Unfortunate Evening and HSV 2, Scared

[bryn1]

Dear Dr.,

Thank you for your informative site.

I am a 40 year old female going through a divorce. I had unprotected sex with a stranger after becoming very drunk. He was mid-20's. This was 3/09/06. 3 days later, I developed lesion on vaginal opening. I went to Dr. a few days later (7 days, to be exact) and was very sick as well with what seemed to be a stomach thing and a fever. My Dr. did culture and tests for all other STD's in protocol.  Culture came back positive for HSV 2 a few days later ( All other STD's negative.) Because of positive HSV test, she had me come back in and tested me for HIV. That came back negative as well (tested only 2 weeks after exposure.) I had been in a monogamous relationship for 15 years but this nasty divorce led me to be very emotionally vulnerable! I know, no excuses.  I recovered quickly from everything immediately after starting Valtrex. I did a 10 day course.  The problem is, I think I had a recurrence. I went away on Spring Break on March 31 with my children. I started having tingling, itching and "pin *****" sensations around my vagina and anus after spending a day by the pool  This continued despite that I started using the Valtrex again.
This has been going on for 2 weeks now. I have had hemorrhoids in the past from childbirth and that is what it kind of feels like. The itching and redness is gone but the "pin pricks" and crawling sensation around anus won't go away.

QUESTIONS
Could flu-like illness days seven days after exposure be ARS? My Dr. said no, but I am scared to death that I have HIV (the guy was young but obviously was not clean, and I don't know his sexual history. I know he is divorced and the father of 2 girls but that means nothing, I know.) I am repeating test at 6 weeks and then at 3 months. It seems unlikely to have been HIV related if my HIV test was negative after the fact? I have read that after one unprotected vaginal encounter my risk is very low, is this true? I feel like my first test probably was not very accurate?

Could the new "recurrence" of symptoms be the Herpes or another STD that may not have shown up yet? I have read various things that first occurences can last a long time and have various symptoms. And, I have been in the sun and been under tremendous amounts of stress (I have recently also been through a business divorce from my partner.)

I plan on going back to the Dr. as Valtrex not helping this maddening set of symptoms.  Do you have any feedback on this?

This is a very unfortunate situation in that I was in a miserable marriage. I have certainly learned my lesson and just pray to God I don't have HIV (there have been no fevers since first thing right after exposure, or any other illnesses.)

Thank you !!!


I

[H. Hunter Handsfield, M.D.]

Your symptoms all are quite typical for initial a primary herpes infection, which often causes a stuttering course of on/off genital symptoms as well as fever and other flu-like symptoms.  Antiherpes drugs sometimes reduce the symptoms without completely eradicating them.  In other words, there is no particular reason to invoke HIV in addition to herpes.  Further, the odds are very great that your casual partner doesn't have HIV.  (It is wrong that what you know about him "means nothing".  He is primarily, if not exclusively heterosexual.  That means a whole lot.)  And, as you already realize, even if he has HIV, the odds of transmission are low during any single exposure.  Even though those odds are significantly elevated in the presence of HSV-2 transmission, on balance it is very unlikely you have HIV.

Given the overall situation, it probably is a good idea to follow up with repeat HIV tests at 6 weeks and 3 months, as you are planning.  But I expect the results to be negative.

As for your continuing symptoms, they don't sound like herpes--and the lack of response to valacyclovir pretty much rules out herpes as an explanation.  But they also aren't typical for any other STD.  Maybe yeast?  Some sort of dermatitis?  You'll need to follow up with your doctor and let him figure it out.  But it doesn't sound like anything serious.

Good luck--  HHH, MD

[bryn1]

Wow, that was fast...I really appreciate it. I will go see my Doctor, in the meantime, thank you so much, I might sleep a bit easier tonight but will do everything you say.

Best regards,

Bryn