Reason for concern? - HSV

Hi. I've previously posted in this forum but I guess the thread was ended. Please take a look at my older post so I can spare you from the whole story.

A few weeks ago - 10 months after that episode of ulceration - I felt the typical sweat/itch in the anus that comes with using tight clothes in a very hot weather. Inspecting myself, there was nothing wrong in there, but I spotted what I thought was an ingrown hair/bug bite at the very bottom of labia majora, on the left side, in a hair-bearing area that might be considered an inside area as well I guess. The ingrown hair theory made sense specially because I had waxed the area the day before. That happened on a thursday.
I admit that I inspected the damn thing almost hourly, to see if would become a blister or something like that (stretched it, picked it, you know). It looked irritated, but nothing much. No pus, no blister, nothing. On saturday, the bump started to look like a tiny open sore, and even watering it was painful. Since it was officially an open sore, I scheduled an appointment with my dermatologist for monday morning, but it was too late - the thing had vanished.
My doctor said that it had healed too fast to be herpes, but she also agrees that it's weird for an ingrown hair to become an open sore. She talked about a possible friction with my panties and said that the absence of blisters or vesicles is a sign against herpes. But I'm obviously concerned, specially because I've read that herpes doesn't necessarily start as a blister/vesicle and also because I think I felt something similar to a stinging sensation in my left buttock on that thursday (lasted less than 5 seconds).

That said: do you think I should request to be re-tested for HSV? I'm wondering if this episode demands further investigation and if I'm not in denial. Thanks.

[H. Hunter Handsfield, M.D.]

Welcome back to the forum.  I reviewed your previous thread.  The conclusion that you had not acquired genital herpes was strong.  As for your current symptoms, recurrent herpes does not occur commonly in hair-bearing areas, which of course is exactly where folliculitis is most common.  And contrary to what you might find on some websites, herpes and folliculitis are quite easy to tell apart from one another, especially by an experienced clinician.  The "stinging sensation" of the buttock also does not suggest herpes.  Here too it is easy to be mislead by health education information that describes burning, tingling, and such symptoms with genital herpes.  But in fact, these rarely if ever are the only symptoms of herpes.  Herpes lesions may burn, sting, or tingle -- but those symptoms without blisters/sores does not occur in herpes.

So I see no need for additional HSV testing.  The only slight wrinkle is that your last HSV blood test was done 2.5 months after onset of symptoms, if I correctly recall your previous thread.  Once it a while it takes 3 or even 6 months for positive results for HSV-2.  If you remain nervous about herpes, you could be retested now.  If that result remains negative, you can be 100% certain your initial genital ulcers were not herpetic.  But even if positive, I would remain confident herpes was not the cause of any of your recent symptoms.

I hope this helps.  Best wishes--  HHH, MD

[pa_pumpkin]

Thanks, Dr. HHH. Very appreciated. I'll probably get re-tested, but I'm not awfully concerned - if I do happen to have it, it's not giving me a lot of trouble.

As for the testing timeline, I ended up settling at the 2.5 months mark because there's absolutely no chance I might have caught this after January 2009. So the test was actually performed 4.5 months after supposed infection. Would you still consider it a wrinkle?

I would also appreciate your opinion concerning the long time that it took for my supposed initial infection to occur - 10 weeks after exposure, aproximately. Is that plausible at all? By initial infection I mean those bilateral, widespread sores.

[H. Hunter Handsfield, M.D.]

Sorry, I misunderstood the timing.  Your negative results at 4.5 months can be considered definitive.  And I agree that 10 weeks is definitely much too long after exposure for the onset of genital herpes.  Considering all the evidence, you can be sure you don't have HSV-2.  There is no need for additional testing.