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Herpes in Pubic Area in 24 hours?
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Herpes in Pubic Area in 24 hours?

Hello All,

(2 years ago I had a troublesome situation then and freaked out for 4 months until the Herpes Select IGG Immunoblot came back negative for HSV2 and positive to HSV1. (And at 6 months same thing too.) A year ago my newer Ex had me take one and she did too. Same result.)

Well, I had *protected* sex with an another Ex yesterday morning (Saturday). Last night (Saturday) I had a lot of itching in my public area. Today (Sunday) I have red marks all over my pubic area. I mean like 8 red marks that itch. Pencil eraser size. Mid to upper pubic hair area. No blisters (yet).

Now, obviously I am freaking out.

Does it usually show up this fast????

I guess I am going to ask her to please take the Herpes Select 1&2 IGG Immunoblot test to she if she has HSV2.

I know I need to wait for my testing. How long should I wait?

Should I take the IgM to see if I have a new infection? How long to wait?

I am going to try and get into a doctor tomorrow and do a culture. But, I am sure that will be about impossible.

Help!

PS: My best friend just told me he had Herpes. At least I have someone to freak out about this in person and on the phone....
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239123_tn?1267651214
Reacting first to the title you chose for this thread, before I read your question:  Initial herpes uncommonly involves the pubic area (i.e., hair-bearing areas); and the initial symptoms cannot start within 24 hours.

Now to the question.  No change. Itching and "red marks" in the pubic area don't sound like herpes, and indeed the symptoms came on too soon.  You should not ask your partner to be tested for herpes unless and until you have a confirmed diagnosis yourself.  IgM testing is useless; NEVER rely on an IgM antibody test.  You probably don't need herpes testing at all. My main advice is to follow through with your plan to see your doctor.  Follow his or her advice. But the chance of herpes is low to zero.

Good luck--- HHH, MD
12 Comments
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Avatar_n_tn
Well ****.

My HerpesSelect HSV2 IgG came back at a positive 6.0! Took the test on Wednesday 10/31.

I am still waiting for my culture. They did it Monday 10/29.

Obviously, if my culture is positive then I definitely have HSV2. (If it was typed.)

So, it looks like I have had HSV2 for a while.

Does the 6.0 mean anything as far as time?

Could the blood test become positive in 4 days?

Thanks in advance for your response.

TD

PS: If the culture is negative should I get the Western Blot?

Here are my past blood tests

1996-ish - 2 Western Blots were negative for HSV2 and positive for HSV1 (Dated a girl with typed HSV2 and I waited 4 months and 1 year.)

2004 - WB = Same

2005 - HerpesSelect HSV2 IgG = Negative

01/2006 - HerpesSelect HSV1 IgG = Positive
- HerpesSelect HSV2 IgG = Negative

06/2006 - HerpesSelect HSV2 IgG = Negative

10/2007 - HerpesSelect HSV2 IgG = POSITIVE
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Avatar_f_tn
Oh well...

At least you'll no longer have to worry about getting hsv2 anymore ; )

AJ

PS You're probably lucky in that you're previous hsv1 infection will limit the recurreny and severity of outbreaks. Shedding also.
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239123_tn?1267651214
Sometime during the roughly year and a half between early 2006 and October 2007, you were infected with HSV-2.  It was not during the late October sexual exposure you describe.  As I said above, symptoms cannot start so soon and the location and nature of the symptoms you describe were not typical.  Most important, 10 days is the absolute minimum time to developing a positive HerpeSelect HSV-2 test; 50% are positive by 3 weeks; and it takes 3-4 months to reach 90%.  You acquired your HSV-2 infection no later than early October 2007.

Ali-jay's comment is only partly right.  Prior HSV-1 often reduces the severity of the initial episode of HSV-2 (another reason your multiple pubic area lesions probably were not herpes) and may reduce the risk of catching HSV-2 in the first place. But there is no apparent effect on the frequency or severity of recurrent HSV-2 outbreaks, or the frequency of asymptomatic viral shedding.

A final comment about the symptoms you have above:  There is a condition called eczema herpeticum.  When someone has both HSV and eczema, a common allergic-type skin rash, they can get extensive, widespread rashes in atypical locations, even in recurrent herpes.  The same phenomenon can occur with other inflammatory skin rashes, and probably some people with genital area folliculitis will have positive cultures for HSV.  It doesn't necessarily mean that the primary problem was herpes.  A dermatologist alwasy should be consulted when eczema herpeticum or similar conditions are suspected.

Find a herpes knowledgeable provider to advise you about clinical care.  Be on the lookout for recurrent episodes, which probably will not appear in the pubic hair area, most likely on the penis.  Advise all your partners that you have genital herpes.  Use condoms unless you know your partner already has HSV-2.  Suppressive treatment with valacyclovir can reduce the chance of transmission.  For high quality personalized advice, consider calling the American Social Health Association's Herpes Resource Center; see www.ashastd.org.
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239123_tn?1267651214
One more comment about my original reply:  In contrast to what I said above, you need to discuss your infection with your partner(s) since 2006, who should be tested (or retested) for HSV-2.
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Avatar_f_tn
From an extensive pdf from ihmf.org: Dr Kinghorn's comments contrast with Dr Hunter's affirmations that a prior HSV-1 infection will not alter the duration/severity of outbreaks, nor the frequency of viral shedding. Who to believe??

"Cinical Observations

Both HSV-1 and HSV-2 cause equally frequent and severe
local and systemic disease manifestations and
complications associated with true primary infections.23
Non-primary episodes of genital herpes occur in those with
prior HSV antibody – usually HSV-1. They are typically
milder, with fewer systemic symptoms, less extensive
ulceration, less new lesion formation, a shorter duration of
viral shedding and, consequently, more rapid healing."

http://www.ihmf.org/journal/download/Herpes%206.1.pdf
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239123_tn?1267651214
The IHMF statement you quote has nothing to do with recurrent herpes, only to the course of the initial genital herpes infection.  Probably you are confused by "non-primary".  That term distinguishes two types of INITIAL herpes, primary and non-primary; it does not mean recurrent outbreaks.  (Primary = first infection with either HSV-1 or HSV-2.  Non-primary = first infection with HSV-1 or -2 in someone already infected with the other type.)
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Avatar_f_tn
I understand the term "non-primary" infection.

My follow-up question would be: if symtoms (symptoms) of a non-primary infection are less severe, less prolonged and produce less shedding, how is it possbile that recurrant outbreaks in someone w/ existant antibodies from another type would subsequently suffer the same severity/prolongation/shedding frequency as someone who suffers a true primary infection?

Which studies been able to prove beyond doubt that a person with a non-primary infection of a different type sheds to the same extent as someone who already has hsv antibodies? Does a person with no clinical symptoms whatsoever shed to the same extent as someone with recurrant outbreaks?

Also, concerning the physical aspects of studying shedding: wouldn't the daily swabbing of certain sensitive areas actually cause shedding rate to increase? Surely, shedding rate peaks during outbreaks?

Thanks for your replies
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239123_tn?1267651214
"...How is it possible?"  I don't know; I just know what the data show.  People with genital herpes due to HSV-2 who are followed prospectively have equally frequent symptomatic recurrences regardless of whether the initial infection is primary or non-primary (see the many published studies by Wald and colleagues).  Clinical advice and recommendations sometimes need to be based on common sense assumptions, if appropriate data are not available.  When data are available, of course that takes precedence.

The rate of asymptomatic shedding is the same in HSV-2 seropositive persons with no, few, or many symptomatic outbreaks.  The calculated rates of asymptomatic shedding are based on asymptomatic days, i.e. days when someone complains of genital sores or irritation are excluded from analysis.

That's will have to do it for this discussion, however interesting it may be.
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Avatar_f_tn
Doctor,

I believe I have the right to reply, in spite of your final comment. I also believe that interest is a key word here.

According to two prospective cohort studies performed by Wald et al, both of which were carried out on women, the rate of asymptomatic shedding varies depending on the patient. Indeed, in the first study almost half the participants showed no signs of asymptomatic viral shedding whatsoever:

"However, it should be stressed that in about half of the women in Wald et al's study no subclinical shedding was detected at all and that, in those who did shed virus, shedding was detected on only a few days overall."

http://www.bmj.com/cgi/content/full/314/7074/85

A later study on men showed that frequency of shedding was similar to that found in women.

Considering this data, isn't your own statement concerning the frequency of shedding misleasding? Perhaps the rate remains the same for one particular patient, but, according to the studies you yourself cited, it can hardly be said that all hsv2 sufferers shed at equal rates.

What is your particular interest in making such statements? Is there any real need for patients who show no signs of asymptomatic shedding to take expensive daily anti-viral medication? Shedding is a great selling point, to be sure, and I also understand that it's perhaps better to be safe than to be sorry, and that calculating the rate of shedding for one particular patient is an exhaustive and expensive process, - one which would surely be less expensive (and also less lucrative for GKS etc) than taking daily valtrex.

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79258_tn?1190634010
I didn't read the article; I'm only responding to your final paragraph.

You don't have to take suppressive therapy. You can decide for yourself whether the risk of transmission makes it worthwhile for your partners. If it is an issue and you don't have insurance, I think you can also try a suppressive dose of acyclovir. One of my partners is a MD and he takes it for that reason; he says its effect is probably similar to Valtrex. Who knows. Ask your doctor.

Regardless, I'm having a really hard time getting bent out of shape over this. Honestly, herpes just isn't a big deal. It's the head cold of diseases. As far as I can tell, for most people its only impact is emotional, and in that case I think the money would be better spent on therapy. Knowing how often you're shedding sounds cool, but I can sure live without it. I can think of about a zillion other things I'd rather see studied first.
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239123_tn?1267651214
You continue to read the literature selectively, including the research by my close colleage and friend Anna Wald (who I have repeatedly credited as one of 2 people from whom I learned most of what I know about herpes).  Her studies show that when HSV-2 serpositive women self-collect genital culture specimens daily for 60 days, 90% (not 50%) have at least one day of asymptomatic shedding.  The proportion of culture positive days ranges roughly from 1% to 10%.  Using PCR--which is a more sensitive test than culture--with once daily testing >95% of HSV-2 seropositive women have at least one positive day out of 60, and the virus is detected 3% to 25% of days.  When PCR is done every 2-3 hours (this research has only recently been reported at a scientific meeting, not yet published), the proportions are still higher, and PCR tests are positive on up to 40% of days.  So the more you test, the more you find.  Most of the PCR positive periods last only a few hours, not several days as previously believed based on culture.  

Men have been studied less than women, and the rates of asympomatic shedding are somewhat lower.  But that might be due mostly to the fact that men are able to see atypical, mild outbreaks better than women can; and as I said in yesterday's comment, all these data are based on the asymptomatic days, excluding days when HSV symptoms are present.  But the basic conclusions are the same.

Many of the positive PCRs in Wald's studies are at low level, and it is likely that the transmission risk is lower that for culture-positive days.  And of course you are right that not everybody sheds at the same rate; I never suggested otherwise.  But the bottom line is that asympomatic viral shedding is a virtually continual process, not as intermittent as believed even a year or two ago.  Probably every person with HSV-2 has at least some potential to transmit the virus every time s/he has sex with an uninfected partner.  

It is also a selective interpretation of my words on this forum to say that I overly promote routine antiviral therapy to prevent transmission.  In fact, I believe the majority of people with genital HSV-2 do not require and should not take suppressive treatment for that purpose, and in innumerable threads I have reminded worried people that the actual risk of transmission is low for any particular episode of vaginal sex.  Nevertheless, every infected person should understand that suppressive therapy is available as an option.  Some will agree it's a good idea for them, others won't.

Finally, don't forget that the people who ask anxiety-driven questions on an online forum are not the same as the general population with a particular health problem.  Among forum users, I suspect more would benefit from taking suppressive therapy (for psychological if not direct prevention reasons) than the general population of HSV-2 infected persons.  As far as GSK  is concerned, the fact is that valacyclovir is the only drug that has been studied and shown to (imperfectly) prevent HSV-2 transmission.  If WackoPharm Inc. comes up with a drug that does the same thing, you will hear from me about it.

Debate is useless with people whose minds are made up and who selectively interpret the available information.  Surely you will be able to dig up responses that seem to undermine some of these points, but you won't have the chance.  As forum moderator, I get to have the last word if I want it, and will delete any further comments on this thread.
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