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HSV-1 Paper-cut lesion every 10 days
I am 23 and I was diagnosed with HSV-1 in mid-December. My diagnosis was by culture. (It was also clear-cut because I've had only one partner--10 days before my outbreak he had a cold sore on his lip and performed oral sex on me).
SInce then, I've had a raised line or paper cut lesion appear on the inside of the left labia about every 1-2 weeks. I have not had a full "outbreak" like the primary outbreak, but the paper cut lesion or enflamed line appears on one side of the labia about every 10 days or so. My ob/gyn prescribed me Acyclovir 400mg 3 times a day. (I understand that this is the dosage for an episode, but she told me to take it 3-times a day everyday as suppressive therapy). From what I can tell, the Acyclovir is having little effect on my HSV-1 symptoms--preventing or treating them.
(1) Can you recommend any experts or specialists in Boston? I'm afraid my ob/gyn seems ill-informed about herpes (she has given me a lot of misinformation and had a hard time listening when I told her that Acyclovir wasn't doing very much for symptoms). Someone on a herpes message board suggested that this could a dermatological problem--could you recommend any dermatologists who might be knowledgeable about vaginal dermatology or herpes?
(2) I'm afraid that I may have gotten a high "dosage" of the virus because I shaved the genital area the night I had oral sex (I know now this increases risk of infection), and my boyfriend had an active cold sore on his lip (he was not just shedding). Could a high "dosage" explain my abnormally frequent symptoms?
(3) How much of an effect can time have on strengthening my body's defense against symptoms? I understand that, theoretically, my body should be creating antibodies, and I've heard that things get better after the first year. Is this true? Is it possible for me to be this symptomatic now and less symptomatic (or asymptomatic) in 1, 5, or 10 years?
(4) Finally, do you know of any clinical trials taking place in my city?
SInce then, I've had a raised line or paper cut lesion appear on the inside of the left labia about every 1-2 weeks. I have not had a full "outbreak" like the primary outbreak, but the paper cut lesion or enflamed line appears on one side of the labia about every 10 days or so. My ob/gyn prescribed me Acyclovir 400mg 3 times a day. (I understand that this is the dosage for an episode, but she told me to take it 3-times a day everyday as suppressive therapy). From what I can tell, the Acyclovir is having little effect on my HSV-1 symptoms--preventing or treating them.
(1) Can you recommend any experts or specialists in Boston? I'm afraid my ob/gyn seems ill-informed about herpes (she has given me a lot of misinformation and had a hard time listening when I told her that Acyclovir wasn't doing very much for symptoms). Someone on a herpes message board suggested that this could a dermatological problem--could you recommend any dermatologists who might be knowledgeable about vaginal dermatology or herpes?
(2) I'm afraid that I may have gotten a high "dosage" of the virus because I shaved the genital area the night I had oral sex (I know now this increases risk of infection), and my boyfriend had an active cold sore on his lip (he was not just shedding). Could a high "dosage" explain my abnormally frequent symptoms?
(3) How much of an effect can time have on strengthening my body's defense against symptoms? I understand that, theoretically, my body should be creating antibodies, and I've heard that things get better after the first year. Is this true? Is it possible for me to be this symptomatic now and less symptomatic (or asymptomatic) in 1, 5, or 10 years?
(4) Finally, do you know of any clinical trials taking place in my city?
MEDICAL PROFESSIONAL
Welcome to the STD forum. I'll try to help.
The first need here is to confirm whether or not your "paper-cut" lesions in fact are due to herpes. Most likely they are not, for at least 3 reasons: 1) Almost no genital herpes causes outbreaks more often than once every 4-6 weeks, and for HSV-1 the usual course averages only 1 outbreak per year, and many people have no recurrent episodes at all . 2) Although "paper cut" lesions can occur, they are not the norm; most herpes starts with typical blisters, especially when patients are on the lookout and watching closely. 3) Continued recurrence on acyclovir is very unusual -- although acyclovir-resistant strains can occur, they are very rare, especially for an early infection. (Resistance usually develops in people with longstanding herpes, i.e. several years duration.) Each of these factors individually argues strongly against herpes as the cause; and taken together, it is exceedingly unlikely that herpes is the cause of these lesions.
To the specific questions:
1) Your instinct about seeing a dermatologist as the next step is exactly right, or perhaps an STD specialist. I don't know specific persons, but Boston is perhaps the most medically sophisticated city in the country and it should be easy to find someone. You could ask your primary doc for a referral. Alternatively, any of the academic hospitals' clinics would be a good starting point -- Boston City Hospital, Mass General, the Brigham, etc. (Maybe the Brigham would be the best bet, with its women's/gyn emphasis.)
Whoever you see, you should ask him or her to provide swabs and vials so you can collect a couple of specimens yourself within a few hours of onset of the next "paper cut" to test for HSV, preferably by PCR test (polymerase chain reaction). I suggest you stop taking acyclovir now (or at least discuss this with the doc who prescribed it), so that you have been off treatment for at least a couple of weeks when you see the consultant.
2) The "dose" of the virus, i.e. the intensity of the initial exposure, probably has no effect on the severity of the initial symptoms or on frequency of recurrence. This has not been well researched, but most experts believe it makes no difference.
3) Since your symptoms probably aren't due to herpes, the strength of your immunity against HSV probably is irrelevant. Anyway, even in proved herpes, the frequency of outbreaks is not believed to be due to abnormalities of the immune system.
4) This too probably is irrelevant, certainly until the diagnosis is confirmed. In any case I am unaware of any current ongoing trials of new herpes treatments, in the Boston area or anywhere else.
Please report back once you have seen a consultant, and/or whenever a definite diagnosis is confirmed.
Best wishes-- HHH, MD
The first need here is to confirm whether or not your "paper-cut" lesions in fact are due to herpes. Most likely they are not, for at least 3 reasons: 1) Almost no genital herpes causes outbreaks more often than once every 4-6 weeks, and for HSV-1 the usual course averages only 1 outbreak per year, and many people have no recurrent episodes at all . 2) Although "paper cut" lesions can occur, they are not the norm; most herpes starts with typical blisters, especially when patients are on the lookout and watching closely. 3) Continued recurrence on acyclovir is very unusual -- although acyclovir-resistant strains can occur, they are very rare, especially for an early infection. (Resistance usually develops in people with longstanding herpes, i.e. several years duration.) Each of these factors individually argues strongly against herpes as the cause; and taken together, it is exceedingly unlikely that herpes is the cause of these lesions.
To the specific questions:
1) Your instinct about seeing a dermatologist as the next step is exactly right, or perhaps an STD specialist. I don't know specific persons, but Boston is perhaps the most medically sophisticated city in the country and it should be easy to find someone. You could ask your primary doc for a referral. Alternatively, any of the academic hospitals' clinics would be a good starting point -- Boston City Hospital, Mass General, the Brigham, etc. (Maybe the Brigham would be the best bet, with its women's/gyn emphasis.)
Whoever you see, you should ask him or her to provide swabs and vials so you can collect a couple of specimens yourself within a few hours of onset of the next "paper cut" to test for HSV, preferably by PCR test (polymerase chain reaction). I suggest you stop taking acyclovir now (or at least discuss this with the doc who prescribed it), so that you have been off treatment for at least a couple of weeks when you see the consultant.
2) The "dose" of the virus, i.e. the intensity of the initial exposure, probably has no effect on the severity of the initial symptoms or on frequency of recurrence. This has not been well researched, but most experts believe it makes no difference.
3) Since your symptoms probably aren't due to herpes, the strength of your immunity against HSV probably is irrelevant. Anyway, even in proved herpes, the frequency of outbreaks is not believed to be due to abnormalities of the immune system.
4) This too probably is irrelevant, certainly until the diagnosis is confirmed. In any case I am unaware of any current ongoing trials of new herpes treatments, in the Boston area or anywhere else.
Please report back once you have seen a consultant, and/or whenever a definite diagnosis is confirmed.
Best wishes-- HHH, MD
Dear Doctor Handsfield,
Thanks sincerely for these very helpful responses. I'll report back once I have see a dermatologist, STD specialist, or other provider.
Thanks sincerely for these very helpful responses. I'll report back once I have see a dermatologist, STD specialist, or other provider.
MEDICAL PROFESSIONAL
If you have trouble finding a suitable specialist, another option is to contact the Westover Heights Clinic of Portland, OR (http://www.westoverheights.com). WHC is directed by Terri Warren, who moderates MedHelp's herpes forum. Terri would agree the best approach is to have a personal, herpes-knowledgeable provider. But if that can't be worked out, sometimes WHC will develop a long distant relationship with patients and can provide them with the materials to self-test for HSV along the lines I suggested above.
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.
