Bumps STD

[geena444]

This is for Dr. Handsfield or Dr. Hook:

I have genital HSV1.  My question is this:  I had unprotected sex once last month  and two weeks later I had a cluster of very tiny bumps on my vagina area, they went away in a few days, no crusting or anything, so I thought it was a yeast infection.  A week later a couple of larger bumps appeared on my vagina.  I had valtrex so I took 3 pills and the next day the bumps disappeared.  I stopped taking the Valtrex and the two bumps reappeared.  Could I have stupidly contracted HSV2?

Is there any other diseases that would cause a cluster of tiny bumps to come and go away in a few days and then larger bumps appear a couple of weeks later?  Thanks

[H. Hunter Handsfield, M.D.]

The initial infection with HSV can have a waxing and waning course; conceivably this could all be one event and perhaps herpes is a possibility.  It still seems somewhat unlikely to me, especially if the current "bumps" don't look like blisters or implies, and if they don't develop into ulcers (sores).  And the time frame is a bit long -- initial HSV symptoms usually start within 3-5 days of exposure.  OTOH, you could have prolonged teh course and delayed the development of more obvious lesions by taking valacyclovir.

All things considered, I'm still inclined to doubt herpes, but it now seems more likely than I thought yesterday.  You should be professionally evaluated.  Do it ASAP, today if possible:  both the visual diagnosis and accuracy of HSV tests from the lesions are most accurate early rather than late.  If you explain the situation to your doctor's office, they'll probably arrange for you to be seen quickly.  They will understand the importance of early rather than delayed exam and testing.  Or go to an urgent care clinic.

And by the way, if they think herpes is a possibility and you indeed have vesicles or ulcers, insist on a swab test from the lesions, preferably an HSV PCR test.  The diagnosis should not rely only on blood testing.  

I'll be interested to hear the outcome after you've been examined.

Oh, and for sure don't take any move Valtrex before being tested.

[geena444]

Thank you.  The current larger bumps do hurt, I think it is different from the first cluster of bumps.  Could I have gotten a small cluster of something not significant and then a week later Herpes?  Does the week in between mean anything at all?  Is there any week in between for herpes or is it one event.

[H. Hunter Handsfield, M.D.]

Welcome to the forum and thanks for your question.

Herpes doesn't behave at all like this.  A herpes lesion will always be inflamed (red, usually tender) and usually will develop into an obvious blister or, in moist areas like the vulva, an open sore; and always will take at least a week to heal.  Non-inflamed little bumps that come and go so quickly cannot be herpes.  Even with Valtrex or other anti HSV drugs, lesions take a few days to heal, not hours.

So for sure no worries about warts, and these symptoms also are not suggestive of any STD.  Beyond that, I really can't help.  My advice is that you see your reproductive health provider if or when the bumps reappear.  In the meantime, don't worry about herpes or other STD.

Best wishes--  HHH, MD