Herpes?

Hello,

I know you answer very similar questions to this every day but I would be so grateful if you could please give me your expert opinion. I am a 23 year old female.

Basically, I have been tested for almost every single STI and all tests have all been negative. The only 2 which I haven't received blood tests for are HPV and Herpes. I did come off the contraceptive pill for 6 months a couple of years ago and experienced vaginal dryness and had 2 small cuts near the top of my clitoris but they were negative for HSV. However, over the last 8 months, I get a regular vaginal discharge which is either watery or like a thick creamy paste which begins just after my period stops and then I experience a lot of pain in any area with hair (pubic and the outer lips) and some itching. I am not sure whether this is through shaving that region (however, I haven't done so in about 2 months) and there are no lesions, blisters or scabs. I am HSV-1 positive and I know you can get some resistance and milder symptoms if you are infected with HSV-2 because of this.

My main question is does pain in the hair region and occasionl itching, sometimes mild burning of the vulva sound like herpes with no lesions or other symptoms. It's occurring every month right until my period starts and I first suspected yeast but my doctor says it's not and I am imagining it all. With no overt symptoms i.e. blisters then I have been refused a blood test for HSV-2. I've read all the threads in the forum and I'm thinking it could be vulvodynia? I've noticed when I scratch sometimes, I have very flaky skin in the pubic region. I'm worrying myself silly that I have HSV-2 and I just wanted your advice. I've recently started applying Hydrocortisone cream to the hair regions.

Many thanks for any advice you can give me.

[H. Hunter Handsfield, M.D.]

My opening comments in the thread immediately before this one also appy to your question:  "If a person has to ask whether particular symptoms are due to herpes, almost always the answer is no.  Herpes can be entirely asymptomatic, but when it causes symptoms at all, those symptoms are generally quite characteristic of the disease and not 'atypical'."  

And now having read your question, indeed herpes is unlikely to explain your symptoms. Even if you were to have a positive blood test for HSV-2, I would suspect you have asymptomatic herpes plus some other cause of your symptoms.  Herpes doesn't cause itching or burning without overt blisters or open sores.  And although herpes can cause vaginal discarge, that is rarely the only symptom, and herpes does no recur so regularly--and rarely as often as once a month.

So I doubt you have herpes.  That said, it's a general principle that HSV antibody testing is a good idea in people with unexplained, possibly inflammatory genital symptoms--so I don't understand your provider's resistance to testing.  It could indeed give misleading results--for example, if positive for HSV-2 it won't prove your symptoms are due to herpes--maybe that's his or her reason.  But if negative, it would prove that herpes isn't the cause and both you and s/he could then more easily.

I'm interested that you know you are HSV-1 positive.  When HSV-1 blood tests are done, usually HSV-2 testing is done as well.  In any case, you are only partly right about the effect of HSV-1 on HSV-2.  There is some evidence (but with conflicting research results) that having HSV-1 might make someone less susceptible to catching HSV-2 if exposed.  But HSV-1 does not change the symptoms or severity of HSV-2 in those infected with both viruses.

Vulvodynia is just a word to use for otherwise unexplained vulvar itching or burning.  Asking whether you might have vulvodynia is sort of like asking whether recurrent headaches might be due to headaches of unknown cause.  In general, however, vulvodynia doesn't include recurrent vaginal discharge, and I believe most women with that problem have continuous and not intermittent symptoms.  But these really are issues for your gynecologist; I'm not an expert in this area.  I advise against hydrocortisone unless recommended by a health care provider.

Bottom line:  Your symptoms aren't due to herpes, but if you remain unconvinced you should discuss the idea of testing with your provider once again (you could show him/her this message).  Further, your symptoms don't suggest any other STD either.  (You mention blood testing for HPV at the start of your message.  You probably didn't mean it; there is no blood test, or any other test, designed to pick up asymptomatic HPV infection.)

Good luck---  HHH, MD

[H. Hunter Handsfield, M.D.]

The end of paragraph 3 is supposed to read "...both you and s/he could then more easily move to evaluating other causes."

[pleasehelpmeuk]

Thank you for your reply doctor. I only know I am HSV-1 positive as I have coldsores on my bottom lip which I have experienced from being very young. I don't believe I have been into contact with the HSV-2 virus as I have been generally very careful although there have been some unprotected instances but of the partners I have had (7 in total, 2 with no sexual experience before me) none have had any HSV-2 symptoms. Furthermore, my current partner who I have been with for over a year (and whilst I have had these symptoms) has not had any herpes symptoms (please god!) although we are very careful, there have been a handful of times when we haven't. I believe the stats in the UK for HSV-2 are 1:10 which I suppose statistically I may not have even come into the virus.

[H. Hunter Handsfield, M.D.]

You are right that about 10% of UK adults have HSV-2 infection, versus about 20-25% in the US.