Gental hsv-1 concern

[susiem]

Hi Doctor,
     Thank you in advance for listening.  I was diagnosed with hsv-1 in the genital region in August of this year.  This was my first episode and I immediately went to the doctor who completed a culture and I was put on Valtrex, which I now take daily for suppression (1gm per day).  I recently requested a higher dosage of Valtrex because I seem to be having problems regularly.  The biggest problem I have is that every time I have intercourse with my boyfriend I suffer from either fissures or cuts, which always present in the same exact spots in two separate locations.  One being on the opening of my vagina (looks like a small cut on the right side near the middle and the other being on the right side of my vagina in between the lip area, which looks like a line or cut (maybe a small blister but not classic lesions)of some sort, this one is a little painful but the other one is not (this is in the same general location as my first episode).  I went back to the doctor who seemed to think that herpes did not cause this but that I may have some other skin condition like eczema.  She treated me for a yeast infection and also told me that when these cuts/fissures return that I should use 1%hyrdorcortozone cream.  I am so confused and was wondering if herpes does in fact act this way and what can I do?
    I am so worried about giving this to my boyfriend if I am indeed suffering from recurrent or continuous outbreaks.  I am not sure if I contracted this from him but he does seem to think that he suffered from cold sores when he was younger.  This does seem to be consuming my thoughts and if I do suffer from recurrent outbreaks what are my chances of giving this to him?  He does not seem to have as much concern and thinks that what I have he has and vice versa,  I am the one who is almost obsessed with giving this to him and will not be intimate with him if I think I may have symptoms.  
Also I was wondering how I could find a doctor in my area that specializes in herpes, I have tried and have been unsuccessful and was wondering if there was some type o network I am not familiar with. Once again thank you in advance for taking my questions.  

[H. Hunter Handsfield, M.D.]

You asked essentially the same questions on January 24.  My answers have not changed.  I am skeptical you have genital HSV-1 infection at all, although as I said 2 weeks ago, that depends a bit on what tests were done by your doctor when s/he made the diagnosis.  Further, as I said last time, the persistent/recurrent symptoms you describe almost certainly are not due to herpes; the disease simply does not behave that way, especially if due to HSV-1.

If you are in the Unites States or another industrialized country, especially in an urban area, for a provider expert in genital herpes you can visit your local health department STD clinic, a dermatologist, or seek out a specialist in infectious diseases. Your local county medical society can help identify such people.  In addition, you might contact the American Social Health Association (www.ashastd.org) and call their herpes information line, for expert advice by a knowledgeable professional. (They might also be able to identify a herpes expert in your geographic area.)

Bottom line (no pun intended):  Herpes probably isn't the main problem here.  I don't know what is.  Find a health care provider you trust and follow his/her advice.  But do not keep seeking answers or more detailed advice online, from me or any other online source.

Good luck-- HHH, MD

[Confused_again]

Usually having genital HSV-1 is milder than having HSV-2, and causes fewer recurrances. In addition, if your boyfriend has HSV-1 orally, it's unlikely that he will get it genitally since he already has antibodies for it. I'm not a doctor so wait for Dr.HHH's advice.

This link has a list of Herepes-friendly doctor.

http://racoon.com/herpes/main/doctors.htm

Good luck !

[monkeyflower]

I've never heard of herpes that occured every time you have sex - especially since you're on suppressive therapy. And pretty high dosage suppressive therapy at that. Plus your doctor diagnosed and treated you for a yeast infection (which can cause cuts and would certainly cause irritation) and thinks you have eczema. S/he told you to use hydrocortisone cream - have you done this? Wait for Dr. Handsfield's reply, but I bet you a zillion dollars this isn't herpes.

And besides, if your bf doesn't care about contracting herpes, why does it matter so much to you? First of all, the risks are pretty small... with HSV2, which sheds far more frequently genitally than HSV1, it's only like 4% over an entire year of having regular sex. You can reduce it to around 2% with regular condom use, and half that again with suppressive therapy. I have HSV1 and 2, and I talk to my partners about the risks and do everything reasonable to protect us, but in the end it's up to THEM to decide if the risk is worth it :-)