Can this herpes?

My wife has a recurring, small vaginal sore that has been diagnosed as herpes by several doctors
for years.  

One doctor tested a sample from the sore (active at time of exam) that was negative for herpes, but said it must be herpes.  No subsequent pap or exam has been at the time the sore was active.  Subsequent diagnoses have been from verbal descriptions.

My wife is 40, non menopausal, in excellent overall health.  

Her first outbreak was when she was 23.  No fever, no swollen glands, no blisters.  Just a single small lesion that looked like an abrasion, opened into a small (less than 1/4") open sore and healed in a few days.

This single sore recurs about every one or two months, sometimes more.  It is usually in the same location, right rear of the vaginal opening/internal lip, but sometimes on the opposite side of the vagina or a slightly different spot near the usual location.  No similar sores appear anywhere else.

Recurrences seem to be triggered by stress (in the complete absence of intercourse) or intercourse.  This soreness and frequent vaginal itching have reduced our sexual activity to once or twice per month, so outbreaks without sexual activity have been fairly common.

In the recurring events, the single sore still starts with the appearance of a small abrasion, no blister, opens into an open sore and heals with 5 to 7 days.

She has never had discolored or foul smelling vaginal discharge or odor.  She has experienced infrequent yeast infections.  She has had occasional outbreaks of oral herpes since she was a small child.

In 17 years of unprotected exposure, I have never had classic herpes symptoms, oral or genital, or these symptoms.

Can her recurring lesions be herpes?

If not, what might it be?  

Several doctors have diagnosed this as herpes, so I think she will need some help leading a doctor in another direction if there is one.

[Alan Rockoff, MD]

Recurrent rashes in the same place are indeed often herpes.  The diagnosis can be confirmed best by culture, which should be done at the first sign of an outbreak.  Since her outbreaks are frequent, this should be feasible.  Blood tests (glycoprotein, so-called gG tests) may help as well.

If this is indeed herpes, as sounds likely, your wife would be a good candidate for suppressive therapy with Valtrex or Famvir, two oral anti-viral medications.  Taking one of these daily would very probably reduce her recurrences drastically, and make both your lives much better.  Such treatment is simple and safe.  I advise that you ask your doctor about this.

Best.

Dr. Rockoff

[ST82]

This sounds very similar to something my girlfriend has had.  A sore occured about two years ago, she was tested for herpes and it was negative, she did have mono and they blamed it on that.  Her partner at the time was also tested, negative too.  Last fall it happened again, she was tested by swab and blood at time of outbreak.  Negative for herpes and several other things.  They said it was probobly stress.  What could this be?  Its got me fairly concerned.

[Smokinjoe]

Doc, can HSV1 be transmitted to the genitals if there is no broken skin?  It sounds like she might have HSV1 on her genitalia.  If the husband doesn't have any symptoms it would make sense.