Sick with anxiety.. Possible herpes? Please help...

[worried970]

I can’t give you all the info I want bc there is not enough room. Basically my history is: 23 y/o white female with history of oral herpes (not documented with testing) and one time Chlamydia infection. Have noticed a recurring painless sore (a few mm in diameter) on the left side of my introitus. First noticed a year ago when was diagnosed with Chlamydia . No pain, no burning when urine passed over it, no constitutional symptoms. GYN refused herpes testing because she said I was not in enough pain. Noticed it a second time after unprotected sexual encounter which seemingly gave me my first ever yeast infection.  Had HSV culture at two different places (neither of which I think swabbed the actual sore.. just kind of randomly swabbed introitus and other excoriations from yeast infection). Both came back negative so was treated for yeast. Noticed sore a third time about 10 days ago after sex in shower. Had severe vaginal burning with urination, but only for one night. Sore was bigger in size than before (now about ½ cm). Still no pain, no burning with or without urination, no vesicles ever noticed. Prescribed diflucan over the phone. Sore since then has gotten smaller in size.

So here are a few questions.

1) What could possibly cause a painless sore to re-appear in the same spot?

2) Is it possible that this sore just comes and goes in this spot due to higher friction in that area during sex? Or maybe the spot was easily eroded off because of a concurrent yeast infection?

3) Could a herpes sore be completely painless? Maybe because I have some resistance to severe outbreaks due to practically 20 years of what I think to be oral herpes? The sore looks as if it could be herpes to me (considering I know what they look like on my mouth).

4) If I auto-inoculated myself in that spot, should I expect a herpes outbreak to be minimal like this? (Due to HSV1 not being in its site of preference and me already having anitbodies to this virus type)

[H. Hunter Handsfield, M.D.]

Your doctor is wrong that herpes sores always cause pain.  Many do not.

Herpes is overall the most common cause of recurrent genital ulceration, and recurrence each time in more or less the same spot is also suggestive of herpes.  Most likely the recurrences have nothing to do with your sexual exposures, however.  Herpes outbreaks are not triggered by sex.

That said, herpes isn't definite.  Other less likely causes include trauma, yeast, various other nonsexually acquired infections, and certain rare immunologic disorders (e.g., a rare condition called Behcet's syndrome, which is most common in people of Mediterranean origin, such as Turks, Armenians, etc).  Finally, syphilis always is a consideration for genital ulcer disease and usually are painless, but recurrent outbreaks like this are not likely due to syphilis.

To the specific questions:

1) Herpes seems the best bet, as I said above.

2) Those explanations might be possible, but seem less likely to me than herpes.

3) Most herpes sores are painful, especially for lesions as large as you describe.  But not always.

4, 5)  If you have genital herpes, it is probably HSV-2, not HSV-1; and probably was acquired sexually from a partner, not by autoinoculation from your oral herpes.  The amount of pain with the lesions isn't related to virus type, or to whether or not someone has herpes elsewhere on the body.  But autoinoculation is rare, and occurs primarily during the very first herpes infection; autoinoculation from a chronic, longstanding oral infection is very rare, if it occurs at all.  Finally, genital HSV-1 outbreaks usually occur no more often than about once a year.

The way to sort this out is to have an HSV blood test to see if you are infected with HSV-2.  In addition, another culture or PCR test from the sore would be a good idea; see your provider immediately (within 24 hours) if or when a lesion appears again.

This probably isn't what you wanted to hear, but I hope the information is helpful.  Best wishes--  HHH, MD

[worried970]

And one more question...

5) Basically, what do you think the chances of me having HSV1 or 2 genitally based on this massive amount of information?

[worried970]

Yeah, that's obviously not what I wanted to hear, but I really appreciate your prompt response. I had blood drawn today for HSV serotyping and should have the results by next week.

Something else that I have been thinking about. When my first sore appeared about a year ago (and was disregarded by my GYN) I thought I was cleared of any STD risk. Therefore I have been having unprotected sex with my bf for nearly a year now, and he has not had any symptoms of genital herpes. I would think that if I had it he would have caught it by now.

I also know that a lot of genital herpes are very mild. I am not thrilled with my GYN and am in the process of finding another one.

[H. Hunter Handsfield, M.D.]

It is likely your boyfriend would be infected by now, but by no means certain.  It often takes months or years before HSV-2 is transmitted, even with regular sex.  And your partner could be infected but have no symptoms.  I suggest you wait the results of your own HSV blood test.  If that confirms that you have HSV-2, then your partner also should be tested.

[worried970]

Alright.. I have another scenario for you to consider. Now that I think of it, ever since I first noticed the sore, or lesion, or whatever.. I have never seen it completely gone. Every time I have checked, for an entire year, it is always there. I just seem to be more paranoid of it if I am having other symptoms (eg. yeast infection, burning with sex, even coldsores). The only time I saw it bigger was about two weeks ago. Is it possible to have an almost continuous lesion or herpes that never completely heals?

And, in your opinion, even if a sore is painless, wouldn't you expect it to at least burn when urine passes over it if it were herpes?

I'm sorry for all the questions, but I'm trying to look at it from every possible angle. I am a very anxious person and this is literally making me sick.

I will also let you know the test results as soon as I find out (which will hopefully be Monday).

I really appreciate your time!

[H. Hunter Handsfield, M.D.]

If there really has been an open sore for a year, it isn't herpes.

I would expect any genital sore, whether due to herpes or anything else, to be painful when urine passes over it.  In other words, that symptom is atypical for every possible diagnosis; it doesn't help at all in distinguishing herpes from other causes.  However, this also suggests the possibility that it isn't actually an open ulcer -- maybe just a depression in the tissues, but with normal membranes or skin covering it.

None of this changes my advice about having an HSV-2 blood test.  I look forward to hearing the result, and also agree that since you don't have confidence in your current provider, you should try to find one who has lots of experience with patients with herpes.

[worried970]

Thank you so much. I really commend you for providing your time and advice in this forum.

I have also considered the possibility that it is just part of my "normal" anatomy; however, the one-time increase of size made me think otherwise.

There are so many "ifs, ands or buts" going through my mind that I won't plague you with those :] I'll just wait for the results of the HSV test and go from there.

Like I said, I'll let you know the results.

[worried970]

I called my doctor's office today and they said they don't think the results will be in until Wednesday :[

Since the increase in size, the lesion (or whatever) has shrunk down to the "original" size that I always remember seeing it at. It has been about 2 1/2 weeks since I had noticed it was bigger and I'm wondering if it will ever completely disappear.

I suppose there is always the coincidence that every time I checked within the past year I was having an "outbreak" if it were herpes. However, I fail to pinpoint any associated symptoms with the sore. I would usually become more paranoid and apt to check the area if I felt anything else was going on down below (yeast infection, UTI, occasional burning with sex).

So I guess a new question for you is:
What do you think about this?
How long would an internal sore that is always moist (on the inner most part of my introitus) take to heal if it were herpes? Longer because of the moisture?

I know I said I'd wait for the results, but all of this is just completely running me down.. I am exhausted mentally and physically :[

Thank you so much again.

[H. Hunter Handsfield, M.D.]

Time to stop guessing and speculating.  Two more days isn't so long to wait for the test result.  Until the test result is available, I have no additional thoughts.

[worried970]

I understand and am sorry. I know you probably get sick and tired of overly anxious people.. I won't post again until I have my results.

[worried970]

HerpeSelect Test Results

HSV-1 IgG 4.53
HSV-2 IgG 0.09

I expected the HSV-1 result as I have had cold sores since I was a child.

So I guess now I have no idea what my vaginal lesion could be. I am very relieved, however, that I don't have gential herpes! (Although my last unprotected sexual partner was June14th ~ I made him get tested and he said his STD "bloodwork" was all fine. I'm assuming he was tested for herpes. I'll ask him to make sure)

Any additional comments or advice?

[worried970]

I asked my last partner about his testing and he said his bloodwork tested negative for herpes.

Finally I can put the worry behind me.

Thanks doc.