Herpeselect at 4 weeks post exposure

[scared805]

I am a woman and had brief (aprox. 1 minute) unprotected vaginal intercourse 6 weeks ago.  2 weeks later I was having milky discharge went to OBGYN and was diagnosed after looking through the microscope with Bacteral vaginosis.  I took Flagyl for 7 days.  One week later I went in for my annual pap smear, all came back fine.  I have been so stressed cant sleep! So at 4 weeks after exposure I went in to be examined again by my OBGYN.  He did pelvic exam and didn't see anything to be alarmed.  He did say he saw a "spot of irritation" deep inside my vagina, but said it was nothing to be alarmed about.  Could have been from my pap smear four days earlier or from intercourse.  He said nothing to worry about.  But I have had it in my head now that it could have been herpes?  I had a full STD panel done at 4 weeks past exposure everything negative.  Chlam, gonn, syphillis, hepatitis, herpes.  All were negative.  But I am still convinced I might have herpes?  I have not seen any visible sores, and have not had any burning irritation besides the time I was treated for Bacterial Vag.  
However I have been feeling kind of "sore" in my vagina.  Almost like a feeling I get after my normal pap swab.  When they scratch you with the brush it feels kind of tender in that area.Well I have felt that feeling for about 2-3 weeks now.pinch feeling inside vagina  when sitting down.

My questions are -

1) Based on my exposure what are my risks for contracting herpes?

2) How accurate is a Negative herpeselect test at 4 weeks past exposure??? Or test again?  I have read in a previous post from you that 80% people will "usually" test positive by 4 weeks

3) Are herpes sores generally deep inside vagina in primary episode?  

A side note...i recently found out I was pregnant. Not from the unprotected episode I am talking about.  But could my uncomfortable pinch vaginal feeling have something to do with vaginal/cerival changes during pregnancy?

PLEASE shed light on my darkness

[Edward W Hook, MD]

You have said several times this will be your last question.  I will enforce that statement and following this reply I will delete further questions without response.  You are asking me questions you should be asking your doctors.

In most clinical settings a wet mount is used for diagnosis of trich and it misses about 20% of infections which are detected by culture.  On the other hand, most of the infections detected by culture but not wet mount are asymptomatic.  I believe you have had multiple wet mounts and, since each repeat wet mount should detect infections missed with previous evaluations, the tests that you have had really should suffice.  EWH

[scared805]

Once again thank you.  

So if current tests sometimes miss trich should I persist for a trich culture?  The NP at Planned parenthood said they specialize in STD's and there is no need for cultures.  
I just want to be positivly certain trich is not causing my soreness so I don't pass it onto my fiance.  Most of the time are trich organisms seen on wet mounts?

This will be my last question.

[Edward W Hook, MD]

Thanks fo rthe follow-up.  To conclude things, if your exam at PPH showed yeast, that would be my first concern.  Yeast can occur without symptoms.  The diagnosis of trich is always a possibility as current diagnostic tests sometimes miss the infection but my advice would be to go with what has been seen on your exam first. EWH

[scared805]

Just wanted to give a follow up to my situation and thank you for all your help.  

I returned to dr. and believe some of my symptoms were due to a missed misscarriage, because most of them dissappeared once that happened.  

I have since tested negative for everything Chlaymida, Gon., Hep, Herpes, Syphillis, and had recent pap that did not show anything abnormal no HPV.  

My concern now is still a little uncomfortable vaginally.  It has been aprox. 3 months since unprotected exposure, and i most recently was seen by Planned Parenthood for the sore vagina.  They examined my discharge under the microscope and said was mild yeast infection.  However I have not discharge that I normally would get with that.  

I was thinking maybe Trich?  They said they would have seen the trich bacteria under the microscope if I had it, but I also read many trich cases are missed with wet mount.  How possible is it that I do have trich but they missed it when looking?  Do I need a culture done to get a positive negative for trich.  
This will be my last post, I have ruled out every other STD but my only question is with trich.  Symptoms are just soreness after intercourse, and slight burning at times.  no discharge.  

Thanks!

[Edward W Hook, MD]

One lat answer - about 70%.  Further questions will be deleted without comment.  EWH

[scared805]

I have an appt next week to see my OBGYN.  I also just got my herpeselect IGG results back from the recent test I took at 6 weeks past exposure.  They said they are negative.  What percentage of results would show up at 6  weeks post exposure.

[Edward W Hook, MD]

You are convinced this is herpes, I am not.  We are at an impass.  At this time, I think you need to return to your doctor for further evaluation.

Perhaps the "spot of irritation" he noted before has increased and can be diagnosed. Alternatively, perhaps it is gone.  For you to have had isolated herpes lesions on the inside of your vagina (were they usually do not cause symptoms, if they occur) is most unlikely.  Again, you need to see you health care provider.  Please let us know what he/she says. Until then, no further questions please.  EWH

[PleaseHelp209]

I just wanted to let you know that on Sept 2, 2008 I took my final Herpes IgG test, 11 weeks after initial unprotected exposure to HSV2 (see original post: Soreness at tip of penis, Jun 27, 2008, 12:37PM).  My results were still negative. I know that this is a mentally exhausting time, but rest assured it's probably not herpes.  I had to leave this post to help anyone who is worried about an exposure... most of your symptoms are anxiety driven... albeit, I'm sure some are legit.  When you are conciously aware of it, your mind plays powerful tricks on you.  Be patient, unless there is true evidence to be concerned.  Thanks to all, and best of luck!  

PleaseHelp209

[scared805]

I am still feeling vaginal soreness more towards my cervix area.  I have been feeling it for about 2 weeks going on 3rd.  Best way to describe it would be the feeling you get when you touch an open cut.  Kind of irritated & sore.  And I seem to notice it more when I am sitting down, or when I am in hot weather.  I can't seem to think of anything else it would be besides internal herpes lesions?  I can't feel anything when I try and feel with my own finger.  I know you mentioned based on my encounter and symptoms I more than likely didn't catch herpes, and that even if you have internal lesions you almost always have external ones.  But is it possible to have them only internally?  Do you see that very often for the primary episode?  

Are there other things besides and STD that could cause irritation inside the vagina? I don't have abnormal discharge or anything like that.

If its not herpes, could that feeling be from the increased blood flow to the vagina in early pregnancy?  

I am just completely scared, and don't know what else this feeling is.

[Edward W Hook, MD]

The study I quoted started counting was 3 weeks after the appearance of sores.  The lesions of gential herpes typically occur within a week of exposure so, if you wish to add that to the calculation, it would be about 4 weeks after exposure.  Remember however that if there are no lesions, then the odds that you got herpes have already gone down substantially since most herpes does start with lesions.  EWH

[scared805]

Sorry one question was not answered.  When do 50% blood tests become positive.  Is it 3 weeks after exposure?  Or 3 weeks after sores appear?  I would think it would be after exposure being that is when the virus enters your body.  But want to make sure.

[Edward W Hook, MD]

The denominator for the 50% figure was people who have herpes. Thus, over time, nearly all would go on to test postive.  Personally, I find it most unlikely that you ahve herpes and doubt that there is anything to be gained from re-testing.  I would look for other causes, pregnancy and anxiety being amoung them ( I say this sincerely, not out of disinterest).  EWH

[scared805]

Sorry last question forgot to post.  When you say that at 3 weeks 50% test positive.  Is that 3 weeks after exposure or 3 weeks after the first herpes symptoms appear?

[scared805]

Thank you so much!  You have helped relieve some of my stress I have been under for the past 6 weeks!  I can't sleep, or eat just thinking about  it.  The more I read on herpres the more conviced I am that I have it.  

Of the 50% of people that test negatvie at 3 weeks, do many of those go on to test positive?

Just been really worried about the uncomfortable feeing I have had vaginally (internally) and can't seem to come up with any other reason other than herpes.  
Would you recommend testing again at 6 weeks? being I tested neg. at 4 weeks?

Sorry to bother

[Edward W Hook, MD]

It sounds as though you are worrying about this exposure more than is necessary.  The chance that you had your first episode of genital herpes following the exposure you describe is very, very low.  In fact all of the evidence is against it.  Persons are typically rather ill during their first HSV episode and have lesions which may be internal but are also almost certainly external as well.  The absence of lesions makes it unlikely that you got herpes from the encounter. A few other facts add to the likelihood that you did not get herpes.  These include: 1. that you do not know that your partner had herpes, odds are only about 1 in 5, on average, that he had HSV; 2. if he had herpes, you might have seen lesions; 3. that your doctor did not see anything suggesting herpes and 4. That even if he had herpes, most exposures to herpes do not lead to transmission.  Putting all of this together with your negative blood test, the probability that you got herpes is very, very low.  So low that it really is not fruitful for you to worry about it.  As for your questions:

1.  See above.  Very, very low.
2.  Half of patients have developed positive HerpeSelect tests 3 weeks after their outbreak and at 6 weeks that figure is up to about 66-75%.  It may take up to six months for the remaining infections to become apparent on the blood test.  In your case, when considered with all of the other evidence that this is not herpes, you really have n little to worry about.
3.  See above.  Typically they are on the outside and are visible to the people who are having the outbreak.  

There is a possibility that part of what was seen could reflect your pregnancy.

Take care.  EWH