HSV or VZV

[hgxxghxx]

Hello Dr.

I had intercourse with my husband last Sunday and it was a bit uncomfotable. I noticed a few days later that my labia minora was a little swollen and red near the vaginal entry. I went to the gynecologist on Wednesday and the doctor told me it looked like herpes. I have looked at pictures online and my vagina looks nothing like any of them. I don't have any blister like lesions. The DR did mention that I had some minor discharge and that I had an infection.  The doctor did a scrape culture and sent me to get tested for HSV 1 and 2. I went again on Friday and my results said HSV 2 >5. I do not know if this was an igg or igm test and will find that out on Tuesday.
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Is there any way that this was a false positive? I have been married for 3 yrs without any sign of this disease and neither has my husband. The last time I had unprotected sex with a man was more than 6 yrs ago other than my husband.

-Is it possible that it was dormant all this time?

-I have also read that VZV is a herpes virus. I had the chickenpox as a child. Will a serology test for herpes pick up on a latent VZV?

-The DR I spoke with told me that I could have gotten this from sitting on a toilet and that I could not infect my husband because men do not get the disease. He also prescribed zovirax ointment, which gave me a burning sensation and apparently will only help with your first outbreak.

-Are there atypical lesions for herpes? He said that the virus can sometimes present itself as paper cut like lesions. I have closely examined myself and have neither form.

Thank you for your time and I am sorry the question is lenghty. I have been devastated since Wednesday and today has been the first time I don't shed a tear over the matter.

[Edward W Hook, MD]

Ignore the IgM, the test is worthless and will not provide you with useful information.  As we discussed, your test makes it VERY liklely that you have HSV-2.  EWH

[hgxxghxx]

Dr,

I ended up going to the ER yesterday because of the vaginal burning. They checked me out and said everything was perfect. I didn't mention my herpes status so I think my symptoms may have been psychosomatic.

I picked up my test results today and it was a HerpeSelect test with an out of range of >5.00 H for HSV 2. I also see that there is a Herpes Simplex Virus IGM AB W/Reflex to Titer test pending. Can you tell me what this means?

[Edward W Hook, MD]

Anything is possible.  Most recurrent outbreaks occur on the outside of the genitalia.  Your question will be best answered by having your doctor examine you.   EWH

[hgxxghxx]

Today I started feeling like a burning sensation inside my vagina. Is it possible that my outbreak is occurring inside rather than out, or can this also be because of a secondary infection?

[Edward W Hook, MD]

The sooner valacyclovir is started following an outbreak the greater its effect in ending the outbreak and reducing discomfort.

HSV lesions can vary a great deal in appearance.  They could conceivably look like paper cuts.

When HSV recurrences occur, the lesions typically occur at about the same time, not over a period of a week.   EWH

[hgxxghxx]

Dr,

Thank you for your prompt response.

I was planning to start taking the Valtrex to treat this possible episode, but read that if it is not started within 72 hrs of first symptoms it is unlikely to work. Can you shed some light on this for me?

I did not see you mention anything about the lesions, can they be paper cut like or vary in presentation other than blisters?

Lastly, if the swelling from last Wednesday was actually a recurrence, what is the likelihood that more of those lesions or blisters were surface now almost a week later? In other words when I have a recurrence from now on will lesions come out all at once or will one come out today and another next week?

[Edward W Hook, MD]

The topic of herpes is a complex one.  The disease is common with HSV-1 being present in over 60% of adults and HSV-2 (the virus which causes most genital herpes) being present in about 1 in 5 Americans.  For both infections, the majority of people who have the infections are not aware that they are infected, either because they either acquired it without knowing in the past or because they misidentified their herpes as something else.  I will do my best to answer your questions and make some clarifying comments but in general, many of these questions and information about herpes can be obtained by accessing excellent informational web sites such as the one run by the American Social Health Association (disclosure, Dr. Handsfield and I are both on the Board of Directors of ASHA).  Now, for your questions:

The values you mention sound like HerpeSelect results.  If they are, it is highly likely that you have HSV-2 as the higher the value the more likely the value is to be a true positive.  If your blood test is from a HerpeSelect, it is unlikely to be a false positive and sounds as though it reflects an infection that you have had for some time, not acquired recently.  Once a person has herpes, they can have it lifelong.  What you may have experienced last Sunday could have been a recurrence.

If your doctor did a "scraping" that was a culture or PCR test.  The result you mentioned was from a blood test.  Inquire of your doctor when you see him/her of exactly what tests were done and what the results of those tests were.  

VSV, the chicken pox virus is a herpes family virus but it would not change your HerpeSelect values.

I don't like to differ in opinion with our clients' doctors but people do not get herpes form toilet seats. Further, if you have genital HSV and it sounds as though that is a possibility, you can infect your husband unless he already has it. The chances are high that he already has infection.  I would suggest he get a blood test to find out.  It will influence what steps the two of you take in the future.

Oral acyclovir or other antiviral therapy is, in general, more effective than the ointments.  It gets higher levels of drug into the blood where it is needed.  In addition, the benefits of therapy go far beyond the initial treatment -check out the information on the web site I recommended.

Hope this helps.  EWH