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ATT OF DR HANDSFIELD - GENERAL PART 2
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The STD Forum is intended only for questions and support pertaining to sexually transmitted diseases other than HIV/AIDS, including chlamydia, gonorrhea, syphilis, human papillomavirus, genital warts, trichomonas, other vaginal infections, nongonoccal urethritis (NGU), cervicitis, molluscum contagiosum, chancroid, and pelvic inflammatory disease (PID). All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.

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ATT OF DR HANDSFIELD - GENERAL PART 2

While I await the the information from the Lab about which type/brand of HSV Type 2 test which the answer for I will post on the previous GENERAL thread.

I would like to recap:

* You initially said that it is highly probable I have genital herpes due to HSV-2 due to the symptoms I presented, the itchiness that started day 5, the sores day 10 and the lymph node involvement.

*We should ignore IgM as they are unreliable.
*IgG results were perceived as Negative by some doctors, you had said they were Positive but we are now doubting this.
* However, IgG (antibodies from previous infection) could take up to 3-4 months to become positive after exposure. Therefore, I need to get re-tested when 4 months is up.
This could also mean that HE could have caught Herpes not long before passing it to me.

OR:

It may have been HSV Type 1.
BUT, would HSV Type 1 cause the same flow of symptoms and sores?

This is what the lesions looked like:  http://tiny.cc/j3bgj

One other thing:

I recently tested positive for HPV type 82 (high risk) and 61 (low risk)
But HPV causes 'wart like' 'cauliflower' like growths,..and don't have other symptoms as far as I know.

Thanks again

Tags: Herpes
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239123_tn?1267651214
You didn't need to start a new thread.  But since you did, we'll continue the discussion here and close the other one.  Don't post anything more there.

The bottom line is that there are mixed messages here regarding a) the probability you had herpes at all; and b) if you did, whether it was due to HSV-1 or 2.

My initial assessment was based on your description of symptoms, that HSV-2 is the most common cause of genital herpes, that your initial HSV-2 result was clearly positive based on the numerical value, and that your partner had a weakly positive HSV-2 test result -- making it logical that he transmitted HSV-2 to you.  However, when I learned that the positive result was only 10-14 days after exposure, that threw the diagnosis of HSV-2 into question.  Further, the subsequent negative HSV-2 test results suggest the first one was falsely positive.  It is true that 3-4 months sometimes is required for positive results, but it usually doesn't take that long; the large majority of newly infected persons have positive results by 6 weeks.

Therefore, if you have genital herpes, it is more likely due to HSV-1.  But you have reported no HSV-1 test results, which would have been helpful.  The photo you posted isn't from you; it's a classical case of initial genital herpes.  If you had discrete ulcers like those in the photo, it certainly suggests herpes, but it doesn't prove it.  Other medical conditions, including certain non-sexually transmitted viruses and certain dermatological problems, can cause the identical appearance.  That said, herpes is a good bet if your lesions looked like that.

Your HPV infections are irrelevant to any of this.  The types you have do not cause warts, and certainly your symptoms do not hint at genital warts.

There are two ways to sort out whether you have genital herpes once and for all.  1) You're already on track for the first one:  have one more blood test when 3-4 months have passed.  In addition to HSV-2, make sure that test includes antibody for HSV-1.  There is no point in another IgM test; only IgG is necessary.  Also, as requested in the other thread, when you report that result, let me know exactly what test was done -- trade name and/or manufacturer.

2) If you have reappearance of genital blisters/sores, seek professional attention immediately -- preferably the same day, definitely within 2 days -- so the lesion(s) can be tested directly for HSV.  If positive for HSV-1 or HSV-2, of course that would nail the diagnosis.

Let's hold off on any further discussion until further testing is done.

HHH, MD
6 Comments
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Avatar_n_tn
Yeah the ulcers were like the ones in the photo example. Quite scary! With the meds they cleared completely in 2-3 days without leaving any sign that they were once there.

So basically HSV1 would also present in the same way as HSV2.

May I ask which other medical conditions, viruses and dermatological problems could cause that appearance?

I wish I had a culture at that time. The gynaecologist didn't suggest it for some reason.

After your next message I won't post again until further testing.

Thanks again.
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239123_tn?1267651214
Herpes lesions cannot completely heal in 2-3 days, even with effective antiviral therapy.  That sequence further suggests something other than HSV.

HSV-1 and HSV-2 clinical presentations are indistinguishable.

Certain enteroviruses; Stevens Johnson syndrome (you would have had to have a generalized skin rash, but that part could have been subtle); Behcet's syndrome; genital aphthous ulcers, i.e. genital area canker sores (somewhat controversial, but some experts believe this explains a modest proportion of unexplained genital ulcers); familial mediterranean fever; allergic reactions to some drugs; and probably other conditions as well.

That will end the discussion until your final test result are available; or if you have another outbreak with lesions tested for HSV.
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239123_tn?1267651214
Please read carefully and pay attention to what I have asked you to do.  WAIT UNTIL YOU HAVE HAD A FINAL TEST AT LEAST 3-4 MONTHS AFTER THE JULY EXPOSURE.  You could have that test at any time now.  Get tested for HSV-1 as well as HSV-2.  AT THAT TIME ONLY, post all your results once more, including the trade name or manufacturer of each test.  (Probably it was the same one for all tests, if all were done by the same lab.)  EIA and ELISA don't help; almost all HSV tests are EIA/ELISA.  You need information like HerpeSelect brand by Focus Techologies; Captia test by Trinity Biotech; etc.  Finally, post the information only on this thread, not your earlier one.
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Avatar_n_tn
Dear Dr Handsfield,

I have not yet had a repeat HSV1 or HSV2 test or found out the details for the blood test performed.

However, I have since found out that I caught Chlamydia. I had had a test before sleeping with the guy in July, and haven't been with anyone else. Therefore it seems that I caught either Chlamydia ONLY or Chlamydia and Herpes in July.

The confusing thing is that I had sores. The sores LOOKED LIKE Herpes, but with antivital medication cleared up in 3 days.  On some websites it says that Chlamydia cannot cause sores, but other websites say that it can.

I am worried that I may have gotten PID as I effectively carried the Chlamidiya for 3.5 months. I haven't had any lower abdominal pain or discharge but PID can have no symptoms.

I would be very grateful for your opinion.

Kind Regards

Asli

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239123_tn?1267651214
As before, I will have no further comment about your possible herpes until the additional lab data are available.

There is indeed a risk of silent PID in women with chlamydia, but it's not very likely.  The vast majority do not have PID or resulting infertility, even when chlamydia is present for several months before treatment.  Presumably you have been treated, preferably either with azithromycin (single dose) or doxycycline (for a week).  You should have a "rescreening" test about 3 months after treatment, to be sure there has been no recurrence.  And of course your partner needs to be informed of your positive chlamydia test and encouraged to be tested and treated.

I still look forward to hearing the final herpes test results.

Happy Thanksgiving.
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