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Atypical HSV, atypical folliculitis or something else all together?
Hi! I am a 24 year old female and this is my play by play of issues.
3/26 shaved pubic area for the first time in a while and had vigorous unprotected sex with my monogamous boyfriend.
3/27 generalized soreness in pubic region that I attributed to the sex
3/28 found some (20ish) red bumps in my pubic region that I attributed to shaving irritation and hair regrowth; had a headache
3/29 bumps really start to hurt and I find that they extend perineally towards my anus, but none seen on internal vaginal surfaces; they appear pustulant, however, popping one (bad idea) did not release any pus; headache and really tired attributed to crazy busy weekend
3/30 pain is still impressive, some are starting to scab over, others appear umbilicated; headache and fatigue continue
3/31 pain is inhibiting my ability to walk; headache and fatigue continue- add burning with urination; called my PCP- can’t get in
4/1 go to urgent care! Pain is minimally better, had a fever of 101 at the time. My guess was folliculitis with possible UTI, but doctor said it looked like herpes. I have never had any herpes outbreaks, but have never been tested. She gives me 2 antibiotics for folliculitis and UTI (urinalysis was borderline) and draws blood to test for herpes. She was also nice enough to give me Diflucan.
4/2 All bumps/lesions scab over
4/3 pain and general symptoms gradually improving
4/4 find new lesions that appear classically herpetic: “small grouped vesicles on an erythematous base”
4/5 finish UTI antibiotic (trimethoprim sulfate), choose to discontinue folliculitis antibiotic (erythromycin), still finding new lesions, original lesions beginning to heal
4/6 get results of HSV 1 and 2 blood test- both negative (which I realize means nothing), also no UTI on culture; original lesions still healing, newer ones scabbing over, most appear to be centered on hair follicles- never had ulceration phase
Questions coming in update. Thanks!!!
3/26 shaved pubic area for the first time in a while and had vigorous unprotected sex with my monogamous boyfriend.
3/27 generalized soreness in pubic region that I attributed to the sex
3/28 found some (20ish) red bumps in my pubic region that I attributed to shaving irritation and hair regrowth; had a headache
3/29 bumps really start to hurt and I find that they extend perineally towards my anus, but none seen on internal vaginal surfaces; they appear pustulant, however, popping one (bad idea) did not release any pus; headache and really tired attributed to crazy busy weekend
3/30 pain is still impressive, some are starting to scab over, others appear umbilicated; headache and fatigue continue
3/31 pain is inhibiting my ability to walk; headache and fatigue continue- add burning with urination; called my PCP- can’t get in
4/1 go to urgent care! Pain is minimally better, had a fever of 101 at the time. My guess was folliculitis with possible UTI, but doctor said it looked like herpes. I have never had any herpes outbreaks, but have never been tested. She gives me 2 antibiotics for folliculitis and UTI (urinalysis was borderline) and draws blood to test for herpes. She was also nice enough to give me Diflucan.
4/2 All bumps/lesions scab over
4/3 pain and general symptoms gradually improving
4/4 find new lesions that appear classically herpetic: “small grouped vesicles on an erythematous base”
4/5 finish UTI antibiotic (trimethoprim sulfate), choose to discontinue folliculitis antibiotic (erythromycin), still finding new lesions, original lesions beginning to heal
4/6 get results of HSV 1 and 2 blood test- both negative (which I realize means nothing), also no UTI on culture; original lesions still healing, newer ones scabbing over, most appear to be centered on hair follicles- never had ulceration phase
Questions coming in update. Thanks!!!
MEDICAL PROFESSIONAL
Your doc's suspicion of herpes has to be taken seriously, so it certainly is possible you have a new HSV infection. However, initial herpes rarely occurs in the pubic area, i.e. in hair-bearing areas. In women, the initial lesions usually are predominantly on the labia minor, vagina opening, etc. That's because for an HSV infection to take, the virus usually has to be massaged into susceptible tissues -- so tha the initial lesions usually are in the areas that receive the greatest friction during sex. On the other hand, in theory shaving your pubic area could have increased your susceptibility to HSV.
I'm disappointed that you don't mention any tests for the virus itself from the skin lesions. As you seem to know, that's the best way to diagnose new HSV infections -- and from your description you clearly had active skin lesions when you were examined. (Or am I missing something?) In any case, if you have genital herpes, it is obviously a brand new infection, not a recurrence. A new infection fits best both with your symptoms and the negative HSV-1 and -2 blood test.
All things considered, I tend to doubt this is herpes. I'm more suspicious of a rather serious case of staph or strep folliculitis. To your specific questions:
1) Sure, your partner could be infected without symptoms. If your problem turns out be herpes, that's probably exactly what's going on here -- i.e. he has either genital HSV-2 or oral HSV-1 and was the source of your infection.
2) The HSV blood test usually is positive in 4-6 weeks; you could have another blood test at that time to see if it has become positive. If that's still negative, you can have a final test at 3 months.
3) Your partner should have an HSV blood test now. There is no need to wait. If you have HSV, he has to be the source -- in which case his test will be positive now for HSV-1 or HSV-2.
4) See above. I lean about 3:1 in favor or folliculitis over herpes.
Please return and let me know the results of your partner's test results and your own follow-up test results. In the meantime, I hope this helps.
Regards-- HHH, MD
I'm disappointed that you don't mention any tests for the virus itself from the skin lesions. As you seem to know, that's the best way to diagnose new HSV infections -- and from your description you clearly had active skin lesions when you were examined. (Or am I missing something?) In any case, if you have genital herpes, it is obviously a brand new infection, not a recurrence. A new infection fits best both with your symptoms and the negative HSV-1 and -2 blood test.
All things considered, I tend to doubt this is herpes. I'm more suspicious of a rather serious case of staph or strep folliculitis. To your specific questions:
1) Sure, your partner could be infected without symptoms. If your problem turns out be herpes, that's probably exactly what's going on here -- i.e. he has either genital HSV-2 or oral HSV-1 and was the source of your infection.
2) The HSV blood test usually is positive in 4-6 weeks; you could have another blood test at that time to see if it has become positive. If that's still negative, you can have a final test at 3 months.
3) Your partner should have an HSV blood test now. There is no need to wait. If you have HSV, he has to be the source -- in which case his test will be positive now for HSV-1 or HSV-2.
4) See above. I lean about 3:1 in favor or folliculitis over herpes.
Please return and let me know the results of your partner's test results and your own follow-up test results. In the meantime, I hope this helps.
Regards-- HHH, MD
MEDICAL PROFESSIONAL
You definitely should follow your doctor's advice about treatment. Finish the erythromycin as directed. And do return to let me know the HSV test results.
Thanks for response. Sorry about my overly long question stem- I wanted to include a lot of detail! When I saw the doctor, there was no testing of the active lesions. I am now aware of the pros/cons of different HSV tests, but at that time, I was caught off guard. I had not considered herpes as a possibility at all. I did quite a bit of research over the last week on herpes. In that time, I also learned a good bit about folliculitis. I am on long term minocycline for acne, so I am theoretically less likely to get common superficial folliculitis with staph aureus. I do not know about the strep though.
Would you recommend I finish the remaining 7 days of erythromycin 500mg bid. I took it initially for 3 days and then have not for the past 2 days. Thanks!
Would you recommend I finish the remaining 7 days of erythromycin 500mg bid. I took it initially for 3 days and then have not for the past 2 days. Thanks!
MEDICAL PROFESSIONAL
Welcome to the STD forum. But in the future (other users, please note), the reason for the 2,000 character limit (about 400 words) is to require that the entire question be posted in the initial question window. The moderators aren't expected to read follow-up comments before replying. (Many MedHelp moderators set their browsers so they never even see any follow-up comments.) Anyway, see below for my responses to your questions.
HHH, MD
HHH, MD
1. Is it possible that my boyfriend is an asymptomatic carrier, but I just now acquired HSV from him due to skin breaks from shaving?
2. Because I don’t have any new lesions (ruling out viral culture and PCR), is there any way to know for sure my HSV 1 and 2 status without waiting 3 months for IgG or doing expensive Western Blot?
3. We are both going to be tested for everything (again) in the very near future, but can we continue to have sex in the mean time assuming we have already shared whatever we have?
4. What are your thoughts on folliculitis vs. HSV in my case?
Again, I appreciate your time!
2. Because I don’t have any new lesions (ruling out viral culture and PCR), is there any way to know for sure my HSV 1 and 2 status without waiting 3 months for IgG or doing expensive Western Blot?
3. We are both going to be tested for everything (again) in the very near future, but can we continue to have sex in the mean time assuming we have already shared whatever we have?
4. What are your thoughts on folliculitis vs. HSV in my case?
Again, I appreciate your time!
You are reading content posted in the STDs Forum
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.
