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Avatar universal

Very worried

Hi,

I've been worried and hope you can help. Here is the story...

I started dating a guy and the day after we first slept together I noticed I had a bump in my throat.  This turned into several tiny cuts in my mouth, swollen gums, and I felt like I had a fever for a day or so.  I didn't have insurance, so I asked him to see a doctor.  He came back clean...although I'm not sure if he had herpeselect or the equivalent. About 3 weeks later my symptoms went away and we continued seeing each other.

About 3 weeks later, I noticed a bump in my throat again.  I then noticed a red bump on my outer labia. I went to a GP, who, upon noticing cottage cheese discharge that I did't know was there, said I had a yeast infection and gave me diflucan.  She swabbed the bump and it came back negative for herpes and other stds like chlamidia and bacteria.  However, a test for yeast also came back negative.

I went to an obgyn who did a wet mount and found multinucleated cells from a swab of my vagina/cervix.  This lead him to believe I had herpes.  Due to the mildness of my sypmptoms, he suspected it was hsv 1.  Herpeselect (I did both types) came back positive for 1 and neg for 2.  This OB told my that the test results indicated I had had the herpes 1 in my body for at least 12 months (which would mean it wasn't from my most recent partner).  However, he also told me my anxiety about this is off the charts and I need to talk to a shrink.

I took 3 valtrexes a day for 2-3 weeks.  Symptoms such as nerve ache and tingling have subsided but I continue to get little bumps around my vagina/bikini line. Also, I have slight fevers from time to time, my throat is still sore, and sometimes there is a small amount of blood in my phlegm.  Altogether I have been experiencing symptoms of some sort since very early October...which I understand to be unusual, particularly considering I took the valtrex.

Could my symptoms be caused by something else?  Should I be worried about HIV?  I have had 6 partners and have regularly used condoms.

I look forward to your input.
10 Responses
239123 tn?1267651214
MEDICAL PROFESSIONAL
Pretty complex story, and of course I can't sort anything out definitively by online description.  But I will say that looking for multinucleated cells is totally and absolutely unreliable as a basis for diagnosing herpes.  That's called the Tzanck test and it works poorly when done on an overt herpes lesion, and is completely unreliable on a cervical or vaginal swab.  Your provider's limited knowledge about herpes also is suggested by his apparent belief that mild genital symptoms suggest HSV-1, which is nonsense.  There is no clinical difference between the two, except that HSV-1 causes less frequent genital recurrences than HSV-2.  

Half the adult population has antibody to HSV-1, and although y Your initial mouth and throat symptoms sound like you could have had a new HSV infection; and contrary to your doc's advice (more evidence of his limited knowledge), a positive blood test can develop in as little as 2-3 weeks and certainly within 6 weeks.

Another (slim) possibility is new HSV-2 infection of the mouth/throat, from oral sex, implying your partner might have genital herpes due to HSV-2.  Although the antibody test can be positive after 3-6 weeks, it can take up to 3 months.

Having said all that, it still is most likely that all your symptoms are due to something other than herpes.  Statistically, it is probable you have had HSV-1 for a long time, probably since childhood.  But the possibilities of other things are too numerous for me to make a guess.  Several viruses can cause sore throat and oral sores.  HIV is not among them, however; you don't describe anything that makes me nervous about HIV.

So you need to find a herpes-knowlegeable provider.  You might check to see if there is an ObG who specializes in infectious diseases in your community; such people can be found in association with many major medical centers.  When 3 months have gone by, it might be good for you to have a repeat HSV blood test, and also have your partner tested around that time.

Sorry to be pretty vague.  Best wishes-  HHH, MD
Avatar universal
OH yeah...I have also had a watery discharge for quite some time.  

I first slept with the guy I mention above in early July.  My Herpeselect test was in late October.

Thanks
97676 tn?1340408973
The fact that you regularly use condoms is assurance against HIV.  HSV1 is common, as most people have it and suffer outbreaks from it.  I believe I read a previous statement from the doctor that said unprotected oral sex carries a near zero risk for HIV, at least in his MANY years of experience in Sexual Health there isnt a documented case of it.  I would put HIV worries to rest.
Avatar universal
Ok...thanks a lot Doc.  I am in the process of making an appt at a hospital - an ordeal in itself given how these insurance companies work.  I'll post an update if I get any definative information.
Avatar universal
Hi Dr,

I'm hoping you can answer another question?  I seem to be having a yeast infection again...at least, I seem to be having cottage cheese discharge.  Is there anything else that can cause this?  As I mentioned in my original post, I was tested for yeast originally and it came back negative (to my gp's surprize). Also, things are just red and irritated there...typical of a yeast infection I guess (altho I had never gotten one until this incident).  

Thanks a lot for your help.
239123 tn?1267651214
MEDICAL PROFESSIONAL
I cannot say for sure you have recurrent vulvovaginal candidasis (yeast infections); you need to see a provider for proper diagnosis.  But recurrent yeast infection is an extremely common problem.  A few such women have diabetes or another underlying health problem, but there almost never is an obvious explanation.  (And contrary to common beliefs, HIV/AIDS probably does NOT predispose to recurrent candidiasis.)  Fortunately, effective preventive treatments are available, such as a once-weekly dose of fluconazole (Diflucan) (available only by prescription).

Notice to believers in yogurt, lactobacillus, diet modification, avoiding tight clothing, or the concept of "chronic candidiasis" as an explanation for fatigue and other systemic symptoms:  Don't even THINK of posting comments here.  I will delete anything about scientifically unsupported remedies or other evidence of magical thinking.

(In fairness, there is scientific reason to think that lactobacillus replacement might help, with the right kind of lactobacillus in a form that would successfully colonize the vagina.  But there are no medical or dairy products on the market that meet these criteria.)

HHH, MD
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