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Avatar universal

HSV, against all odds.

You can check my history through my previous posts. In a nutshell, I had an initial outbreak in march 2009, TWO MONTHS (!) after one-time exposure. Had bilateral sores, widespread. PCR negative, sorology negative at 4.5 months mark after exposure. Partner tested negative 4 months after exposure. The evidences against herpes were surely strong.

Now, may 2010, I'm having another outbreak. Not sure if it's my first recurrence, since I spotted a sore in January next to my hair line (as I told dr. HHH in my last post). Three sores, unilateral; even spotted one as a tiny blister. My OB/GYN will only see me on wednesday. But I guess the recurrent sores leave no doubt that I most probably have HSV.

Questions that arise now:
1. Is it normal to only have your first recurrence a year after the first one?
2. I'm not thinking about suppressive theraphy for now (my current partner is aware of the risks and I want to observe my outbreak patterns). During my initial episode, I took famvir. Where I live, acyclovir is the least expensive medicine for HSV - is it less effective than the others? Can I use it for episodic treatment and eventually for suppressive therapy?
3. According to my exams, I'm HSV1+ but I don't remember having cold sores at all in teenage/adult life. If I do have HSV2, is HSV1 supposed to reduce the outbreak frequency at all?
4. Short-term suppressive theraphy (taking medicine to reduce the chances of having an outbreak during a trip, for instance): how does it work? When should I start taking it before the event?
5. Honestly: have you ever seen an incubation period that lasted TWO MONTHS?

Thanks a lot.
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300980 tn?1194929400
MEDICAL PROFESSIONAL
The data in no way suggest you have HSV-2.  You have a positive blood test for HSV-1 but do not know the location.  It could be genital or it could be oral, as most are.  I think it is time to let this go.  Should the lesion occur again, you need to be seen quickly by a dermatologist to get an answer.  EWH
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Avatar universal
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Avatar universal
I'm back with my lastest results for HSV2: still negative. HSV2 IgG 0.41 (15 months after supposed initial infection). So unless the lab is really screwing up big time (they assured me that they're using the Focus kit), I apparently don't have HSV2.

I know that there's a possibility that HerpeSelect might miss a few cases of HSV2, but I'm thinking that a combination of several negative results, a negative result by my former one-time partner four months after our encounter and an incubation period of two months makes it rather unlikely for it to be HSV2. Am I correct? Should I let it go?

So...what else should I do (if there's anything left I should do)? I'm not even sure I can assume it's genital HSV1 (which would make some sense, since my current partner is HSV1+). I thought I had had cold sores as a child; besides, the exams showed that I was HSV1+ just a few days after symptoms.

Thanks a lot, Dr. Hook.
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300980 tn?1194929400
MEDICAL PROFESSIONAL
You seem to want to believe the you have herpes.  I doubt that you do.  I predict that whether or not you test a 4 months or 40 months, the test will still be negative because I doubt that you have herpes.

With all due respect to your GYN, when STD experts make a diagnosis of herpes by the appearance of the lesion, they are wrong 25% of the time.  That is the reason that the CDC recommends, as do we, that all suspected HSV be tested to prove that this is what it is.

As for your "but what if it is" questions:

1.  No, this is unlikely to be due to HSV.
2.  If you have genital lesions due to herpes, you will not spread your infection by having oral sex with your BF.  HSV is spread by direct lesion contact.

Let us know what your 4 month test shows.  Until then, take care.  EWH
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Avatar universal
Thanks for the answers. Just to clarify: I don't recall having cold sores, but my mother believes I had it as a child. Besides, in my very first blood test (during my first episode), I tested HSV1+ - wouldn't make much sense in terms of antibody production timing I suppose.

Went to the Gyn today. She spotted the two ulcers (they look like canker sores by now) and told me that I should assume it's herpes, 'cause it's the most common cause for genital ulcers. I also showed her a sore (sort of a pimple) that showed up concomitantly to the other sores, but this one was located in my left buttock, close to my coccix. But since it's already dried she was unable to say anything about it. Would that be common - having sores in the vulva and also in the buttock, apart from one another?

As for the previous exams results, she told me to basically chill out and not to persue further testing. She believes that clinical/visual diagnosis is enough and that we should only observe the outbreak pattern for now. She prescribed me famvir (5 days) and some topical cream.

Either way, I plan to get tested within a month or so and post the results here, if you're ok with it. Till then, I guess I should assume I belong to that 1% of population that does not seroconvert within 4 months, or that 1% that has an incubation period of two months, or even that 1% that has dealt with lab errors in a row =]

Just some additional questions:
1. I've been feeling some back/leg pain. If this is herpes, is it related to it? I thought that this sort of sensation was only associated with the prodomes. From your experience, should I expect pains AFTER the sores show up?
2. Can I safely perform oral sex on my boyfriend during outbreaks (considering that he might not be the source of infection)?

Thanks a lot, again.
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300980 tn?1194929400
MEDICAL PROFESSIONAL
Welcome back to the Forum and my apologies for the delay in getting to your question.  I do not think the recurrence of your lesions "proves" that you have genital HSV by any means.  There is no evidence that other than your HSV-1 and the associated cold sores, that you have HSV.  There are a number of dermatological problems which can cause recurring genital ulceration and the evidence is quite strong that you do not have HSV-2.  Whether this might a very, very unusual situation in which you have both cold sores and genital lesions due to HSV-1 could be considered but, as we have said here again and again, this is incredibly rare and, in your case, you have negative PCR tests which make the possibility of genital HSV-2 even less likely.  I am disappointed you can't be seen by your Gyn more quickly. When acute problems occur, they should be evaluated in a timely fashion. Furthermore, with all due respect to your Gyn, I do believe this problem might be better served by working with your dermatologist than with your Gyn.

I will briefly answer your other questions but in doing so, please note that I think that assuming that you have genital herpes when there is so much evidence that you do not is a mistake.

1.  The majority of initial recurrences occur before 6 months following the initial episode..  For yours to not appear for a year is not typical of HSV.
2.  Acyclovir, famciclovir, and valacyclovir are all related drugs that work in a similar fashion.  Acyclovir is available as a generic while the others are not although we anticipate that generic valacyclovir should be available at some point in the next year.
3.  I thought you had a history of cold sores?  We do know that having HSV-1 is associated with some reduction in risk for getting HSV-2.
4.  Yes, short term, event-related suppressive therapy does work to reduce the frequency of recurrences and to reduce their severity when they do occur.  Some people on suppressive therapy have no recurrences at all.  You should start suppressive therapy a day or two before your trip.
5.  Yes but it is rare.  As I said, I still am unconvinced that you have genital HSV-2.

EWH
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Avatar universal
Forgot to mention that I plan to get tested once again (that would be the 4th time!) for HSV (sorology). I gave up on the PCR not only because it has showed negative results in the past but also because it's a nightmare to find a lab that offers it.
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