Could painful ulcers on my labia be something other than herpes?

[Healthynut2]

I first noticed pain on my left labia minora while in the shower and dismissed it as a razor cut. When the pain had not gone away two days later I got a mirror and took a look. I saw four very small whitish ulcers on the inside of the labia. It became extremely painful to pee. I suppose I could say that I was fatigued with body aches and low grade fevers, but my general malaise could have been due to multiple factors. The doctor removed the top layer of one of the ulcers and cultured it. Although neither he or I ever saw any blistering, he said the most likely diagnosis is herpes. However, the culture was negative for HSV-1 and HSV-2. I returned to the doctor after still being in pain and noticing two more small white ulcers show up over night. Never saw any blistering, they seemed to just start as very small ulcers. He drew my blood for antibody testing (although he said it would likely be negative regardless and we'll re-draw in two months anyway), he gave me 1 gram Azithromycin for the small chance that it might be Chancroid or some other bacterial infection and drew blood for CMV and EBV titers to exhaust all possibilities. I mentioned to my doctor that one a few occasions in the past couple of years I will get one or two white ulcers in my throat or inside of my cheek that look identical to the ones on my labia and they cause severe pain, then go away within 24-48 hours (they test negative for strep). He wasn't sure if there was any way that could be related. I am in a committed relationship with my boyfriend of 2 years and we've both had a few previous sexual partners and previously negative genital histories.

I am looking for input regarding the manifestation of the ulcers and if it is possible that herpes ulcers could show up without any blistering? It was my understanding that it's the blister that ruptures and turns into an ulcer. And does anyone know of bacterial infections or other viruses such as Epstein-Barr or cytomeglovirus causing genital ulcers? I don't know if I have many specific questions, I guess I am just looking for input and information! I was relieved to hear the culture was negative for HSV-1 and HSV-2, but realize that false negatives do occur. Though I do not know the rate.

[Healthynut2]

Thanks Grace,

He has never had blood testing for HSV, but my doctor drew my blood for a sample yesterday. However, we're both aware it will more than likely be negative and I'll need testing again in a few months. And my boyfriend is simple minded, to say the least. He had a herpes swab done a couple of years ago due to something that ended up being a benign wart, and according to him that means he has no chance of ever having anything. End of story. I doubt he'll do any blood work, and if he did I'm sure he would decide it was me that gave it to him. Not worth my time.

I am assuming my doctor ran a PCR with the swab, because my results were back within two days and I would assume he would choose to do a PCR over a classic viral culture, am I correct? Doesn't a viral culture take longer and not specify between HSV-1 and 2? I just forgot to ask him...

And I understand it is possible that there could have been some blistering before the ulcers that I did not notice, but if so, that could be something else too right?

I know HSV can lay dormant for years, but it just seems like it came out of nowhere for no reason. I am awaiting the results of a bacterial culture and we considered yeast or vaginosis. However, the ulcers don't seem typical for the kind of fissures a yeast infection might cause and vaginosis typically results in erythema and swelling rather than distinct ulcerations? I do have a history of yeast infections, but this would just be so atypical.

Also, my left vulva (the same side of the labial ulcers) is swollen and slightly sore. Whether it is swollen lymph or just edema and irritation from the ulcers I don't know. Is this significant or is it characteristic of pretty much anything?

Thanks again, I know I am fishing blindly and desperate to find an answer other than the one I want to hear. But I was really depressed before I got the negative swab and then very relieved when I got the result. Now I am kind of bouncing back to doubt and depression after my doctor says he thinks it was false negative. He's not a OB/GYN, in fact he is a family practice ARNP, but there's no reason to doubt him, especially when what he is saying is reasonable. Was just looking for hope that he is wrong and a negative test result really could be negative.

[gracefromHHP]

many things can cause these sorts of symptoms in the genital area, not just herpes. did your provider also test you for yeast and bacterial infections vaginally when you were seen?

odds are that neither you nor your partner had herpes igg blood testing as part of your previous std testing. since this has appeared now, it's a good time to cover all bases and you both pursue it so you have answers as to who has what.  unfortunately lesion cultures have a high false negative rate so you have to follow up with blood testing for you both.

yes, other viral infections can cause genital symptoms too.  

grace