Is my life over?

[sadgirl789]

Doctor, I hope you can help sort out a health crisis that’s absolutely ruining my life.  

Please note I’ve only had sexual intercourse with one partner, a boyfriend of four years. We were both each others first sexual experience.  After this relationship ended, I was overseas for three years and had no sexual contact during this time.  

I met a new guy.  Nine weeks ago, we kissed and he touched my vagina for about ten minutes.    I’m not sure if he touched himself first.  It’s possible. I was clothed; he wearing underwear.  

Five days later I found a small group of lesions on the top of my thigh, one inch over (laterally) from the pointy hip bone (like bed bug bites).  They didn’t hurt, itch or tingle.  I called my new guy, told him about the lesions, etc., that’s where he proceeded to tell me that he’s HSV2  positive but hadn’t told me yet because “we hadn’t done anything that could transmit it.” WHAT?

The next day I developed intense vaginal itching, buttock tingling and the thigh lesions started to hurt (alternating between tingling/hot poker stinging).  I went to the local clinic, the doctor said there was nothing wet to culture.  He looked in my vagina, didn’t see any lesions. There was discharge and suspected a yeast infection.  He gave me Diflucan; it worked.  I was told to return if more lesions develop and/or at 16-weeks for blood testing.

One week after the initial lesions surfaced, two tiny widely spaced, scabs (no blistering) developed on the medial side of the hip bone. They, too, had that “hot poker” feeling, radiating into my groin.  They healed in four days; the initial lesions took longer to heal.  

No additional lesions have surfaced.  The tingling/hot poker feeling are still occasionally present where the lesions once were. I’m sick with worry that I contacted HSV2, have lost 16 lbs because I can’t eat.  Could I be that unlucky one in million? Could I be that statistical anomaly in medicine?

The irony is that I never saw his penis!

    

[sls63]

A related discussion, My daughter is freaking out was started.

[H. Hunter Handsfield, M.D.]

The patient described almost certainly had a recurrent HSV-2 outbreak.  About 40% of people who present with what seems to be their initial herpes outbreak -- i.e. who have no recollection of previous herpes-like problems -- in fact have recurrent infections, not initial ones. It's just that the initial outbreak was asymptomatic or otherwise unrecognized at the time.  That this does not apply in your case is proved by your negative HSV-2 blood test.

[sadgirl789]

Thank you again for your help.  I won't worry about it again.  

During my research on HSV I came across this article

http://www.consultantlive.com/display/article/10162/38494

I know this thread is over but, if you have the time/inclination....could you comment on the following:  Out of personal interest (I'm a teacher) and perhaps those of fellow readers, do you think this article is accurate in its understanding of non genital lesions in recently acquired infections?

No more from me.  Best wishes.  Have a nice weekend.

[H. Hunter Handsfield, M.D.]

My apology!  I first saw this and replied from my iPhone and missed the top part of your message, i.e. the test results.  I have deleted that reply and replaced it with this one.

You need to look at these results, and the entire picture, as one of very good news, that you do not have genital herpes.  Is there a small "bad news" element, that you don't know (and will never know) the cause of the initial symptom?  I suppose so, but that's a pretty trivial issue at this point.  The important thing is that you don't have herpes.  The initial symptom you had, and any continuing symptoms that may concern you, are not due to herpes.  Period.

To your final questions:

1) No, there is no realistic chance you had a genital area HSV-1 infection.

2) I suppose herpes zoster (shingles) might have been a possibility.  There is no need for shingles to have a linear distribution of lesions.  (I had shingles of the forehead several years ago.  It caused a small cluster of 2 or 3 lesions.)  I have never heard of any association of shingles with yeast, but I suppose it could happen.  In any case, if you had shingles, it's a done deal and not likely to recur.

3) Sure.  Staph doesn't require a break in the skin to get started.  That sometimes happens, but not necessarily.

So all in all, good news.  Please move on with your life, with no concerns about genital herpes.  You need not mention this business to future sex partners.  If symptoms continue that concern you, keep working with your own health care provider about the possible causes.

[sadgirl789]

Thanks, Dr., but these are my 12-week post-exposure test results.

[sadgirl789]

I finally got my results:

Negative for HSV 2
Positive for HSV 1
IGG ELI test utilized

Good news!  

I still can't understand why I'm having these symptoms.  Three VERY last questions:

1) Could these symptoms be attributed to HSV 1 genitally, recently acquired, even though I've had cold sores orally as a child?  How often does re-infection occur?

2)  If, for example, these symptoms were/are caused by shingles.....is it possible for shingles to cause a small cluster of lesions on the hip (and not an elongated strip of blisters)? And can a yeast infection coincide with a bout of shingles?

3)  Can someone get a staph infection without having a break in the skin in the area affected?

That's all.  Thanks for everything.  You were very kind, patient, and, most importantly, knowledgeable.  We are all lucky you offer this service.  

[H. Hunter Handsfield, M.D.]

I have never seen initial genital herpes that didn't involve the genitals directly.  No hip, no buttock, no elsewhere.  But it's pointless to speculate when the blood test is in the works.  Let's wait for that result and not play guessing games in the meantime.

[H. Hunter Handsfield, M.D.]

I have never seen initial genital herpes that didn't involve the genitals directly.  No hip, no buttock, no elsewhere.

[sadgirl789]

Thanks for your words of reassurance.  I'm going for the blood test.  I know that hand contact is a very low (if not zero) risk for HSV.   And I also know you've never seen someone contract HSV by hand contact. Just one last question:  have you ever seen an initial outbreak on the hip? Just wanted to know about the atypical outbreak area occurrences in your experiences---just to settle my nerves.  How usual is the atypical?  

Will post the blood results when they come available.

Thank you.  

[H. Hunter Handsfield, M.D.]

My inclination is to wait for the 3 month mark; or to test at around 6 weeks for 80+% reliability rather than only 3 weeks (around 50%).  In the meantime, you can relax.  Given your former partner's negative HSV-2 test, there really is no realistic chance your hip rash was herpes and I can't recommend spending good money to prove what is already certain for all practical purposes.  Or at least if you need the additional reassurance of the negative test, don't risk doing it more than once.

[sadgirl789]

Have a brief update and wanted your advice.

Spoke to my ex-bf last night on the phone about testing, etc.  He's currently in a new relationship with a public health nurse.  Interestingly, she insisted on a full STI screening before having sexual contact.  Included in the battery of tests was HSV (both types), in addition to the other usual suspects.  He tested positive for HSV 1 (something he knew would happen since he (as do I) had coldsores as a child) and negative for HSV 2.

In light of this news, should I be tested in three weeks (the 12 week post exposure marker from recent hand job exposure) for HSV 2 just in case I am that "one in a million" case who had a very low risk exposure that resulted in an atypical initial outbreak?

What do you think?  Thanks.

[H. Hunter Handsfield, M.D.]

You are correct that the timing is consistent with new herpes.  Still, I think the other arguments strongly outweigh that factor.

I didn't understand this had all happend 2+ months ago.  More than half of people with newly acquired HSV-2 have positive blood tests by 3-4 weeks and around 80% by 6 weeks, although it can take 3-4 months.  So you could be tested now; if positive, you'll know the score.  But if you wait a few more weeks, you won't run the risk of having to get yet another test.  There isn't much difference in outcomes between 12 and 16 weeks.

As for shingles, it's probably possible and I don't think t's so aytpical, other than your age.  Shingles is most common at age 50 and up but not rare in younger folks (and my son had it at age 14).  Or it could have been a localized bacterial infection (staph, strep, etc).

It would still make sense for your previous boyfriend to have an HSV-2 blood test, but also OK to wait until your own testing is complete.

[sadgirl789]

Thanks for your insights.  You put my mind at rest, although I am trying to find a differential diagnosis for these lesions and the only one I can find, apart from HSV, is shingles---and that possibility seems very remote, at best. Have you ever seen shingles present so atypically?

It's been nine weeks post exposure.  I've been told I need to wait 16 weeks for proper (100% accuracy) blood testing.  I've also read that 12 weeks is sufficient.  Which is best?  

You outlined three (very solid) reasons why this is not HSV, or at least an initial infection.   The only thing I can't get my head around is the timing of the lesions, five days post exposure. Isn't this the average incubation time for an initial infection?  If HSV, the timing seems way to coincidental to be an older infection.  This would also mean that I was asymptomatic for at least 3 years; my bf cheated, not likely given his background, etc..   I understand that most initial infections produce symptoms, even mild ones.  I doubt I would have missed something like this before.  I definitely need to get a blood test to sort this out.  

Thanks again for you help.  

[H. Hunter Handsfield, M.D.]

Welcome to the STD forum.  My first response is that your life definitely is not "over", even if you have genital herpes -- but anyway, I'm pretty sure you do not.

There are 3 main facts that make a new herpes ifnection unlikely.  First, the initial outbreak of genital herpes in women almost always involves the vaginal opening and labia minor, or the anus if exposred.  Second, your new partner is correct that you have not yet had any contact with him that risks catching his HSV-2 infeciton.  HSV-2 is rarely if ever transmitted by hand-genital contact.  Third, other than the cluster of skin lesions, your symptoms do not suggest herpes, which does not cause tingling or pain in the absence of actual lesions.

Although initial outbreaks would rarely involve the hip, buttocks, etc, recurrent herpes outbreaks can appear anywhere in the "boxer shorts" area, so a cluster of lesions where you describe would be possible.  But if you have herpes, it is probably not a new infection, but one you acquired from your previous partner, not your current one.  And this also seems unlikely.

At this point, you need to see a health care provider knowledgeable about genital herpes.  (You may already have one.)  You should have a blood test to see if you are infected with HSV-1 and/or HSV-2.  If negative for HSV-2, that will rule out recurrent herpes as the cause of your symptoms.  If positive, then your former partner could be tested -- in which case you can expect to find he also has it.  Finally, if and when there is another outbreak of lesions on your hip (or anywhere else), see your herpes-knowledgeable provider ASAP, preferably within a day of onset, so the outbreak can be tested for HSV by culture or PCR.

My bet is that when all is said and done, this will turn out not to be herpes.  In the meantime, don't be hard on your new partner.  You have not yet been at risk of catching HSV-2, and he was entirely justified in not telling you about his herpes before having intercourse with you.

I hope this helps.  Best wishes--  HHH, MD