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Worried about genital HSV1.
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The STD Forum is intended only for questions and support pertaining to sexually transmitted diseases other than HIV/AIDS, including chlamydia, gonorrhea, syphilis, human papillomavirus, genital warts, trichomonas, other vaginal infections, nongonoccal urethritis (NGU), cervicitis, molluscum contagiosum, chancroid, and pelvic inflammatory disease (PID). All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.

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Worried about genital HSV1.

I'm a 24 year old female.

In October I was dating a man. We engaged solely in hand/genital stimulation, and at some point he may have used his saliva as lubricant on me. No oral or genital sex. I tested previously for HSV, and was negative for both types, and so I asked him if he got any cold sores, and he replied that he never had. As I said, 2 months passed after this with no further contact with him, I began dating someone new, and I never developed any symptoms of any kind.

In December my current boyfriend obtained a Herpeselect before any sexual contact (and at the appropriate time..it had been 6 months since his last sexual contact/kissing with anyone) and it was negative for both HSV1 and HSV2.  A couple weeks after we get his results, two days after oral sex, I developed diffuse vaginal redness, itching, and little white pustules on my vulva and a large white flat plaque on my clitoris. No fever, swollen glands, etc. I immediately went in to see my gynecologist. He examined me, and took out a colposcope to look at the lesions on my clitoris and was actually able to scrape one off. He said it was a cutaneous yeast infection. He also reluctantly took a herpes culture and blood, because I insisted upon it, but he said it wasn't necessary.  He prescribed diflucan, and I had relief within 15 hours and complete resolution of symptoms within 4 days. The viral culture and the new herpeselect all came back negative.


My anxiety is getting the best of me. I know my current boyfriend doesn't have HSV. I know my symptoms were 99% likely to be yeast. But just for my peace of mind, could my October exposure to an individual of unknown HSV status have produced the symptoms I described 2 months later? I had blood drawn 9 weeks after during the bad yeast infection I had, and it was negative. I got tested again at 20 weeks yesterday.
239123_tn?1267651214
Welcome to the forum.  Thanks for your question.

I think you're dealing with a "left brain, right brain" conflict.  Your left brain objectively understands you don't have herpes, and it provides an excellent explanation of the rational reasons.  But your right brain -- the emotional, intuitive side -- remains fearful that it's really herpes after all.

I can assure you with great confidence that your left brain is correct.  You have been examined by an apparently knowledgeable and competent gynecologist, who undoubtedly has cared for hundreds of women with both yeast infections and herpes; your symptoms are more consistent with yeast than herpes; you provide strong evidence you were not sexually exposed to anyone with either HSV-1 or HSV-2; and the negative HSV culture is also strong evidence; with the active inflammation you describe, the test surely would have been positive if you had herpes.

Also, the answer to your direct question is no.  If your symptoms were due to herpes, they were suggestive of an initial infection, not a recurrent one.  And initial herpes symptoms generally start 3-5 days after exposure, rarely later than 10 days, and never more than 3 weeks.  Two months is way too long. Finally, the large majority of new HSV infections give positive blood test results within 6-8 weeks; your negative result at 9 weeks is additional evidence against HSV.  Had you been my patient, I would have agreed with your gynecologist in advising against testing for HSV.   You can be sure your 20 week blood test will also be negative.

So do your best to stop worrying about this.  You clearly don't have genital HSV-1.

I hope this has been helpful.  Best wishes--  HHH, MD
8 Comments
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Avatar_m_tn
Thanks Dr. Handsfield, your comments have been greatly reassuring. I have two short additional questions.

Were my symptoms (the diffuse redness, white plaques that gyno was able to rub off, rapid healing time in response to diflucan, and lack of sores/ulcers, NO swollen glands or fever or pain urinating) indicative of herpes in any way, and could I have just had a simultaneous infection with yeast?  


Finally, I came across a quote by you that I just want a little clarification on. "It is quite common for people to have genital HSV-2 for years before experiencing their initial symptomatic outbreak." Could this apply to me with HSV1? Or do you mean that people DO experience symptoms within the incubation period, they just are mild and don't notice them until later, or do they legitimately pass through the incubation period with no symptoms and don't have an initial outbreak until much later? These will be my final comments.
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239123_tn?1267651214
Herpes can cause some of the specific symptoms you mention, but the overall pattern is against herpes as the cause.

When there is delayed onset of first symptoms, as in the quote you found, the first symptoms mimic a recurrent herpes outbreak, i.e. mild and localized.  That's why I emphasized that in your case, the symptoms were more suggestive of an initial outbreak -- and that would have to mean catching it only a few days (up to 3 weeks) earlier.

It would appear you are spending far too much time researching this online and by seeking statements on this forum.  I suggest you stop.  Anxious people almost always are selectively drawn to information that reinforces their fears and don't "see" the reasuring bits.  It isn't worth it.  Do your best to accept the reasoned, science based reassurance you have had and move on with your life.
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Avatar_m_tn
I'm just concerned because people on this website harp about how the Herpeselect misses 1 in 10 cases of HSV1.

I did develop symptoms 2-3 days after oral sex with my current boyfriend. He has never had a cold sore, and his Herpeselect was negative for HSV1 (and HSV2),  and now with you telling me that some of my symptoms can be attributed to herpes, I'm obviously pretty concerned. My gynecologist said that it looked nothing like herpes, and that the flat white plaque on my clitoris that he inspected with a colposcope, and was able to rub off, was particularly indicative of yeast, along with my rapid healing time (from symptoms to diflucan administration to complete healing, it was about 4-5 days).
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Avatar_m_tn
I should also mention that when I had the "yeast infection" all around my vulva on both sides, tiny little pustules appeared. Some were preceeded by a red base. They weren't clustered. They left flat reddened areas, but were not sores or ulcers. They healed rapidly following diflucan administration. Can a cutaneous yeast infection cause symptoms like this?
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239123_tn?1267651214
My confidence you don't have it is based on all the information available.  It is a mistake to focus on any one element, such as the reliability of HSV-1 blood tests.  There is simply no chance you have it.  And yes, yeast infections frequently look like and behave exactly as you describe.

You came here for reassurance, and even stated you were already 90% convinced.  I would advise you to accept the reasoned, science-based advice you have had, without second guessing or over-analyzing it.  You can safely go the last 10%.

That's my last advice.  Try to move on.
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Avatar_m_tn
Hi Dr. Handsfield, just updating you with my blood results,

At 20 weeks, my HSV1 antibody titers were 0.14 and HSV2 0.08. My HSV1 titers were previously 0.09. Is there any reason that it's higher than my HSV2 titers? Could I be in the process of seroconverting?
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239123_tn?1267651214
No, no chance.  You misunderstand how the test works.  Any number below the positive cut-off is truly negative.  If the very same specimen were tested 10 times, it would given 10 different numbers that might range more widely than your numbers have.  If below 0.9, such changes are meaningless.

Please ignore any and all other "what if" or "could it be" sorts of questions that come to mind -- or at least do not post them here.  There is no additional information that could possibly change my opinion or advice.  Do your best to move on without worry about herpes.  If you find yourself still obsessing about it, you'll probably need counseling to get beyond it.
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