[Question #1518] Possible herpes, possible post heretic neuralgia

81 months ago
On 9/28 I had sex with a hsv positive man.   This was the first time I had had sex in a long time.   He believes it is hsv2, but was diagnosed 20 years ago.  We did not use a condom, and he was not on antivirals, but no breakout.  Between 9/29 and 10/01 I came down with a cold.  On 10/05 I started to get itchy down there.  It was buzzy, similar to hives consistently in 2 spots.  This sensation grew and grew and I became raw and swollen down there.  I thought I saw a few spots but they came and went quickly.  I also saw 2 white painful spots in the back of my throat that came and left quickly.   

I've now been tested multiple times, all negative, but I continue to be very uncomfortable.  The redness has gone down a little, but it feels like worms and tacks are in my underwear.  

Tested on 10/31 swab.  Tested on 11/10 swab.  Tested on 11/15 swab.  Tested on 11/28 igg for hvs2 only.  All tests came back negative.  Took a 10 day run of aciclovir that ended right before Thanksgiving.  It may have been helping slightly.  I also was given a 2 pill z pak and a 2 pil antifungal.  I am incredibly uncomfortable.  

My underwear touching me hurts at times like I'm being burned.  Everyone is telling me it's in my mind.  I have to wait till late January to retest the igg.  Still dubious as they did not test for hsv1.  Could I have had an internal outbreak that the doctor didn't recognize?  Could I be experiencing constant internal breakouts?  

I have been tested for bv, yeast, chlamydia, gonorrhea, trich.  All negative. I had tested positive in July for chlamydia that my exhusband brought home, was treated and retested.  It seems to be connected with my glands.  But I'm not sure.  There is intense pressure around my clit. Could this be in my mind?  What are my options at this point? Is this herpes and the negative results have been incorrect?  Should I push for more antivirals?  I lost my insurance in the middle of all of this so I need to figure this out quickly.  Thank you.   
Terri Warren, RN, Nurse Practitioner
81 months ago
I'm so sorry - this sounds very uncomfortable! 
I doubt that all of this discomfort could be in your mind but it also doesn't sound like herpes to me.  First, I think the chances of you getting herpes at a single encounter are statistically very low.  Not impossible but really low.  I'm wondering -were any bacterial cultures done of your genital area?  I've seen some pretty amazing bacterial infection - staph and strep - of the genital area in my career.  This is one idea that you might want to pursue. 

I particularly remember a woman referred to us by her OB because she "couldn't get her herpes under control".  She had been taking 2 grams of Valtrex daily for 9 months for her herpes (she was positive by culture previously) but still had terrible symptoms of redness, burning and even breaks in the skin, but none of it made sense because the Valtrex should have been taking care of things.  Sure enough, our bacterial culture revealed a strep infection.  A week of antibiotics resolved the whole thing.  The point is that sometimes bacteria can cause this burning, redness and discomfort. 

I think you can believe that IgG test for HSV 2 with 95% certainty, compared to the gold standard herpes western blot.  I don't think you need to worry too much about HSV 1 in this situation - first you don't mention receiving oral sex from this person and that's how most HSV 1 is transmitted to the genital area but also, HSV 1 genitally is a pretty benign infection, after the first outbreak, and I don't think it would cause you these constant problems. 

81 months ago
I was tested for bv, yeast, trich, all negative.  Not sure if bv is the same as what you mentioned as a possibility...strep or staph.  We DID exchange oral, and we did have sex a few times after this.  I was given 2 azithromycin pills that I took at the same time as directed.  Would that be enough to clear up this type of bacterial infection?  I took that a few weeks ago.  We have not had sex since October 28th.  Tested by igg 4 weeks later, again only for hsv2 per Planned Parenthood's protocol.  

I don't have insurance so going to the doctor is problematic.  I am much less red and swollen (although still a little), it's these pressure, poking, and sandpaper sensations that won't go away.  Should I get tested for strep or staph or anything else at this time?  I also wondered if I might be experiencing a gland problem.  

I am taking supplements now, as well....magnesium, vitamin d, garlic, vitamin c, along with a lemongrass tincture.  Is there anything more that I can be doing to ease my discomfort?  

Thank you for your response.  
Terri Warren, RN, Nurse Practitioner
81 months ago
  1. Because I don't know what is causing your discomfort, I'm at a loss as to how to make it better.  If the swelling as decreased, that's a good thing.  BV is not the same as a strep infection, no, it's different.  Two azithromycin would not clear up a strep or staph infection, no. If money is an issue, you could wait and see how this goes, for sure.  it's good that you were negative at 4 weeks but it looks to me like you were also negative at 8 weeks, is that right?  If that is true, per your post, then there is greater than a 70% chance that the results will stay the same at 12 weeks.  i doubt that you are infected with herpes, honestly. 
  2. What do you mean,  a "gland" problem?


81 months ago
I may have mispoke about the gland issue, although I've wondered if the bartholomew gland was something to consider.  I think it's the something in the vestibular bulb that throbs and pokes sometimes. Mostly on the right side.  Is this important?  I have even felt some zaps in a few different spots.  

We had sex 4 times without protection and 4 times with protection.  My partner has had this for 20 years, his last outbreak was a years and a half ago and he was hesitant to take antivirals because he felt it might alter how in control the virus was in him.   I've heard that for some the longer that they've had hsv, the less they shed. Is this true?

 I have a copper iud that was put in place in July.  Is that a clue?

How does one get strep or staph down there?  How does one get tested?  Can it be left untreated?  Will it resolve itself?  I am allergic to penicillin.  What would be the appropriate medicine for me?  Would my partner need to be tested and treated?

How possible is it that this is/was an internal outbreak?  I began itching on the outside around October 5th.  I hesitated to go to the docs because all I could see was red with a few spots that quickly came and went.  I was finally swabbed on October 31st.  But I don't remember the doc swabbing anything internal.  That came back negative but I worry that I waited too long and I've heard that swabs can have an incorrect negative reading.  What are your thoughts on the effectiveness of the swab?

By November 8th parts of me that are near my perenium and are internal were so swollen and red that they were external and touching my underwear.  This has subsided although I'm still sore and red.  I've had quite a bit of white discharge, some runny, but most chunky and gooey.  

What about those 2 white painful spots in the back of my throat?  I did perform oral one time.  Would that give me oral hsv1 or 2 or both?  The spots disappeared within one day.  Very odd.

I've also had a weird extra period, more than full length last 7 days which is long for me.  I believe that the stress I've been going through caused this.  My last 3 periods were excruciating as neither tampons or pads were comfortable. 

I've lost a lot of weight and sleep overy this issue.  I am ocd (if you couldn't tell by my questions) and have an anxiety disorder that is being really problematic.  I really need to figure this out, but unless I have an actual outbreak I am on hold regarding hsv until I can get retested by igg in late January/early February.  And of course google is full of horror stories that are beyond scary.  

I am also diagnosed with lichen sclerosis.  This has not bothered me noticibly at all, but the first doc thought maybe it was flaring up.  I don't think so.  It is definitely more noticable because I'm so red and the white areas are standing out more.  But I was wondering, would lichen sclerosis make me more likely to contract hsv or hiv?  I already have hpv.  

One other treatment I've tried is a yogurt douche.  That did seem to ease my discomfort.  I was considering adding some minced up fresh garlic.  What are your thoughts?

Anything that you could tell me would be appreciated.  I'm going just a little crazy here.  I've been told that I might have mentally created these symptoms.  Is that possible?  If I relax or stop thinking about it (which is next to impossible) the throbbing and poking ease quite a bit.  

Still think that I'm at 70% odds?

What is your opinion of antivirals being used to protect negative partners?  I've heard that without condoms and no antiviral's my chances were about 8%.  6% if condoms were used, and 4% if antivirals were being taken.  Is this true?

Thanks, again.  This is a very helpful service.  

Terri Warren, RN, Nurse Practitioner
81 months ago
Bartholin gland infection would present differently, I think, or it would have been seen on exam.
People do shed less over time, yes and antiviral therapy taken daily reduces the risk of transmission of HSV 2 by almost 50%
Staph an strep can be transmitted via sexual contact - his skin may have on or the other and yours did not.   It would be diagnosed by swab test by bacterial culture and can be treated with antibiotics other than penicillin, if that's what is going on.  However, your symptoms sound very much like  bad yeast infection to me, from your description.
A swab test for herpes is most effective when gathered early in an outbreak
If your partner has HSV 2 genitally and you gave him oral sex and acquired this in your throat, it would be HSV 2 orally.
If you lichen sclerosis causes breaks in the skin, yes, it would make you more vulnerable to acquisition of HSV.
I would not recommend adding garlic to your yogurt douche, no.
Yes, I still think you are 70% odds
I would say the odds are more like 10% if nothing is used, 5% if antiviral therapy is taken and around 2-3% if condoms are used, even less if they are used every single time.