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Misdiagnosis?
Hi, I'm wondering about the chance of misdiagnosis.
I had unprotected sex with an uncircumsized partner 8 days ago. The next evening, I started feeling itchy as with a yeast infection. I purchased the over the counter medication but was having not even the slightest improvement in 2 days. I called my gynecologist and she was out of town on vacation. A prescription for single dose diflucan was called in for me. Another two days pass and sx continue and I start to notice some spots in my genital area that are really tender, kind of sting when I was bathing. It was only 2-3 to begin with, but by one week post-sex, they were all over and it looks like raw spots, as a few layers of skin were missing. I called my GYN again and was told to go to non-emergent clinic as my GYN is also booked next week when she returns. I went to the non-emergent clinic I have always had good results from (accurate diagnoses). I had a PA and told her my concerns. She did a pelvic exam and said my lesions were not herpes as they present in small clusters of blisters and mine are more like shallow ulcers. I'd say I currently have 30 or so separate spots around the labia and anus. Urinating was a nightmare and sitting was unbearable. I think she also took a swab but I'm not sure as I could not think after she said herpes sore are different. She came back in later and said I had a urinary tract infection and the sores were likely caused from scratching. I still wasn't thinking beyond ITS NOT HERPES to mention I haven't been scratching, especially not to cause sores like this. They are all defined circles, like it has a whitehead just beneath the skin on SOME of them, not all. They itch like crazy, then burn but no pus or anything. She stated that bacteria, etc during sex and irritation from semen can cause problems, etc. I am on bactrim for the UTI and using a petroleum based diaper rash ointment so I can urinate without feeling like I'm in agony. while sores are still present, they no longer seem to be multiplying. I have researched herpes a lot in my sleepless nights and my sores do not look like most photos, but occasionally, I see one or two that look like mine. Any chance of misdiagnosis as I know PAs go through extensive training and I have no qualms about seeing a PA instead of an MD, but how much training does one have on STDs and such? Maybe she was wrong? I have not scratched and given myself perfectly round sores so that explanation isn't making sense right now. I've read where sometimes the bacteria that causes the UTI can cause sores dependent on the bacteria but it's highly unusual and not an associated sympton.
I had unprotected sex with an uncircumsized partner 8 days ago. The next evening, I started feeling itchy as with a yeast infection. I purchased the over the counter medication but was having not even the slightest improvement in 2 days. I called my gynecologist and she was out of town on vacation. A prescription for single dose diflucan was called in for me. Another two days pass and sx continue and I start to notice some spots in my genital area that are really tender, kind of sting when I was bathing. It was only 2-3 to begin with, but by one week post-sex, they were all over and it looks like raw spots, as a few layers of skin were missing. I called my GYN again and was told to go to non-emergent clinic as my GYN is also booked next week when she returns. I went to the non-emergent clinic I have always had good results from (accurate diagnoses). I had a PA and told her my concerns. She did a pelvic exam and said my lesions were not herpes as they present in small clusters of blisters and mine are more like shallow ulcers. I'd say I currently have 30 or so separate spots around the labia and anus. Urinating was a nightmare and sitting was unbearable. I think she also took a swab but I'm not sure as I could not think after she said herpes sore are different. She came back in later and said I had a urinary tract infection and the sores were likely caused from scratching. I still wasn't thinking beyond ITS NOT HERPES to mention I haven't been scratching, especially not to cause sores like this. They are all defined circles, like it has a whitehead just beneath the skin on SOME of them, not all. They itch like crazy, then burn but no pus or anything. She stated that bacteria, etc during sex and irritation from semen can cause problems, etc. I am on bactrim for the UTI and using a petroleum based diaper rash ointment so I can urinate without feeling like I'm in agony. while sores are still present, they no longer seem to be multiplying. I have researched herpes a lot in my sleepless nights and my sores do not look like most photos, but occasionally, I see one or two that look like mine. Any chance of misdiagnosis as I know PAs go through extensive training and I have no qualms about seeing a PA instead of an MD, but how much training does one have on STDs and such? Maybe she was wrong? I have not scratched and given myself perfectly round sores so that explanation isn't making sense right now. I've read where sometimes the bacteria that causes the UTI can cause sores dependent on the bacteria but it's highly unusual and not an associated sympton.
Best Answer
So, after seeing my doctor today, I think we have a good game plan. I'm not doing blood tests. We really all know it's pointless. She did a PCR swab and said that if it comes back negative, it means my body responded well to the Valtrex. I'm on daily suppressive therapy. I also have a script for Xanax as needed to help in times of extreme stress. She also said that she sees no signs that my cervical cancer could be back and I was likely irritated from the initial outbreak. I think she said the best thing she could have to help me feel better and maybe it will help someone else. She said it isn't me, one who is aware and on suppressive therapy that people should be worried about. It's those out there who have it and so not know or take safer measures that people need to worry about. She said someone is less likely to catch herpes from someone who is knowingly infected, who takes responsibility to practice safer methods & taking medications than picking up a random person at the bar. Something about that just really helped it sink in.
I will post blood work results as soon as I get it. I would expect the first to be negative, but I'm going to request it be done as a baseline for another test in a few months. I had another conversation with the "partner" in preparation of going to my gyn tomorrow. He is going to have his blood work done tomorrow. He is scared to death. And unless I have been harboring the virus unknowingly, he is the only person I could have contracted it from. I even asked if he was prone to cold sores, or ever had blisters on his fingers, anything that would be in the HSV-1 or 2 category. I asked about things he may have brushed off as an ingrown hair, or a pimple, or a scratch. Ever showering and feel a pinprick or tingly sensation. He says he's never had any of those things. He says he's met someone he's very interested in having a relationship with and he's worried he's carrying this around and passing it along without knowing. I could be an idiot, but I truly believe him. If he had it and knew it, all he had to do was ignore my messages. As soon as I told him I tested positive for HSV-2, he was quick to respond and has kept communication open. He's asked lots of questions about what he should look for and what steps he should take as far as testing. A person with something to hide wouldn't be that way unless they are really sadistic.
I certainly hope everyone posts their blood work results on here. It would be beneficial to many who are also in similar situations. Good luck to you all.
You should always go with ur guts ... Denial or not, it's always good to be certain as this is a condition for life. If u will get blood test, u do have to stop the viral medication as it may alter the test results. Even blood test need to be verify as I am in the process of waiting for my WB.
I think next time u get a lesion or sore or ulcer again... Go get it swabbed. Nothing wrong with testing again. I'll be praying for u and may God lead u to a place of peace with verification. Keep us updated and go to a support forum... Read others experiences, that may be helpful to know what to do next! This is how I knew about the WB!
I think next time u get a lesion or sore or ulcer again... Go get it swabbed. Nothing wrong with testing again. I'll be praying for u and may God lead u to a place of peace with verification. Keep us updated and go to a support forum... Read others experiences, that may be helpful to know what to do next! This is how I knew about the WB!
I definitely plan to do that. I am sorry about this roller coaster I am on, I'm sure everyone has been on this ride. I'm going to write up a list of questions for my OBGYN too in order to get my mind straight while waiting appropriate testing time.
Of course I forgot to mention that the day prior to sx appearing, I was working in 100 degree heat wearing skinny jeans 2 sizes too small for over 4 hours (stupid on my part but I didn't want to mess up good jeans!) Another explanation for the blisters but not for the positive culture.
Just so many things going on at one time to explain this nightmare away and tons of posts about how people's cultures have actually turned out to be false positives (they say it's very rare, but apparently it's not!) in many cases as proved by IgG bloodwork every 3-4 months for over a year, I can't help but pray to be one of those fortunate souls. I'd love to have HSV-1 over 2, although I'm aware it's no picnic either and when the results show HSV-1 was not tested, I can't help but wonder how reliable the type result is.
Bloodwork will give me answers. If I can just keep sane in the meantime.
Thank you all for your time and your responses. I know almost everyone is in denial initially, and rationally, it's not a death sentence. Where I live, it's a social death sentence so I have to protect this secret with all I have, which means isolating myself.
Of course I forgot to mention that the day prior to sx appearing, I was working in 100 degree heat wearing skinny jeans 2 sizes too small for over 4 hours (stupid on my part but I didn't want to mess up good jeans!) Another explanation for the blisters but not for the positive culture.
Just so many things going on at one time to explain this nightmare away and tons of posts about how people's cultures have actually turned out to be false positives (they say it's very rare, but apparently it's not!) in many cases as proved by IgG bloodwork every 3-4 months for over a year, I can't help but pray to be one of those fortunate souls. I'd love to have HSV-1 over 2, although I'm aware it's no picnic either and when the results show HSV-1 was not tested, I can't help but wonder how reliable the type result is.
Bloodwork will give me answers. If I can just keep sane in the meantime.
Thank you all for your time and your responses. I know almost everyone is in denial initially, and rationally, it's not a death sentence. Where I live, it's a social death sentence so I have to protect this secret with all I have, which means isolating myself.
To the best of my knowledge, I've never had a herpes test before. I say that in I've been tested for STDs regularly, which have always been negative but I understand now that herpes tests aren't a part of standard screening. I've always taken the phone call with "your lab results are negative" at face value due to lack of knowledge.
I guess I'm wondering about the positivity of it being HSV2, as I have one ulcer on my tongue too that showed up two days ago. I did not perform oral sex on him, however, he did on me. I did not kiss him afterward. I am in healthcare and am always washing my hands, and most specifically after toileting. It's second nature so I'm not worried about cross-contamination. I was also covered in A&D ointment at the time of the culture and the lesion she took the swab from was the first to appear which made it 6 days old at the time.
I also finished my medications, both the antibiotic and the antiviral and the UTI is still present. The pain I went to the doctor with was due to urine hitting the skin. The pain I have now is on initial urine flow. I have had that "weird" feeling of something being off the entire duration of both antibiotic and antiviral. I wouldn't call it tingling or prickly feeling, just a constant awareness. Maybe just psychosomatic.
I'm sure I'm grasping at straws but something really just isn't seeming right to me in all of this. I do go to my OBGYN this Thursday finally. It's been the longest 2 weeks of my life. When everything (skin lesions) was cleared by Tuesday when I started meds on Sunday, I figured it couldn't be herpes, it had to be responding to the antibiotic as everything I've read says it takes antivirals some time to work. I was completely healed up within 48 hours of that second visit.
I guess I'm wondering about the positivity of it being HSV2, as I have one ulcer on my tongue too that showed up two days ago. I did not perform oral sex on him, however, he did on me. I did not kiss him afterward. I am in healthcare and am always washing my hands, and most specifically after toileting. It's second nature so I'm not worried about cross-contamination. I was also covered in A&D ointment at the time of the culture and the lesion she took the swab from was the first to appear which made it 6 days old at the time.
I also finished my medications, both the antibiotic and the antiviral and the UTI is still present. The pain I went to the doctor with was due to urine hitting the skin. The pain I have now is on initial urine flow. I have had that "weird" feeling of something being off the entire duration of both antibiotic and antiviral. I wouldn't call it tingling or prickly feeling, just a constant awareness. Maybe just psychosomatic.
I'm sure I'm grasping at straws but something really just isn't seeming right to me in all of this. I do go to my OBGYN this Thursday finally. It's been the longest 2 weeks of my life. When everything (skin lesions) was cleared by Tuesday when I started meds on Sunday, I figured it couldn't be herpes, it had to be responding to the antibiotic as everything I've read says it takes antivirals some time to work. I was completely healed up within 48 hours of that second visit.
Have you ever been tested for herpes before this incident? If so were both hsv 1 and 2 negative ?
Some of the comments relating to the visual exam do seem suspicious regarding herpes. I may well be wrong, but I always sensed that there was greater variation in the appearance of herpes on the differing parts of female genitals.
It all seems definitive that HSV2 is present. What you describe does also almost certainly seem to be the initial outbreak. You could have a blood test now and see if you are negative for antibodies, even low positive, and then test more strongly in 3 months time. This would be pretty conclusive that you haven't had the virus previous to this encounter.
I wouldn't be surprised if your partner is connecting a few symptoms in his mind from in the past. It does not seem terribly likely that he would have been infected in the past 12 weeks, not know it, and then infect you. A blood test will therefore probably be positive for him now.
It all seems definitive that HSV2 is present. What you describe does also almost certainly seem to be the initial outbreak. You could have a blood test now and see if you are negative for antibodies, even low positive, and then test more strongly in 3 months time. This would be pretty conclusive that you haven't had the virus previous to this encounter.
I wouldn't be surprised if your partner is connecting a few symptoms in his mind from in the past. It does not seem terribly likely that he would have been infected in the past 12 weeks, not know it, and then infect you. A blood test will therefore probably be positive for him now.
One final note: The "partner" is communicating more willingly since I gave him the news. He has not been tested in any manner due to the holiday weekend. I know people aren't always honest, but he does however seem pretty scared himself now that I shared my results. He has not yet had an OB (I wondered if he weren't potentially a new infectee as well) and I'm not sure if this plays any role in it, he has a weakened immune system due to having spleen removed a few years ago due to injury. I would think that might make him prone to OBs. I told him if he has sx, to get cultured immediately, otherwise, a blood test. But if he were newly infected, he should have blood test repeated in 3-4 months. Hope that sounds correct. If he does not have HSV, then for whatever reason, it's been dormant in me for a very long time and I managed not to pass it to him.
I just got my medical records (AND lab results) in and am still confused. Hoping someone with some experience can shed some light on this:
Date 08/22/14
Pt. reports of vulvar itching and pain, sores in the area and urinary frequency starting 2 days ago. She has hx of recent sexual intercourse with new sexual partner 7 days ago. She has used Diflucan and OTC Monistat without relief of sx. Onset: 4 days ago. Severity level: Moderate Pertinent negatives: lower abdominal pain, cloudy discharge
Physical Exam: Genitourinary: Sparse, external papular lesions, mild erythema, no pustules. No noted excoriation, no venereal warts, NO HERPES CLUSTERS. Vaginal vault with scar tissue-like, yellowish-white mucosa with moderate erythermatous borders circumfrentially to include cervix. No CMT, no PID, non-tender bimanual.
Dx: UTI, BV, candida, vaginitis, allergic rxn, syelo, PID, STD
Assessment/Plan:
Cystitis
Vaginal irritaton
Pt. advised she will be called in 2-3 days with GC/Chlamydia results. Pt. instructed to follow up with OBGYN this week for further evaluation of scar tissue.
Rx: Bactrim DS; discharge instructions for UTI given to patient.
Bacteria: Few
Clue cells: Negative
RBC: Trace
Trich: Negative
WBC: Many
Yeast: Negative
VISIT 2: 2 days later 8/24
Pt. complains of worsening vaginal blistering and painful urination with increased frequency
Physical Exam: Pt. exhibits multiple macular papular lesions to the right aspect of the labia; some with vesicles, some ulcerations to the introitus with tenderness, no clusters, no weeping, no crusting. (NOTE: Again, this PA said not consistent with herpes).
Assessment/Plan:
Discussed urinalysis with patient showing signs of an infection. Swab performed. Pt. advised to discontinue Bactrim.
Rx: Keflex, Valtrex, Prednisone, Diflucan
Dx: Acute Cystitis
Vaginal lesions
QUEST DIAGNOSTICS:
Herpes Simplex Virus Culture w/RFL to Typing
Test status: Final
Specimen Source: Vagina
Specimen Quality: Adequate
Result: Herpes Simplex virus type 2
HSV Type 2: Isolated.
HSV Type 1: The incidence of HSV 1 infection in the presence of HSV 2 (dual infection) is extremely rare. Therefore, testing for HSV 1 was not performed.
NOTE: I have a hx of pre-cancerous cells in my cervix and had CKC done 15+ years ago. Going to follow up although pap was clear last October.
Within 2 days of being on both Keflex and Valtrex, all lesions were clear. Not a sign of them at all.
Date 08/22/14
Pt. reports of vulvar itching and pain, sores in the area and urinary frequency starting 2 days ago. She has hx of recent sexual intercourse with new sexual partner 7 days ago. She has used Diflucan and OTC Monistat without relief of sx. Onset: 4 days ago. Severity level: Moderate Pertinent negatives: lower abdominal pain, cloudy discharge
Physical Exam: Genitourinary: Sparse, external papular lesions, mild erythema, no pustules. No noted excoriation, no venereal warts, NO HERPES CLUSTERS. Vaginal vault with scar tissue-like, yellowish-white mucosa with moderate erythermatous borders circumfrentially to include cervix. No CMT, no PID, non-tender bimanual.
Dx: UTI, BV, candida, vaginitis, allergic rxn, syelo, PID, STD
Assessment/Plan:
Cystitis
Vaginal irritaton
Pt. advised she will be called in 2-3 days with GC/Chlamydia results. Pt. instructed to follow up with OBGYN this week for further evaluation of scar tissue.
Rx: Bactrim DS; discharge instructions for UTI given to patient.
Bacteria: Few
Clue cells: Negative
RBC: Trace
Trich: Negative
WBC: Many
Yeast: Negative
VISIT 2: 2 days later 8/24
Pt. complains of worsening vaginal blistering and painful urination with increased frequency
Physical Exam: Pt. exhibits multiple macular papular lesions to the right aspect of the labia; some with vesicles, some ulcerations to the introitus with tenderness, no clusters, no weeping, no crusting. (NOTE: Again, this PA said not consistent with herpes).
Assessment/Plan:
Discussed urinalysis with patient showing signs of an infection. Swab performed. Pt. advised to discontinue Bactrim.
Rx: Keflex, Valtrex, Prednisone, Diflucan
Dx: Acute Cystitis
Vaginal lesions
QUEST DIAGNOSTICS:
Herpes Simplex Virus Culture w/RFL to Typing
Test status: Final
Specimen Source: Vagina
Specimen Quality: Adequate
Result: Herpes Simplex virus type 2
HSV Type 2: Isolated.
HSV Type 1: The incidence of HSV 1 infection in the presence of HSV 2 (dual infection) is extremely rare. Therefore, testing for HSV 1 was not performed.
NOTE: I have a hx of pre-cancerous cells in my cervix and had CKC done 15+ years ago. Going to follow up although pap was clear last October.
Within 2 days of being on both Keflex and Valtrex, all lesions were clear. Not a sign of them at all.
Thank you all for your responses. The psychological part of it is the tough part. I am reading other people's experiences and it helps not to feel all alone in this.
I'm sorry that your swab came back positive but at least now u know for sure and can be proactive in treating your outbreak. The guy you dated sounded like a jerk anyway and u went above and beyond to let him know. Whether he test or not..that is on him now.
You should seek out forum to help u cope with this. Often times the disease is not as bad as the physiological impact so please reach out to support forum as many are in the same boat. god bless, S
You should seek out forum to help u cope with this. Often times the disease is not as bad as the physiological impact so please reach out to support forum as many are in the same boat. god bless, S
Of course he said there is no way I got it from him. I explained that people can have it and not know it. We had been seeing each other a few weeks prior to the incident and had discussed our prior testings and status, which of course means nothing. He broke all contact with me the day after. I still took the higher road last night and made contact. I said timeline coincides with him, he could have it and not know it (or possibly does know it) but either way, we were together and I tested positive and he should know. Still in a weird, numb denial that there has to be a mistake. He said he will get tested but I'm unlikely to learn of his results. My UTI is not resolving after a second course of antibiotics. I live in a very small town and once anyone learns of the "H" word, I will never find anyone interested in dating me again. I step outside the small town and this happens.
You could ask your partner to test to confirm, but there would be almost no doubt that they are the source of the HSV2.
I just got the call. Still in denial. Neg on swab test for hsv1. Pos for hsv2. I keep thinking she said it doesn't look like herpes at all. Two doctors said that. I know there is 0% chance for false positives per my research but I ... I don't know. I was much better 3 days later.
I just got the call. Still in denial. Neg on swab test for hsv1. Pos for hsv2. I keep thinking she said it doesn't look like herpes at all. Two doctors said that. I know there is 0% chance for false positives per my research but I ... I don't know. I was much better 3 days later.
Insist on a swab of the lesions to be tested for HSV using a PCR test. 12 weeks after the episode, you can seek an IgG blood test or ask your partner to test to identify what the actual risks were.
Going theough the exact same thing right now..theyve told me it isnt herpes because it doesnt look like it but i cant imagine what else it could be! S
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You are reading content posted in the Herpes Community
Herpes spreads by oral, vaginal and anal sex.
Herpes sores blister, then burst, scab and heal.
STIs are the most common cause of genital sores.
Millions of people are diagnosed with STDs in the U.S. each year.
STDs can't be transmitted by casual contact, like hugging or touching.
Syphilis is an STD that is transmitted by oral, genital and anal sex.
I really feel the best moves are for your partner to test and then you test at 12 weeks. (Blood IgG antibodies).