Genital HSV-1 testing

Almost three years ago I contracted oral HSV-1 by kissing my at-the-time boyfriend.  It turned out later that he had a cold sore at the time.  The same night I contracted the initial HSV-1 he performed oral sex on me. I got extremely sick as a result of the primary oral infection- fever, chills, sores in my throat. I did not develop any genital symptoms so I thought I was fine.  I did, however, go on acyclovir because I was having recurring cold sores.

I have not had any sexual relations since that night.  Now, almost three years later I developed what appeared to be one genital blister and a fever and chills while still taking the acyclovir.  I went to my doctor and had the genital blister tested but it came out negative for herpes.  I believe this was a false negative because it was already beginning to heal at the time it was tested. These problems went away, but over the last couple months the back of my right leg has been in pain and I have had very bad vaginal burning.  These symptoms go on for weeks at a time.  I am convinced that I have genital HSV-1 because of the symptoms. I would like to know how one gets tested for genital HSV-1 in the absence of an open blister.  I know that if I have a blood test it will come out positive because I tested positive for oral HSV-1.  

[H. Hunter Handsfield, M.D.]

Unfortunately, no test is available to determine whether an HSV-1 infection is genital, oral, or both, except to try what you already attempted:  testing an outbreak for herpes to determine virus type.  The best I can suggest is to await another outbreak and see a provider very promptly (within a day of onset) for repeat testing.  You could consider stopping acyclovir; you are more likely to have a recurrence that can be tested if you aren't on treatment, and being on acyclovir might be the reason your culture test was falsely negative.

Certainly the appearance of a genital blister is consistent herpes, and likely means you indeed acquired genital HSV-1 at the same time you acquired it orally.  Breakthrough lesions can occur on acyclovir.  On the other hand, fever and chills are rare with recurrent genital (or oral) herpes, generally seen only with first infections.  So perhaps something else was going on, but that is speculative.

If not done recently, you might want to have a type-specific blood test for HSV-2.  Although recurrent genital herpes due to HSV-1 can happen, the vast majority of recurrent genital herpes lesions are due to HSV-2.  In other words, if your blood test is positive for HSV-1 only, you can assume with some assurance your genital lesion was due to HSV-1; but if positive for HSV-2 (with or without HSV-1), you should assume you have genital herpes due to HSV-2.

Finally, whatever else is going on, vaginal burning and leg pain going on "for weeks at a time" almost certainly are not due to herpes.  Look for other causes for those symptoms; herpes outbreaks simply never last that long.

Good luck--  HHH, MD