Possibly herpes? But how?

[Hobbes27]

A bit of a long question, but I figured I'd give the full breakdown...

The woman I've been seeing for the past 2 months was a virgin when I met her. We started having sex (protected initially) approximately 3 weeks after we started dating. The second time we had intercourse, she bled quite a bit. Saw the doctor the next day, who said she had a vaginal tear, and to give it a rest for a week or so. We did, and all was (basically) fine until last week. We had sex, and 2 days later she was c/o significant pain in her vaginal area with some spotting. I also noted during the time that I had maybe 10 or so "pimple" like bumps in my pubic hair region, and a couple of small red bumps on the shaft closer to the same area. I have had these bumps rarely before and basically always coincide with trimming/shaving my pubic hair (which I had done a few days prior). The bumps now are essentially gone and looked identical to foliculitis (with no dischange or pain, mild itching, no blister/ulcer appearance).

She goes to a walk-in during this time, and the GP states she has tears along her vaginal canal up to her cervix. He also was surprised that the exam (in general) wasn't bothering her. He also said that she has a fairly narrow vaginal canal/opening (and I have an above average penis) that could explain why the injury occurred. He attributed it to a high pain tolerance, gave her a topical antibiotic (Fucidin) and T3 for pain. He said it should resolve within a week or so. She has been off work essentially since with the pain/difficulty walking. She went to another doctor (at a women's hospital) a few days after the initial assessment for a second opinion. The GP there basically confirmed, and said to stay on her course of treatment (plus Epson salt bath). Yesterday, she went to the original GP (this is the 3rd doctor visit within the week), because she was concerned things weren't getting better (she is quite active, and doesn't like being held up like this). The GP did another exam, and after a fair amount of searching, found the specific spot she was having pain. She described it as him "popping a scar" or something. He took a swab, and told her he was 80% sure it was herpes. She has started on Valtrex...

I have never had any of the classic signs of herpes in men. I have been tested for STI's 4 times within the last 14 months (all negative). I have had unprotected sex with 3 women in that time (aside from her). All of which I was in a relationship with for X time. None of these women ever told me they had an STI ever and ALL asked if I did and if I had been tested. I am in loose contact with all, and none have ever approached me with symptoms after the fact. Prior to the last 1.5 years, I was in a 3.5 year relationship having unprotected sex and she has never approached me with any concerns after the fact. The last time my current relationship had oral sex with someone was approximately 2 years ago. She states that he never had any cold sores during the time they had been seeing each other (or period to the best of her knowledge).

Is it possible that due to her vaginal trauma and current course of treatment, that some type of blister/cyst/lesion could mimic herpes? Seems like a very atypical presentation from what I've read. It is very localized, and according to her, difficult for the physician to find. She has no external/visible lesion on her vagina. At no point during the other 2 exams this week did the physicians query herpes. She is quite upset (obviously), as am I. I realize that there really is no point in getting worried until the swab results come back. I'm just curious if there might be another explation.

Thanks.

[gracefromHHP]

yes, about 1/2 of folks who contract hsv1 genitally never get another recognizable recurrence.   Of those who do get recurrences, the average is 1 additional ob the first year and then 1 ob every other year. Only a small percentage of folks with hsv1 genitally get recurrences more often. If she does fall into that category, daily suppressive therapy is an option to prevent recurrences.

keep asking questions as you both have them :)

[Hobbes27]

No, no blame issues. Both of us are investigative people by nature (and occupation). It is obvious at this point that there is no way of knowing for sure how it was acquired. We are educated, mature, and have great communication.

Yes, we did engage in oral sex prior to her symptoms (and during the time when the trauma took place). She'll hate to hear that it is as much bad luck as anything, but I guess that sounds like what it is.

Hopefully the problem never arises again, and if it does it is much milder. Reading and stats seem to support this.

Thanks for the info.

[gracefromHHP]

if there was a lot going on down yonder initially, it might've been hard to see herpes symptoms as well as perhaps the herpes symptoms didn't occur until a few days into all of this going on. It sounds like she had multiple issues going on.

You don't have to have an active cold sore present in order to transmit the virus to a partner. You still shed the virus periodically even without obvious cold sores present. So why no prior partners contracting hsv1 from you?  well it's not THAT contagious for starters as well as if they had hsv1 already it wasn't an issue as well as it is just as much about bad luck as anything to get it genitally.  You'll never figure it out at this point.

did you and your partner engage in oral sex prior to her symptoms?

[Mistakeguy789]

Visual diagnosis is wrong about 1/3 of time even among the experts.  So even seeing the doctors it can sometimes not be easily identified.  

It sounds almost like you are trying to sort the blame.  Really it doesn't matter.  Yes she could have had it from a previous oral encounter.  But that doesn't really mean much.  Finding out your status is important as well to know what you have if you have HSV-1 as well.  This heps in knowing who has what.  You can request an hsv type specific igg test.

If you have HSV-1 orally and she has HSV-1 genitally you aren't going to get HSV-1 genitally and she won't get it orally.  At least not easily.  Your body has an antibdoy response that is going to fight the infection in a new location.  HSV infects the nerves in that area.  For example orally the virus is in the nerves that are supplied to the skin in the oral orea and in the genital area the same thing applies.

[Hobbes27]

Yes, it was a lesion culture that came back as hsv1+.

Again, kind of weird because she had 2 gyne exams (by ER/GP docs, not gynecologists) within a week and neither suspected herpes. The swab was from a localized internal spot that wasn't readily obvious to the physician.

Just to clarify, she had never had intercourse prior to me. She has had multiple partners where she received oral sex though. The last one being 2 years ago...

I do agree that odds are she did acquire it from me. However, a health care professional she spoke too said that it is possible she could have acquired it at any point and this initial outbreak was exacerbated by the vaginal trauma. Again, I'm not deflecting blame, just seeing where the possibilities lie.

I do not have a cold sore. The last one I did have (if it was a cold sore) was approximately 4 years ago. I have no lesions on my penis. I do understand that a large percentage of people can be asymptomatic carriers. But I have been with multiple women over the years and none have no cold sores or vaginal signs/symptoms...

Wouldn't I now have it genitally as well and her orally? Why has she not had any cold sores and me not had any penile lesions? Do you simply always get it wherever the primary outbreak was? Can I still get it genitally and her orally?

And yes, lube it going to be paramount now (though she doesn't have an issue with "natural lubrication"). I assume it would be a good idea to consult an actual gyne prior to resuming sex...

[gracefromHHP]

if she was a virgin, odds are this is a newly acquired hsv1 genital infection for her. Just to confirm, it was a lesion culture that came back as hsv1+?

odds are that you do have hsv1 orally. totally up to you if you want to pursue testing or just assume it.

so what do you do now? well just avoid sex anytime she has anything going on genitally. Her having it genitally and you having it orally means it's really not an issue.  I also recommend you start using a lot of lube for sex too. If she's torn that much and is tight to begin with, you want to prevent more trauma for her so that she doesn't end up scarring internally. she should continue to work with her gyn as needed if she continues to have tearing issues.

[Hobbes27]

She got the results today, and it was positive for HSV1. She was quite upset. She spoke to a couple of medical professionals and from the sounds of it, she potentially could have acquired it at ANY point in her life. I could have given it to her, she to me, or we both concurrently could have had it (asymptomatic) with the outbreak being triggered by the vaginal trauma. She is a bit of a hypochondriac (because of her work), so this doesn't help much. She already mentioned about getting another bottle of Valtrex for the next outbreak, which I told her is absolutely ridiculous...

So I don't have a cold sore (nor any genital symptoms), and she has never had a cold sore. Recently, I saw my passport photo and I think I might have had a cold sore during that time (4 years ago), with nothing since. My GF at the time however never got one, so I probably didn't think anything of it. Also, none of my relationships since have had any cold sore's or genital symptoms...

I guess when it's all said and done, it's just too common. Too many people can be asymptomatic carriers (or minor symptoms that aren't grossly obvious). HSV1 looks to be the "lesser" of the 2, with recurrent episodes being much milder or potentially not at all.

So from my end, what should I do? Call my GP and see if any herpes blood work was done in my STI panels over the last year? Is it worth it to have another STI panel specifically for herpes (even though I don't appear to have any s/s) considering she has had a recent outbreak? Or should I just leave it and know that I potentially have HSV1 and be loosely aware.

Also, how should we proceed sex wise? Physically, she is feeling almost 100%. How long should we wait before we have (unprotected or otherwise) sex again?

[gracefromHHP]

At this point waiting for test results is the best you can do. this could be many things going on so ruling out things 1 at a time is all you can do.

[Hobbes27]

Thanks...

Unfortunately, I won't be able to see if Herpes blood work was done until mid next week. By then, she will likely have results from the swab. Her doctor also told her that it is still possible that she could have acquired it from previous oral sex partners and potentially due to this recent trauma it somehow triggered this outbreak. Seems more likely though (if it is herpes), that it would have come through me :( I just don't see how...

Any other differentials? It does seem like an unusual presentation (given both our histories and lack of signs/symptoms with myself or previous sexual partners). She did say that she read about another case online VERY similar to hers (tearing, with subsequent herpes dx without other high risk factors or signs, that turned out to be a wrong dx).

[gracefromHHP]

Just double check to be sure that herpes testing has been a part of your std testing. it's typically not a part of routine std testing so you might not have had it done.

grace