. She uses a decent amount of force and was thorough to make sure she got a good sample. I’m given Valtrex.

Next day – I get a call from the nurse, the PCR swab was negative. I’m told it was highly unlikely that it was a false negative because it was taken from the lesion, but PCP wants me to come in for another evaluation. I’m told to stop Valtrex.

I go into PCP yesterday. I ask him to test me for a plethora of things (infected cyst, strep b, mycoplasma, urealplasma, etc), including more resistant yeast infections (I ask for a culture instead) he says no. He does a bacterial swab (pending) and syphilis test (negative). He does the exam and is convinced that my single lesion must be HSV because it is tender. He said he didn’t know why my PCR swab came back negative. I explain that everything I’ve read says that PCR is highly sensitive, highly accurate, the nurse was thorough with the swab, and that I had it done within the “right” timeframe for accurate results. I read it was over 90% accurate and another doctor said it was 95% accurate. He said well that still leaves room for error. I ask him to repeat the test, he says no. He tells me to take valtrex and start doxycycline (which I was due to start for a facial rash I’ve had since long before this all started).

Now I’m confused – different practitioners are telling me different things. As I said, everything I’ve read says PCR swab is the gold standard for testing and it’s highly sensitive, highly accurate, highly reliable. My PCP says it isn’t sensitive and that it was not reliable. But he wouldn’t repeat it even though I still have the lesion (which looks worse). He wants me to do antibody testing in 4 weeks (which is a LONG time to wait for results?) and I've heard the blood tests can be unreliable. When I got my syphilis blood draw, my neurologist had randomly already ordered HSV 1 & 2 tests so I got those done as well (and another set in 4 weeks from PCP).

Does anyone have insight into this? How likely is it that a thorough PCR swab is a false negative, especially when I had it done within the “right” timeframe? I’m lost and having a hard time navigating this on my own. It’s been a rollercoaster and causing a lot of anxiety. I asked the nurse if I could see an OBGYN and she said “what for” and wouldn’t refer me. Thanks.

[Flowerteacher55]

Hello! 

I am so sorry that you have been struggling with so much. Please know you are not alone. We are here for you!

Yeast infections are so sassy! They literally spring up at worst times, and of course, in the worst places. An internal yeast infection must have been so painful. I am so sorry you had to experience that, and I hope since you posted this that the symptoms have ceased or have gotten better.

In regards to the bump you noticed: how large was it? Were there any other bumps around it (like a cluster of small bumps that made up the large spot)? 

I am so sorry that the nurse did not want to ask the doctor for an OBGYN referral. And, I am sorry that the doctor refused to swab it again. If you need to see an OBGYN, heading to a sexual health clinic like Planned Parenthood would offer the medical, and emotional, support that is needed in such a situation. You deserve quality, kind care! 

A PCR swab always has the liklihood of providing a false negative, however, the fact that you did it within the 48 hour timeframe would reduce the risk of it being a false negative. 

Has the sore healed at all, or has it grown or shrank? Have you had any physical symptoms (fever, headache, tingling, itching, etc)? Also, have you asked the person you were intimate with if they have ever been tested for HSV or other STIs?

I am sending you happy healthy vibes! Stay strong ❤️

Blessings,

Grace

[Vinic]

2 hours ago, Flowerteacher55 said:

Hello! 

I am so sorry that you have been struggling with so much. Please know you are not alone. We are here for you!

Yeast infections are so sassy! They literally spring up at worst times, and of course, in the worst places. An internal yeast infection must have been so painful. I am so sorry you had to experience that, and I hope since you posted this that the symptoms have ceased or have gotten better.

In regards to the bump you noticed: how large was it? Were there any other bumps around it (like a cluster of small bumps that made up the large spot)? 

I am so sorry that the nurse did not want to ask the doctor for an OBGYN referral. And, I am sorry that the doctor refused to swab it again. If you need to see an OBGYN, heading to a sexual health clinic like Planned Parenthood would offer the medical, and emotional, support that is needed in such a situation. You deserve quality, kind care! 

A PCR swab always has the liklihood of providing a false negative, however, the fact that you did it within the 48 hour timeframe would reduce the risk of it being a false negative. 

Has the sore healed at all, or has it grown or shrank? Have you had any physical symptoms (fever, headache, tingling, itching, etc)? Also, have you asked the person you were intimate with if they have ever been tested for HSV or other STIs?

I am sending you happy healthy vibes! Stay strong ❤️

Blessings,

Grace

Thank you for your response. The bump is smaller than a pea and there were no lumps around it or anywhere else - it was just a single lump. Unfortunately PP is not covered by my insurance and they were booking weeks out, but I did find out I can self refer to my insurance OBGYN so I have an appointment today and am hoping they will be much more knowledgeable about what is going on and bring some clarity.

 

The sore has not healed, it looks a tiny bit smaller today, but it's still tender (only when I touch it/around it) and itchy (again, only when I touch it/around it). My overall itchiness has decreased. I did not have any other physical symptoms (outside of my regular symptoms due to chronic illnesses, which did not change or get worse).

 

I haven't asked the person that I was intimate with as I was hoping for a definite answer before bringing up the subject as I already feel really awkward talking about it. It would be a lot easier for me to approach if I knew I got XYZ from him, rather than just asking because I'm unsure... Especially because I don't know if this is unrelated (although it seems unlikely). But my tests for everything else has come back negative too.

[Vinic]

6 hours ago, Vinic said:

Thank you for your response. The bump is smaller than a pea and there were no lumps around it or anywhere else - it was just a single lump. Unfortunately PP is not covered by my insurance and they were booking weeks out, but I did find out I can self refer to my insurance OBGYN so I have an appointment today and am hoping they will be much more knowledgeable about what is going on and bring some clarity.

 

The sore has not healed, it looks a tiny bit smaller today, but it's still tender (only when I touch it/around it) and itchy (again, only when I touch it/around it). My overall itchiness has decreased. I did not have any other physical symptoms (outside of my regular symptoms due to chronic illnesses, which did not change or get worse).

 

I haven't asked the person that I was intimate with as I was hoping for a definite answer before bringing up the subject as I already feel really awkward talking about it. It would be a lot easier for me to approach if I knew I got XYZ from him, rather than just asking because I'm unsure... Especially because I don't know if this is unrelated (although it seems unlikely). But my tests for everything else has come back negative too.

Just an update after OBGYN appointment (in case anyone is wondering) - OBGYN said that it looked nothing like HSV (and his colleague confirmed). They think I had a labial abscess that came to a head and burst, and is now draining. I showed him photos of how it developed and he said that confirmed it too. He said I likely had a yeast infection as well which was treated with the anti-fungals. He said to wait to see what the bloodwork says but HSV is highly unlikely. I'm happy to have some clarity around the situation.

[Flowerteacher55]

Hi!

That is great news!! 😺 It's always great to get a second opinion, especially when it's from a specialist, such as an OBGYN. 

Ouch! I wonder what would cause the abscess. Is it similar to a cyst? Does it need to be removed or will it just go away on its own? 

I hope your HSV test comes back negative when you eventually take it in 12+ weeks. 

I will pray for you! ☺️

Sending blessings and healing thoughts! 🌄

-- Grace

 

[Vinic]

He said it could have been a clogged pore, or irritated by the day I went hiking and was sweaty in tight yoga pants for 12 hours, combined with having sex the next day. Now that it has popped (which he said is good), it's just a matter of time until it heals. He said to do sitz baths.

[Flowerteacher55]

Oh gosh yes, ouch! And aw yay I'm glad it popped and is healing. The baths should help!! Salt baths are especially healing, as the salt draws out any inflammation and infection.

Feel better! ☺️❤️