Cervical Herpes Mystery and Risk for other STDS

[ablindmanfell]

Hello Doctor,

I was recently diagnosed with HSV, but am still encountering a lot of confusion which I hope to clear up.
In mid-October I had sex with a man I had been on a few dates with. I've always taken my sexual health seriously (I actually want to work in sexual health ed. and violence prevention), so I told him that condoms were necessary until we got tested for STD's. I only slept with this man twice, and a few days later I feel a lot of itching and pain in my vaginal area, so I went to a doctor to get checked out.

Since I am not in the state where my actual gynecologist is, I first went to a regional clinic, where they saw no signs of irritation, but swabbed the irritated area for herpes (which JUST came back positive today, after the labs misplaced it) . I saw another doctor, who took one glance and said "definitely herpes". She then looked inside and told me that I also had lesions on my cervix. She also had me get a Igg blood test (which I told her would be pointless since I know about the 3 month waiting period), but she insisted a positive would show up now. It came back negative for both types.
For me this was devastating. I called up the guy who claims to have never had a genital lesion or a positive test (although he did say that he does get oral cold sores), and neither of us can recall any breakage or tears in the condoms. He said he would get tested during this conversation, but recently has dropped off the face of the earth, and won't take my calls--so it seems like I'm on my own with this and wont get any answers from him.

When I spoke with my gyno at home, she thought the presence of lesions on the cervix seemed very odd (she said they dont happen there), unfathomable with the use of a condom. So, I'm wondering how the lesions got there? Did this guy lie and somehow sneak it in without my noticing? If so, What are the chances of my infection of other STDS? Even worse, of HIV? what information do you have about lesions on the cervix?

[Edward W Hook, MD]

Actually, you could still have cervical lesions due to infection transmitted by oral sex.  

If the condom appeared intact, it almost certainly was.  When condoms do fail (which happens about 1% of the time), it is obvious- they break wide open.  

As far as HIV is concerned, as a heterosexual woman your risk is not high. Simply take the appropriate precautions as it sounds like you are doing.  EWH

[ablindmanfell]

Thank you for the quick response--my gynocologist from back home also said it would be more consistent with HSV-1, but I feel like that would be impossible given the lesions on the cervix?

I guess I'm secretly fearing that a condom broke, or somehow unprotected sex occurred. And since this partner is no longer in touch with me, I can't get that peace of mind by knowing his test results. Maybe more of this paranoia is more a reflection of feeling so betrayed since he promised to get tested and didn't. And I guess I'm just concerned because of the fact that having HSV increases your chances of getting HIV.

[Edward W Hook, MD]

Actually, your history is more compatible with genital HSV-1 than HSV-2.  Your genital contact with your partner was codnom protected but you did receive oral sex and he has a history of cold sores The clinical presentation of genital HSV-1 and genital HSV-2 is exactly  the same so the only way to tell is with a culture or, in your case if your blood test is positve for HSV-1 an not HSV-2.  If your partner's test is postive only for HSV-1, that too supports the idea that this is HSV-1.

As far as your question- recognition of recurrences, this can be difficult. The best way to find out if you are having a reurrence is to have a culture or PCR test done from a lesion at the time of a ?? recurrence.  In general however, in most people, recurrences tend to follow a pattern so once you ahve recognized one, you will recognize subsequent recurrences as well.  EWH

[ablindmanfell]

The positive culture was from my initial outbreak (before any visible symptoms) on a swab of my outer labia. I did not really look at myself once there were symptoms (I was so depressed that I pretty much just took valvacyclovir and stayed in bed). There was some confusion at the lab as to which doctor I saw or my results were going to the wrong place, so thats why it took so long for them to get back to me. I asked if they knew the type from the swab, and the woman on the phone said she did not.

I do not think I have had a recurrence since--shortly after the clearing of the initial outbreak I started having itching above my clitoral hood (where no lesions had been present before). I took the medicine again and had no changes for better or worse. I was prescribed a pill for yeast infection 3 weeks later even though the rash and itchiness had mostly cleared up. .  I still feel a bit of itching in the same spot, but again, can admit that I'm really paranoid--and that dealing with this diagnosis hasn't been helping. I've also had *very* small amounts (no bigger than the size of a pea) of discharge twice that has a slight yellowish tint, but no odor.

Even though I can't really see it being anything other than HSV-2, I'm still planning on getting a blood test for sure at the end of January.


And thanks for all the help in advance--it has been difficult in of itself dealing with some doctors who don't seem to know all the facts about this diagnosis in addition to the diagnosis itself, so I really appreciate you all putting in the extra time and effort.

[Edward W Hook, MD]

Welcome to the Forum.  I read your interactions on the HSV communtiy site to prepare to address your questions.  Before I do, please answer the following questions so I do not mislead you.  You state above that you did have a positive culture- was this from your inital outbreak or have you have a recurrence?  Also, am I correct that you did not have cultures taken at the time of yoru inital outbreak?

When I hear back I'll provide more infomration.  EWH

[ablindmanfell]

Also, for whatever its worth, I didnt have any symptoms assosciated with internal lesions.

My primary outbreak was only painful on the outside and only when touched or during urination. I was fortunate enough to be spared the body aches, head aches, fever and other flu-like symptoms that often come with outbreaks.

And sorry, but one more question. It seems like symptoms and severity of herpes varies a lot from person to person. Again, my primary outbreak seems to have been overall pretty mild, and cleared up with really quickly with the antivirals. What I'm wondering is how will i know for future reference if its a recurrence or something else (given that there are a lot of things that go on down there often confused with herpes?)
For example, my most prominent symptom was the itching--but thats also a symptom of yeast infections (which I'm also prone to). I also have skin tags, and bumps etc.?
Are there any good ways to know that its herpes and that its a recurrence?

Sorry, I'm a little paranoid and having trouble dealing with this since I've never had sex without a condom in my entire life, and have just put so much effort into avoiding this kind of situation (even though, yes I know, abstinence is the only 100% way to prevent infection)


Thank you again.