Herpes or Vulvodynia

[petrified]

Okay, this is getting ridiculous……….my connection at the hotel has disconnected 2 times now……..therefore, I have attempted to post my question 3 times to this web-site - - I have made 3 donations!!!  I am starting to wonder if I shouldn’t be posting my question????

Okay, here’s my situation.  I have had vulvar burning for the past 7 months (on again/off again)…..I can not tell you whether there is a pattern since I stopped tracking.

I have tested negative for Herpes using HerpesSelect at 13 weeks, 17 weeks and 24 weeks past exposure - - all results came back negative.  I have also been swabbed twice (once vaginally and once anal - - I have an anal fissure that won’t heal) - - both cultures came back negative.

At this point my GP has concluded that I have Vulvodynia and has referred me to a vulvar pain specialist.  In my GP’s mind, Herpes is not the cause of my vuvlar pain nor my anal fissure.

Given I have read way too much on this web-site, I know that some people may never seroconvert using standard tests.  My GP believes, given my “extreme” symptoms, I would have seroconverted.  My GP believes that someone that doesn’t seroconvert has a mild/no symptoms and has very low viral load and therefore isn’t detected.  What’s your opinion?

So, given I’ve been negative using HerpesSelect………how can I 100% eliminate Herpes as an explanation to all my Vulvar burning?  When I get intimate again with another man, I would like to know that I can tell him with a 100% certainty that I don’t have Herpes.  What test can I take?  (I understand that using Western Blot is only a good tie-breaker, given my negative results/non-confusing results, I am assuming that is not a good option).

So, I really have two questions:

(1) Seroconversion - - do you believe that given my extreme symptoms, I would have seroconverted?
(2) What other test can I take to 100% eliminate Herpes as a potential cause of my Vulvar burning and anal fissure?

Thank you very much!  Regards.

[H. Hunter Handsfield, M.D.]

1) Yes, if you had herpes almost certainly you would have seroconverted.  I have never seen a case of vulvodynia due to herpes.  In other words, a persons who has pain due to herpes always has visible herpes lesions, in my experience and it is easy to confirm the diagnosis by viral culture.  If you add up the odds based on both the clinical syndrome you describe and the risk of a false negative blood test, the likelihood that herpes explains your symptom is virtually zero.  (Your GP may be right that seroconversion is related to viral load and therefore to symptoms; it makes sense.  But to my knowledge no research has shown that to be the case.)

2) You correctly state the normal use of Western blot.  You could still do it, however; the anticipated negative result might help convince you about the non-diagnosis.  The other thing you could do is ask your provider to presecribe a 10 day course of antiherpetic therapy, e.g. valacyclovir.  If you have herpes, your symptoms should markedly improve within a few days; if no improvement, it will be further evidence against herpes.

Bottom line (no pun intended):  It is very unlikely herpes explains your symptoms.  But knowing how distressing vulvodynia can be, I understand your desire to be even more certain than normal.  I suggest starting with the trial of herpes therapy; then consider WB only if it seems to control your symptoms.  (I don't mean subtle control, e.g. "I think it's a little better."  If you have herpes, your symptoms will be totally gone within a few days.)

If your credit card really was charged more than once, contact the MedHelp administrator; you'll be credited appropriately.

Good luck--  HHH, MD

[petrified]

Dr. HHH, thanks for your response.  One more for you........and I think I know your answer, but didn't want to assume.  I had been having incredible burning vulvar pain from Sunday - Monday.........On Monday night I just couldn't stand it anymore (and couldn't get in touch with my doctor) so I finally used gyne-lotrimin in hopes maybe it would give me relief.  Well, about 36 hours later and the pain is not as intense - - not completely gone, but much better (I don't want to cry from the pain now).

So, my question, can I conclude that if it were Herpes, I would still be in pain?   I know with repeat Herpes "outbreaks", the duration is shorter.  I just was curious how long a "typical" herpes sufferer is in pain during recurrent episodes?  Could it be possible to have incredible pain from Herpes for two days and then start to get relief because it's starting to heal?

My assumption is that you will tell me if it were Herpes it would not have responded to the gyne-lotrimin or that a typical recurrent Herpes outbreak would last longer than 2 days........

Thanks for your help!

[H. Hunter Handsfield, M.D.]

Both herpes and vulvodynia have variable symptoms over time, and the apparent response to the antifungal cream might be coincidental.  Or you might have a yeast infection, either as the sole problem or in addition to vulvodynia.  Or the cream might have just been soothing.  In any case, this doesn't help differentiate vulvodynia from herpes.  Recurrent herpes generally is painful for 2-7 days and then heals over the next few days.  But as I said above, you can be certain herpes isn't your problem.

HHH, MD

[vmac]

A related discussion, vulvodynia? was started.