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possible herpes misdiagnosis?
Drs. Hook and Handsfield,
Thanks for taking the time to answer my question. Last July I was diagnosed with genital herpes, but some recent reading has been making me wonder if I should not question this diagnosis. Here's what happened:
Last December I suddenly had a strange rash that covered the entire surface of both buttocks. The rash consisted of painless little red bumps, not fluid filled. It persisted for about a week. While it was resolving I noticed some painful red bumps (again, not fluid filled) around the opening to my vagina and on my labia majora. I was concerned and immediately went to my student health center - the nurse practioner there said she didn't think it was herpes and sent me home with antibiotics for folliculitis and a script for Valtrex "just in case." The bumps resolved on their own without treatment in a few days - no ulcerative stage.
The bumps recurred in July, at which point I went to the public STD clinic. The doctor there said that my story of having begun a new relationship a few months before my first outbreak together with the bumps made him "fairly sure" it was herpes. He also advised me to stop shaving the region.
Here's what concerns me: he did scrape the lesions (I'm not sure if for viral culture or PCR?) and they came back negative for HSV1 and HSV2. Although I understand there's a strong possibility this is herpes, what I'm wondering is should I pursue this further? My boyfriend has never noticed any bumps and we always had sex with condoms. Is it possible this is some sort of razor burn or folliculitis? Since I stopped shaving it has not recurred.
Do you recommend I get the HerpeSelect test or should I just let this be? Also, I've had cold sores my whole life, so I'm assuming HSV1 will test positive either way. From what I understand from your earlier posts there's no way my genital lesions could be due to HSV1 since I'd be immune. Is this correct?
Thanks for taking the time to answer my question. Last July I was diagnosed with genital herpes, but some recent reading has been making me wonder if I should not question this diagnosis. Here's what happened:
Last December I suddenly had a strange rash that covered the entire surface of both buttocks. The rash consisted of painless little red bumps, not fluid filled. It persisted for about a week. While it was resolving I noticed some painful red bumps (again, not fluid filled) around the opening to my vagina and on my labia majora. I was concerned and immediately went to my student health center - the nurse practioner there said she didn't think it was herpes and sent me home with antibiotics for folliculitis and a script for Valtrex "just in case." The bumps resolved on their own without treatment in a few days - no ulcerative stage.
The bumps recurred in July, at which point I went to the public STD clinic. The doctor there said that my story of having begun a new relationship a few months before my first outbreak together with the bumps made him "fairly sure" it was herpes. He also advised me to stop shaving the region.
Here's what concerns me: he did scrape the lesions (I'm not sure if for viral culture or PCR?) and they came back negative for HSV1 and HSV2. Although I understand there's a strong possibility this is herpes, what I'm wondering is should I pursue this further? My boyfriend has never noticed any bumps and we always had sex with condoms. Is it possible this is some sort of razor burn or folliculitis? Since I stopped shaving it has not recurred.
Do you recommend I get the HerpeSelect test or should I just let this be? Also, I've had cold sores my whole life, so I'm assuming HSV1 will test positive either way. From what I understand from your earlier posts there's no way my genital lesions could be due to HSV1 since I'd be immune. Is this correct?
A related discussion, Misdiagnosis of Genital Herpes was started.
I'm sorry I should have been more clear - the recurrence was on the labia only. But regardless it sounds likes I should go ahead and get the blood test - thanks for your help.
MEDICAL PROFESSIONAL
From your description I am skeptical you have herpes. Initial herpes rarely involves the buttocks. The virus has to be "massaged" into the skin, and the lesions occur exatly where that happens--in other words, the genitals or anus, usually where sexual friction is greatest: mostly the vaginal opening and labia minor in women, the penis in men. I have never seen a case in which the initial infection was manifested primarily on the buttocks, even though recurrent outbreaks can happen there.
As to the second "outbreak", that also doesn't fit. Recurrent herpes is always localized to one side of the body's midline, and typically very localized--generally in a small patch no more than 1-2 inches in diameter. Lesions on both buttocks is unlikely to be recurrent herpes. Anyway, although recurrent outbreaks can involve the buttocks, upper thighs, etc, that occurs in no more than 5% of infected people; 95% of recurrences are genital or anal.
The negative PCR or culture doesn't help much one way or the other. Even in herpes, those tests can miss the virus, especially if the lesions are healing when the specimen is collected.
Therefore, I agree with your tentative self-recommendation: Have the blood test. You are correct that a positive HSV-1 result won't mean anything one way or the other. But the HSV-2 result will be the important one. If negative, you can be confident you don't have genital herpes after all.
Good luck-- HHH, MD
As to the second "outbreak", that also doesn't fit. Recurrent herpes is always localized to one side of the body's midline, and typically very localized--generally in a small patch no more than 1-2 inches in diameter. Lesions on both buttocks is unlikely to be recurrent herpes. Anyway, although recurrent outbreaks can involve the buttocks, upper thighs, etc, that occurs in no more than 5% of infected people; 95% of recurrences are genital or anal.
The negative PCR or culture doesn't help much one way or the other. Even in herpes, those tests can miss the virus, especially if the lesions are healing when the specimen is collected.
Therefore, I agree with your tentative self-recommendation: Have the blood test. You are correct that a positive HSV-1 result won't mean anything one way or the other. But the HSV-2 result will be the important one. If negative, you can be confident you don't have genital herpes after all.
Good luck-- HHH, MD
You are reading content posted in the STDs Forum
Herpes spreads by oral, vaginal and anal sex.
Herpes sores blister, then burst, scab and heal.
STIs are the most common cause of genital sores.
Millions of people are diagnosed with STDs in the U.S. each year.
STDs can't be transmitted by casual contact, like hugging or touching.
Syphilis is an STD that is transmitted by oral, genital and anal sex.
