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Avatar universal

How could I have gotten it?

I recently saw my OB due to genital sores and white discharge. She told me it appeared to be genital herpes, took a swab culture, and we are waiting for results. However, I don't recall the presence of any blisters. Instead, the sores started out looking like white spots. They had the appearance of a white layer covering the skin, not like a whitehead. The white layer easily comes off the skin and the skin is raw underneath.
I am looking for some clarification of how I could have contracted herpes.
Some facts:
I do have HSV1 with occasional cold sore outbreaks but am fanatical about washing hands during outbreaks. Last outbreak was at least 9 months ago.
I've been with the same partner for over 10 years and he does not have HSV. We do not kiss or have oral sex during a cold sore outbreak.
We haven't had sex for at least 2 weeks, probably more like 3 weeks, and it did not include oral.
At the time of this outbreak, I had been getting little sleep and stress was high.
Before the sores appeared, I had a fever and chills, then noticed one sore two days later. It increased in size over the next two days and then another small sore appeared a couple inches away. I never saw any blisters. The sores do not itch.

So what would be most probable or even possible?
During a previous cold sore outbreak, I spread the virus to the genitals somehow? Would it have taken 9 months to have an outbreak?
Due to stress/fatigue, the HSV1 virus broke out in a different area? I have gotten a mild case of shingles during another period of stress and fatigue.
Could this be something other than genital herpes? I had been exposed to pink eye two days prior to having a fever.

Thank you for your insight.
7 Responses
239123 tn?1267651214
MEDICAL PROFESSIONAL
Welcome to the forum.  Thanks for your interesting question, one that will have educational value for other forum reader.  I'll try to help.

From your description, my guess is that your doctor is correct in diagnosing genital herpes.  Your symptoms are typical, and when moist tissues are involved (vaginal opening, labia minor) blisters often quickly ulcerate; tender "white spots" is typical.  I expect the swab test to be positive.  There are other viruses, and non-infectious medical conditions, that can cause genital ulcers, and some of these can also cause conjunctivitis (pink eye) -- so that's a possibility.  But herpes probably remains the best bet.

Almost certainly this is not HSV-1 from self-infection (medical term = auto-inoculation) from your oral herpes.  People with longstanding HSV infections are immune, or at least highly resistant, to new infections with the same HSV type they already have.  Auto-inoculation can occur, but mostly during the initial HSV infection.

Another theoretical possibility is that you have had asymptomatic HSV-2 or genital HSV-1 all along, and this is actually a recurrent outbreak.  However, this is unlikely based on your symptoms, which are typical for an initial HSV infection (multiple lesions, vaginal discharge, and fever all are uncommon in recurrent herpes).  Initial herpes symptoms usually start within a week of exposure, so that aspect is a little atypical based on your last sex with your partner, but 2-3 weeks still is consistent with new herpes.  Presumably you aren't pregnant or you would have said so.  During pregnancy, recurrent herpes can be more severe than otherwise, mimicking initial infection.

So we have to assume you have a new genital HSV-2 infection.  Assuming you haven't had sex with anyone else, your longstanding partner is the source.  Since 10-30% of males in the US (if that's where you are) have HSV-2 without knowing it, your partner might have been infected since before your relationship.  It is quite common for couples to have regular unprotected sex for many years before the virus finally is transmitted.

Here is what I recommend, while you wait for the swab test result.

1) First and most urgently, you don't mention treatment.  If your doctor didn't prescribe valacyclovir or one of the other anti-HSV drugs, call and request it right away.  Improved symptoms depends on the earliest possible treatment, and you shouldn't wait until the swab test result is available.  The drug will do no harm if you have something other than herpes.

2) Talk to your doctor about having an HSV blood test right away.  If the swab test is negative, the best alternate diagnosis comes from an early blood test followed by a later one a few weeks later.  Conversion of the result from negative to positive confirms the diagnosis.  And if the intial test is positive, it would suggest you have in fact had HSV-2 for a long tim and this is actually a recurrent outbreak.

3) Your partner should have an HSV antibody test, which is likely to be positive for HSV-2.  If not, it would suggest that you have something other than herpes.  However, this could wait a few days, until your swab test is available.

You might find it useful to print out this discussion as a framework for discussion with your doctor, especially if she seems uncertain about these recommendations.

Please return with follow-up comment(s) to let me know your (and perhaps your partner's) test results and how this all shakes out.

Best regards--  HHH, MD
239123 tn?1267651214
MEDICAL PROFESSIONAL
On further reflection, and realizing you had only 2 genital ulcers (is that correct?), I'm less certain herpes is the cause.  Onset of fever before the ulcers also is atypical, as is the time since last sex with your partner (as already mentioned).  I would still recommend the steps suggested above, but you should also ask your doctor about testing for other viruses that could be responsible (enterovirus and others) and also about non-infectious allergic conditions like Stevens Johnson syndrome, which is the genital ulcer version of erythema multiforme -- a systemic allergic reaction.  EM/SJ would be especially likely if you have any sort of rash elsewhere on your body.

Also, if your swab test is positive for HSV, make sure your doctor has instructed the type the virus as HSV-1 or HSV-2.  Sometimes type testing isn't done if not specifically requested, but the virus type is quite important both to judge the origin of your infection and treatment you may need in the future.
Avatar universal
Thank you. Your explanation has been very helpful and it eased my mind to have a clear plan for figuring this out.
I did get my blood drawn yesterday per your advice, but before those results got back my swab culture results came back. The swab was positive for HSV1.
I am not pregnant, but I am still nursing my infant. Would that still have the same effect as being pregnant?
So now I am still left wondering what the most likely cause is for this outbreak. Since my last cold sore hasn't been for 9 months or so (when I was pregnant), would this outbreak be more likely to have been from auto-inoculation or could it have just cropped up in a different location on its own due to stress or hormones?
Thanks again.
Avatar universal
Also, I've been getting cold sores since childhood so I imagine it isn't very likely that I've also had genital HSV1 this whole time and only now had an outbreak, right?
239123 tn?1267651214
MEDICAL PROFESSIONAL
Thanks for the follow-up.  I'll be happy to comment further.  But first, please describe your oral cold sore outbreaks.  Tell me as much as you can, including their frequency, locations, description (blisters, sores, scabs, etc), how long most outbreaks last, and whether the were ever diagnosed by a health professional and, if so, what diagnostic tests were done.  Also any treatments you have tried.
Avatar universal
Sure.  I get a cold sore maybe a couple times a year. They are usually brought on by having chapped lips either from illness or sun exposure. I've gotten pretty good at catching them in the earliest phase and apply an OTC remedy, usually Abreva or Zicam, or ice. When I'm not pregnant or nursing, I'll also take a lysine supplement.  Many times, they don't even get to the blister phase if I can start treating them right away, but if they do progess I'll get one cluster of small blisters which scabs over and heals in about a week.  They don't seem to get the yellow crust any more, the blisters tend to recede before popping. They form on my lips (upper or lower), sometimes on the border of where the pink lip skin meets regular skin.
I've never had professional diagnosis or treatment during an outbreak since I've been getting them for as long as I can remember, as do my mother and siblings.
Thank you again for your insight. This service has been very helpful.
239123 tn?1267651214
MEDICAL PROFESSIONAL
OK, thanks.  These sound like typical oral herpes outbreaks, almost certainly due to HSV-1.  However, as I said in my original reply, it is rare to acquire a new HSV infection with a pre-existing type.  So this raises these possibilities:

1) Your recurrent oral problem is something other than herpes.  I doubt this, based on your description.

2) Your oral herpes is caused by HSV-2.  This is unusual, but not unheard of.  Is there any chance of that?  It's virtually impossible if the problem started in childhood, but if it began during adulthood, and especially after performing oral sex on a partner, it would be more likely.

3) The typing of your genital HSV-1 strain is erroneous.  You should ask your doctor to convey her surprise and uncertainty to the laboratory and ask the lab to double-check the result.

4) You really do have a genital HSV-1 infection, despite preexisting oral HSV-1.  This in turn has 3 possible explanations:

a) You have had genital HSV-1 all along and this is a recurrent outbreak.  This seems unlikely; your symptoms etc are more like an initial than a recurrent infection.  As I said, pregnancy -- which is naturally accompanied by immune suppression (your body has to tolerate and not reject a large, biologically foreign body for 9 months) -- can be associated with recurrent herpes that mimics initial infection.  Nursing doesn't do it.  But maybe if delivery was recent?  How old is your baby?

b) New genital HSV-1, by auto-inoculation from your oral herpes.  This is possible, but also has the problem of the severity of your genital symptoms.  Auto-inoculation herpes probably doesn't usually result in fever etc.

c) New genital HSV-1 acquired sexualy.  This would require your husband to have oral herpes; or, less likely, to have genital HSV-1.  All things considered, this has to be a serious consideration, especailly if there was an oral exposure to him in the 2-3 weeks before onset of symptoms.

There's a lot of information there.  But to summarize, here is what to do.  Note the questions/uncertainties implied in these comments and let me know what you can.  In addition, go ahead with the blood test for which the specimen was just drawn, and plan on a follow-up test in about 3 months.  Make sure your doctor requests both HSV-1 and HSV-2 testing on both specimens.  Speak with your husband about oral or genital symptoms that may indicate herpes at either site; and ask your husband to have a blood test for HSV (both types).  Finally, arrange with your doctor that when you next have an oral herpes outbreak, you can be seen within a day or two for an HSV swab test (and don't treat the outbreak before testing).

However, there is one final option. That is to do nothing. As you will note, none of my potential explanations implies sexual infideltiy, and genital HSV-1 recurs infrequently, so you probably will have few or no recurrent outbreaks.  So you (and your husband) could decide to not go through the hassle of figuring this out in any more detail than you already know.  A lot of people with herpes, either oral or genital, don't feel a need to work out when and how it originated.
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