STDs Expert Forum
Could this be HSV-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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Could this be HSV-2?

About a week ago I noticed "paper-cut" like cuts around the opening and on the inside of my vagina. About 2 days after, the cuts got worse and 2 new sores appeared.

On Aug 11, I got checked at a local walk in clinic. I told the doctor about my "cuts". She said that herpes is a possibly, but it also could be a yeast infection and is not 100% sure if it is herpes. She swabbed for herpes and other STDs. She also prescribed me Valtrex to get over the pain, even though I wasn't properly diagnosed with herpes.

I started to get more and more paranoid, so I continued to see different doctors at different clinics. Two doctors were usless. They just took one glance at it and said it was herpes. They gave me no prescription, took no swabs, nothing. I found those doctors to be quite unprofessional and unhelpful.

On Aug 13 I went to my family doctor. She didn't say anything when she saw the sores. All she said was, "Oh, I see that you have some sores. We'll just do some cultures for them and your results should come in between 3-5 days." She also told me that the first herpes outbreak is extremely painful and my genitals would be covered in sores, which it is not. She also gave me info on genital herpes.

I went to the walk in clinic today to see if my results came in. All bacterial STDs came out negative. I asked the doctor about herpes. He said that the doctor who did my swabs wrote in my file that I have herpes and prescribed me Valtrex. Um, what? Why wasn't I informed?

Q1: How come the doctor told me that it MIGHT be herpes and that she wasn't 100% sure, when she wrote down in my file that I have it?
Q2: If the Valtrex is working for my cuts/sores does that mean I have herpes?
Q3: Could the two doctors who just glanced at my vagina be mistaken? How come they didn't do swabs or prescribe me anything and just jumped to conclusions?
Q4: Am I being too paranoid? Should I wait for my swab results to come back? What if they come back negative?
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300980_tn?1194933000
  Welcome back to the Forum. In preparing to address your questions I reviewed your earlier interchange with Dr. Handsfield.  Your questions reinforce the fact that the topic of herpes is a complex one.  The disease is common with HSV-1 being present in over 60% of adults and HSV-2 (the virus which causes most genital herpes) being present in about 1 in 5 Americans.  For both infections, the majority of people who have the infections are not aware that they are infected, either because they either acquired it without knowing in the past or because they misidentified their herpes as something else.  I will do my best to answer your questions but in general, many of these questions and information about herpes can be obtained by accessing excellent informational web sites such as the one run by the American Social Health Association (disclosure, Dr. Handsfield and I are both on the Board of Directors of ASHA).  

Herpes presentations are quite variable as well.  It sounds like most of the doctors who have seen your vaginal lesions of late have at least considered herpes as a possibility with some feeling more strongly about this than others.  This means that there is a good possibility that you do have gential (genital) HSV.

Several comments about testing.  When the infection starts to heal, cultures may not be positive, despite the fact that there are still sores present.  If none of the culture tests for herpes that have been performed are positive, that does not mean that you do not have HSV – you still could.  On the other hand, if any of them are positive, you know that you do have HSV.  A types specific blood test may also be helpful in sorting things out.  If you have a positive blood test, it will not tell you where you are infected and will not tell you how long you have had it but it will help. If the blood test is positive for HSV-2, then you can say that your genital lesions are probably due to this.  In sorting this out, it may also be helpful for your BF to get tested at the same time you do.  The reasons for this are in part to help you sort things out and in part to help address the risk of transmitting herpes that may or may not be present with you have sex.   Now, for your questions:

1.  Drs'. notes are their own shorthand.  I obviously cannot assess how strongly your doctor felt about the possibility.  In addition however, I would point out that while many doctors still feel that they can accurately diagnoses HSV on inspection, this is incorrect.  Testing is quite important.  As I already told you, you need testing to help you sort this out.
2.  The lesions of HSV are self limited and can heal by themselves.  Valacyclovir helps this to occur more quickly.  If the valacyclovir has made a dramatic difference for you that makes it possible, but by no means a sure thing that you have herpes since you might have been already healing on your own and just coincidentally "turned the corner" at the time you started with the valacyclovir.
3.  See my answer above.  Some doctors believe they can recognize HSV without testing.  We recommend testing.
4.  No, you are  not being paranoid.  Reading your story, I think there is a fair chance that you have HSV.  You need tests to help sort this out.  In addition, to put things really to rest, in addition to the swab/culture tests you've had, you will need blood tests.   Although blood tests may be helpful now, they really are not completely definitive until about 4 months after the initial outbreak occurs.

I hope this helps.  There is lots to know about HSV.  Please check out the websites I mention above.  I'll be happy to help with further questions as part of this thread as your test results b become available.  EWH
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This helps a lot Doctor, thank you. I also forgot to mention that I got a blood test done for HSV-2. Since I live in British Columbia, I had to pay $130 for it. What if both the swabs and blood test come out negative for HSV-2? Could these lesions be caused by something else? What else causes lesions down there?
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300980_tn?1194933000
Let's wait for your test results to start with the "but what ifs".  

As I said, if your blood test is negative it may be because it was taken too early.  Let's work through this step by step and wait for your test results.


In the meantime, as I suggested, check out the web sites- they are helpful.  EWH
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Dr Dr.,

I just got my swab results back today and it came back positive for HSV-1. Guess I did contract this from my partner when he had a cold sore on his lip. So where do I go from here doctor? What can you tell me about having HSV-1 genitally?
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300980_tn?1194933000
Well, you now know what is going on.  Among persons with genital herpes, those whose infections are due to HSV-1 tend to have fewer outbreaks and are less likely to spread their infections to others than persons with HSV-2.  As far as interactions with your BF are concerned, since he already has HSV-1, he cannot get it back from you, even in a different location.  His body's immune system will prevent him from getting re-infected at a different site.  

I would also check out the web site I mentioned in my initial answer to you.  It has much valuable information.  EWH
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What I don't understand doctor, is that how come I contracted this genitally and not orally? Clearly I was kissing him and all that first while he had a cold sore, then later on, we had oral sex. Another weird fact, is that it took 3 weeks for symptoms to show. I totally thought I was safe here because his sores looked healed, and plus the odds of me already having HSV 1 were 50/50, so that's why we took the chance. My family doctor said that I could have contracted this as a child and "coincidently" had my first outbreak around the time when my partner performed oral sex on me. I feel very irresponsible. I took chances without even knowing the facts!
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300980_tn?1194933000
Whether a person such as you acquires infection at the mouth or genitals is simply a matter of chance if both sites are infected.  As for when you got it, you may not have gotten if from his cold sore.  Please realize that when persons have HSV they have what is called asymptomatic shedding of the virus (in the absence of lesions). Thus you may not (in fact are unlikely to have) acquired the infection from his lesion.   Most genital herpes is spread (both HSV-1 and HSV-1) when a person who has asymptomatic shedding comes into contact with a person who is not infected.  

Sorry to disagree with your doctor, but the chance that this was a coincidental appearance of your 1rst HSV recurrence after acquiring it at childhood is negligible and really not worth worrying about.  To learn more about HSV I would suggest accessing the excellent information available at the American Social Health Association web site (disclosure, both Dr. Handsfield and I are on the ASHA Board of Directors)  EWH
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Another thing that I forgot to mention doctor, is that I got my first culture done at a walk in clinic and it came out positive. Two days later, I went to my family doctor and got another culture, which came out negative.

1) Is it possible that this could have been a false positive result? Do you suggest that I get a blood test done to be sure?

2) Is genital HSV 1 a big deal? I'm really scared of passing this on genitally to future partners. How often does genital HSV 1 shed? I have heard that it is uncommon for it to shed and have heard that it sheds 3-5% a year?

3) My partner has only performed oral sex on me once, and that was when he had a visible lesion. I let him perform oral sex on me because the lesion was scabbed and healed. Could another lesion may have been forming around/near is old one and could have been asymptomic viral shedding?

4) Since genital HSV 1 doesn't reoccur often, asymptomatic viral shedding is uncommon and genital-to-genital- transmission is rare, is it necessary to tell future partners about this infection? Can I continue to have unprotected sex with HSV 1 negative persons?
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Edward W Hook, MDBlank
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