IS this Herpes-related??

[JBee70]

Hello,
I am about to have a vulvar biopsy done today. My OB/gyn and my RE are both baffled by my symptoms. A new dermatologust saw me yesterday and said he thinks what's happening may be related to Herpes (HSV-1). I have had a battery of tests done to rule out infectious causes, and all have been negative, including HSV-2, cultures for yeast, bacteria, fungus, parasites, Strep-B, etc.
I have had these problems since June 2007. My symptoms are the following:
"Flare-ups" each month of redness, sometimes mild itching of the vulvar skin. A fissure recurs in the natural skin folds next to my clitoral area. Upon examination at the Gyn numerous times, my cervix has what she calls "erythmetous patches", as does my vaginal walls, and redness at the vaginal opening. I have also had fissures on the perineum.
Wet mount on more than one occassion has shown "elevated" white cells. In months past, this discharge has been quite profuse and thick.
My RE suggested that I take 4Life Transfer Factor, a natural supplement created from bovine collostrum and egg yolks that is meant to boost your own immune response. Since starting this regimen in mid-March of this year, my symptoms have dramatically been reduced, but not cured. I get less itching and the recurring fissure this month was more superficial and not as bothersome. The discharge I've come accustomed to over the past 10 months has improved as well.
The dermatologist said he does not think that I have Lichen Sclerosis. He said the biopsy is a great idea, but he believes that this is all related to Herpes type 1. He said even though I am negative for Herpes type 2, Herpes type 1 can cause genital symptoms at times, including fissures etc.
He recommended that I take Valtrex for a few months and see if my problems go away. He said I could then stop the meds to see if the problems return.
Any ideas on this? I almost hope that the biopsy reveals nothing, because I honestly would rather deal with Herpes -1 than Lichen Sclerosis! Would a biopsy reveal shedding Herpes-1 in the skin cells? Thanks for reading.

[gracefromHHP]

I really don't think this is hsv1 genitally.  It rarely reoccurs in the vast majority of folks who have it.  It also shouldn't be causing such dramatic and constant symptoms for over a year as you've reported.  What makes them think it's hsv1 genitally? Have you ever had a lesion culture that said hsv1?

A biopsy is an excellent idea. I had long term issues in the genital area myself in the past and the biopsy was what finally after 1 1/2 years put us on the right track to figuring out what was going on.  It was actually a vicious cycle of things - just so many things that can be an issue in the genital area.

Good luck with all of this!  Hopefully it gets you answers so you can start treating whatever is going on properly and finally get back to a more normal feeling down yonder :)  

grace

[JBee70]

Hi Grace,
Thanks for the response. To answer your question, I have never had a culture for HSV-1, only the usual blood tests that the Dr ordered to see if I had Herpes type 1 or 2.
Type 1 was positive (as I know is true for 90% of the population).
How extensive are biopsies? Are they simply looking for Lichen Planus, Lichen Sclerosis etc, or are they scanning the tissues to find ANY "abnormal" looking cell? (Like inflammation etc). Do they look for Herpes in the tissues when they do a biopsy?
I need to grill the Dr when I get there today, but sometimes I've experienced that they don't even know what is being looked at!

[gracefromHHP]

They will take a little bit of skin and the pathologist will examine it under the microscope.  Anything that isn't normal in the biopsy they will do testing until they figure out hopefully what is going on. Sometimes it just comes back with the generic - inflammatory skin changes detected which isn't of much help ( well duh you can see the skin is inflammed! ) but at least then you know it's not likely to be one of the lichens or a malignancy going on or anything of that sort.

A blood test for hsv1 isn't an accurate way to diagnose hsv1 genitally.  Even if you can't recall a cold sore it's still most likely oral hsv1.  

grace