Worried about possible genital herpes with abnormal presentation?

[Jenjen1026]

I have been with my boyfriend 18 months and have had oral/genital sex with condoms until I started birth control in January. He has had cold sores-none of which he would even kiss me on the lips. Both tested for STDs & negative.
March 9th, I noticed one tender pimple like bump on my genitals-on the right side of the labia majora towards the back.  Almost in between the vaginal opening and the rectum.My PA didn't think it was herpes but a "vaginal abscess." I shave down there but hadn't for a few weeks, though I believe I remember cutting myself in around that area, but hadn't felt anything since. Did an I&D, and cultured it for bacteria only-negative. She repeatedly stated it didn't look like herpes. The pain from the I & D healed though the painless bump persisted. March 20th, the area around the bump was red/warm to touch and my right labia became swollen only on that right side. Noticed the pain when I was wearing tight pants and walked a lot. Went to urgent care, got antibiotics (Augmentin 875/125 PO TID for 10 days) and this helped. Worked two long 12 hour shifts and was walking a lot on March 27/28. I also had some breakthrough bleeding-which dried blood on my underwear-made for a pretty rough piece of material that was rubbing my private parts. I got extremely irritated/swollen on the left labia and was diagnosed w/ an ext yeast infection. Treated with antifungal cream (burned a lot) & diflucan. Showed BV on a wet wound, treated w/ metrogel which burned my skin too. My culture showed yeast and BV after treatment. Treated again w diflucan &PO flagyl. I am irritated again in the spot of the initial bump-though that is GONE completely and my doc felt it was possibly jock itch, looks a bit macerated in that area. Treated w/ a steroid/antifungal which again burned.Vaseline has helped though it still hurts to walk-it is in a skin crease. on 4/9 all STD tests negative but could a generalized achey mons pubis and persistent swelling be reason to think it's herpes?

[Jenjen1026]

Great. That sounds good! Should I have protected intercourse just in case or does this seem unnecessary seeing my blood test was already negative & symptoms are not really consistent with herpes either?

I will probably do another test in a month. Thank you very much again. I feel a lot better.

Sincerely,
Jennifer

[H. Hunter Handsfield, M.D.]

Your negative blood test is fairly reassuring.  Around 50-60% of newly infected persons would have positive results by 4 weeks.  Consider another one at 3 months, but you can definitely expect it to remain negative.  Given your current result, I don't really see a need for your partner to be retested.

Thanks for the thanks.  Take care.

[Jenjen1026]

Hi Doctor,

Thank you so much for your prompt response. I figured as much, but I've read stories where people have one pimple-like bump that ends up being herpes so I got paranoid. :-)

I actually had an HSV 1 and 2 blood test on 4/9 about 4 weeks after the initial symptoms. Both of which were negative. But I've read it takes time for those to become positive? So I again, got concerned since my symptoms have been so persistent. Though I don't have any other bumps or lesions thought this entire time. So again, I think youre right to say herpes doesn't seem to be the cause. I'll ask my partner to be tested again. I actually woke up today feeling much less irritation after applying Vaseline for two days and the swelling has subsided.

Thanks again for everything,
Jenn

[H. Hunter Handsfield, M.D.]

Welcome to the forum.  Thanks for your question.

Your symptoms really don't sound like herpes, which causes entirely different symptoms than deeper infections like pimples and abscesses.  And gynecologists are highly familiar with all such conditions, so your doctors' opinions and advice are highly reliable.  Further, herpes doesn't cause the apparently prolonged sort of problems you have had, and doesn't generally cause lesions in skin creases -- but that's a typical place for various bacterial and fungal conditions.  (Are you by chance over weight?  Heavy people often have great difficulty with such infections, because the skin folds keep the area moist and warm.)  And no, "a generalized achey mons pubis and persistent swelling" doesn't suggest herpes either.

Having said, that I cannot rule out that you don't also have genital herpes, in addition to the abcess, BV, etc.  While herpes clearly isn't the main problem, conceivably a herpes outbreak could get secondarily infected, i.e. to provide an opening for a bacterial or fungal infection.  I doubt you do, but you might speak with your doctor about having an HSV blood test for reassurance.  In fact, both you and your partner could be tested.  Probably you would find that your boyfriend has a positive result for HSV-1 (due to his oral herpes) and that neither of you has HSV-2, the usual cause of genital herpes.

I would be happy to hear about the result of an HSV blood test, if you do that.  But for now, I don't think you should be at all worried about herpes.  It clearly isn't the main problem explaining your symptoms.

Best wishes--  HHH, MD