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Any hope it's not Genital Herpes
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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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Any hope it's not Genital Herpes

My 15 year old daughter had sex for the first time about 3 months ago. She has only had that one partner, her boyfriend of 8 months. Since they began having sex, there have been 2 occasions where sex was unprotected.  Over the last 2 months, I have taken her to the doctor for treatment for UTI's, the last just 3 weeks ago. Last weekend she mentioned increased discharge but no distinct smell, tenderness, odor, etc. About 5-6 day later she mentioned discomfort during urination again and there was on medium size sore present inside the labia, just below the clitoris and the opening of her vagina was like raw skin. The doctor conducted several tests, advised of a UTI and prescribed metronizadole as well as vaginal cream, until the other lab results came back. Over the next 48 hours, her entire vaginal area erupted in many small scattered sores, not clustered, but individual. They quickly burst and are raw and open. We returned to the doctor, and were seen by another who immediately suggested it was herpes and submitted a new culture to the lab, advised to stop all other meds and prescribed Aciclover, a topical mix of mylanta with novacaine for pain and advised us to return in 7 days to discuss the results. I am completely devastated at the thought of this, and am just hoping that he is wrong. Are there any conditions or infections, bacterias, anything else that this could be? Or is it highly unlikely? The information online points in so many directions and gives so many varying descriptions and explanations, that I don't want to get my hopes up in vain, nor do I want to give in to the idea, when there may be some hope..Please help
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Welcome to the forum.  Thanks for your question.

Your description of your daughter's symptoms, her sexual history, the appearance of her genital lesions, and her doctor's opinion all add up to near certainty that she is suffering from primary herpes, i.e. her first infection with herpes simplex virus (HSV).  While there are other conditions that can cause similar problems -- including immunological conditions and certain other viruses -- they are much less likely.  Therefore, I cannot hold out the hope you are seeking.

Presumably one of the lab tests in the works is a swab test for HSV.  Ideally, it would be a PCR test, but in this situation a culture would be almost as good.  I expect it to be positive for HSV.  When it is, be certain the doctor has requested it be typed, i.e. determine whether it's HSV-1 or HSV-2.  (Some doctors are under the impression that the type doesn't matter, but in fact it is crucial -- as discussed below.)

That said, I believe you have an inflated view of genital herpes and how much of a problem it will be for your daughter.  My guess is she'll turn out to have HSV-1, the usual cause of oral herpes, and not HSV-2, the most common overall cause of genital herpes.  Why?  Not many 15-16 year olds have HSV-2, but up to half have oral herpes due to HSV-1.  So assuming your daughter's boyfriend is roughly her age, I would bet on HSV-1 acquired through oral sex.

Which brings me back to the importance of virus type.  Genital herpes due to HSV-1 usually recurs infrequently (40% of people have no recurrent outbreaks at all), and has relatively little asymptomatic viral shedding.  Therefore, the risk of sexual transmission to future partners usually is low.  By contrast, HSV-2 tends to cause frequent recurrent outbreaks and is readily transmitted sexually.  For the same reasons, ongoing suppressive anti-herpes drugs usually are unnecessary in people with genital HSV-1, but often recommended for HSV-2.

Finally, I would urge you to be less fearful than you now seem to be about the effects of genital herpes on your daughter.  As already noted, if she has HSV-1, it may not be an important issue in her future.  And even with HSV-2, with proper management the large majority of infected people are able to control and prevent both symtpoms and the risk of transmission.  While nobody wants genital herpes, in the end it's usually more an inconvenience than a serious life event!

I hope these comments have helped.  I'll be interested to hear the outcome of her lab tests and treatment.

Best wishes to you, and of course to your daugher.  Please relay my reassurances to her.

HHH, MD
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239123_tn?1267651214
I meant to add that I hope both you and your daughter will go easy on the boyfriend.  Most genital herpes is acquired from partners who are unaware they are infected, or if aware, did not believe there was any risk of transmission at the time.  It will be interesting to eventually know whether he has oral herpes or symptoms of cold sores; or, less likely, genital herpes.  If uncertain, then somewhere along the line, he should have a blood test to determine which HSV type(s) he carries.

All this can be done in time -- there is no need for immediate answers.*  And in any case, you need to respect your daughter's privace and autonomy, and I would not suggest you probe the details of their sexual practices.  Of course you're her mom, and I can't judge what overt or de facto boundaries you or she consider appropriate.

* With perhaps one exception:  if your daughter thinks there is any chance her boyfriend has had other partners recently, then there is likely a third party who will need to be informed of the situation.
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Thank you for your informative and kind response. I will follow up with the results, as difficult as they may be to digest. I'm sure that with time, this will get easier and she will be fine. Thanks again
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239123_tn?1267651214
The hard part, I suspect, is the simple bad luck of it -- knowing your daughter's introduction to sex came with such a cost.  The emotional impact can be significant even if the physical illness ultimately isn't so serious.  Best of luck with it all.
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Hello and thank you again for all your advise and guidance, Definitely more than I was able to get from the doctor we saw. As you expected, her results cam back positive for HSV-1. It doesn't appear in her blood or his, which I'm hoping is normal, but I was under the impression that it would show in his at least, if he's been carrying it and maybe not in her's since she just picked it up. Either way, I don't want to bust my brain trying to get to the bottom of something, especially when that won't really solve or undo anything. Things are much more calm now and she seems to be doing very well; it is definitely unfortunate that her first experience would lead to this, but we are getting through it together and it will instill a deeper sense of responsibility when it comes to sex as she gets older. There is a tremendous amount of information out there but it's hard to decipher what is valid and what isn't. If there are more outbreaks, will they likely always be genital or can she have cold sores also with HSV-1? I'm not too worried about transmittal within the household, but read some things about that too. Would you be able to perhaps recommend an informative source that doesn't just give the overall description and symptoms? Once again, I appreciate you taking the time to respond and to provide so much information and advice.  Warmest Regards, M
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239123_tn?1267651214
Thanks for the follow-up.  I'm glad to hear things are going fairly well.

It takes several weeks for the blood tests to become positive.  If your daughter is retested in the future, she should expect a positive result.  However, up to 10% of people with HSV-1 never develop detectable antibodies, so her test could remain negative -- as her partner's apparently has done.  He should assume he is infected, regardless of that test result, and should be instructed to see a doc in the event of blister- or pimple-like lesions around the mouth (or genital area, but that's less likely).

As discussed above, your daughter probably will have few if any recurrent genital outbreaks. Below I have provided links to three other threads that go into more detail about genital HSV-1 compared with HSV-2.  The bottom line is that although nobody wants genital herpes, if it happens HSV-1 is the "preferred" type.

http://www.medhelp.org/posts/show/969931
http://www.medhelp.org/posts/show/1159077
http://www.medhelp.org/posts/show/1274603

For additional information about genital herpes, two excellent sources are the American Sexual Health Association (www.ashastd.org) and the Westover Heights Clinic of Portland, OR (www.westoverheights.com), which is owned and operated by Terri Warren, moderator of MedHelp's herpes forum.

Best wishes to you and your daughter.
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Error above:  it's up to 20% of people with HSV-1 whose blood tests remain negative.
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I can't thank you enough for the info and kind wishes, All the best to you Doctor. Be well!!
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