[Question #1388] Very concerned - possible HSV infection.

46 months ago
I had been travelling Europe for a month and became extremely run down with a chest infection. 11 days ago (when sick) I had vaginal sex with a man - the condom fell off and he ejaculated inside me. I took the morning after pill. Approximately 4 days later I went to an std clinic due to discomfort in my vagina, burning and white discharge - I was diagnosed with thrush and a mild UTI. I was given thrush cream and antibiotics for the UTI. Approximately 2 days after that I experienced an intense burning sensation across my buttocks, the pain eventually became worse and began to radiate down my legs and into my feet. The pain was very extreme 8/10 - definitely nerve pain. I also had a slight fever with chills, sweats and nausea - I presented to ED - they gave me high doses of endone nothing helped the pain. Applied ice packs to my legs but it only made the pain worse. They did a thorough vaginal examination and could not see any lesions. I was discharged with "unknown STD ?herpes" told to follow up at the STD clinic. Hospital gave me prophylactic aciclovir but it made me too nauseous. The clinic said all results were good and there is no way my symptoms could be related to herpes. I'm still getting ongoing almost constant sensations in my legs buttocks & even arms at times like I've been sunburned and pins and needles. Absolutely no signs of any lesions. I'm still really run down, lethargic, no appetite. Every doctor I've consulted is baffled. I have had chicken pox and shingles in the past. Please help - is this HSV2 despite no lesions??? Could lesions still appear? How can I ever confirm if this is HSV2 - should I request an igg test? I suffer from anxiety and am terrified by all of this. 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
46 months ago
Good morning,
That sounds like a pretty miserable experience - being away from home and having all that going!
While I think it is unlikely that this is herpes due to lack of lesions, the timing is a bit worrisome as well as the nerve pain.  Many things could cause the nerve pain, but if you were my patient, I would recommend an IgG test to rule out herpes infection.  Where are now, are you back in the US?  You can either go to your provider for this test or order the IgG test on your own on the internet - there are many services that do this that use the usual labs of Quest and LabCorp.  Do NOT EVER order an IgM test, OK?
When you mentioned that you had shingles, when was that and where did the shingles lesions show up on your body?

Terri
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46 months ago
Thank you so much for your response, I appreciate it. I can't stop crying I'm a total wreck :( I'm back in Australia now. I just cannot believe how much misinformation there is on this condition, I've seen 3 GPs prior to going to ED who looked at me like I was crazy. I had a small patch of  shingles on the right side of my neck a few years ago.

A few questions:

1. How long would I have to wait post exposure to get the igg test for it to be accurate?
2. Is it possible to have an "outbreak" with no lesions?
3. Can you get lesions later on in "recurrences" if you had none in an initial outbreak? 
4. Have you seen an initial presentation like this before?

I appreciate your help so much 


Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
46 months ago
1.   You should wait about 12 weeks from the encounter for the most reliable results
2.  It is possible to acquire herpes with no lesions, yes, I have seen a few interesting situations in my career with people acquiring disease without symptoms, but clearly, it is the exception to the rule, so try not to run with that response.
3.  Yes, you can
4.  Yes, perhaps 3 times in 33 years, which makes it very rare!

Terri
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46 months ago
Thanks again for that information. Last question - do you think it would be of benefit to me to take the valaciclovir if I can tolerate it? 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
46 months ago
NO!  If you do that, it could interfere with antibody development and leave you still wondering.  If you were my patient I would NOT start you on antivirals without a positive test - either swab is you get a lesion or antibody.

Terri
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