[Question #1921] HSV 1 or 2?

53 months ago
Good morning, thank you in advance for answering my questions.

I am a 31 year old heterosexual female. Last month I had unprotected sex with a new partner. Total times having unprotected sex was 4. 

18 days after potential exposure, I began having a tingling sensation all over my genitals. The tingling was constant for 7 days, and continues to be intermittent throughout the day with periods of numbness (total 15 days now). I have no visible lesions or sores. No discharge, no itching and no flu-like symptoms accompanying the tingling. If any other symptoms are present, they are slight inflammation and increased sensitivity of the labia majora and mons pubis, increased thirst, and increased urination. 

24 days after potential exposure, I had a full STD panel done with my family physician. HSV 1 and 2 IgG and IgM tests came back negative. The only test that came back positive was HPV, which I have tested positive for in the past. She has recommended another round of tests in 6 weeks.

My questions are:
1. Is it common for HSV 1 or 2 to present as strictly a tingling/crawling sensation (prodrome phase)?
2. What percentage of people build up detectable antibodies by 24 days post exposure? 
3. If I am tested while experiencing a symptom, does that make my initial test more reliable?
4. If I develop sores, will they be quite obvious or will they be something I have to look for? Do HSV sores always hurt, and do they always break open and scab over? Are they always raised? What does a typical outbreak look like?
5. If this was not HSV 1 or 2, what would you recommend moving forward?

Thank you again!
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
53 months ago
1.  No, it is not common AT ALL.
2.  About 50% of people who are going to test positive in the future will test positive at 3 weeks out from the contact.
3.  No, not if the test is a blood antibody test.  If it is a swab test, yes, it will be more likely to test positive, If indeed you are infected, when symptoms are present
4.  generally speaking, the symptoms will be obvious and you will not have to look hard for them. It is best to look and see if you have sores if you feel something abnormal in the genital area. Happy sores do not always hurt but I would say that they hurt quite often and may only hurt when touched as opposed to hurting all the time. Sores in women in the genital area often start out as water blisters but quickly break as the labia rubs together.  Ulcers then form. Lesions do not always scabbed over in the labia Area but rather skin comes in and fills in the area where is the ulcers were located. It is best to obtain a swab test when lesions are very new. Lesions look like tiny water blisters, often in a group, or like ulcerations into the tissue.
5.  if the test for herpes simplex one or two is negative at 12 weeks out from the encounter, you may wish to consider a bacterial culture of the area to see if this could be staph or strep or a mild yeast infection

In addition, 18 days out would be a very long time for first infection to appear.
Please let me know what other questions you might have.

Terri
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53 months ago
Thank you for your response!

In your professional opinion, with the symptoms I mentioned, is herpes something I should be concerned about? I have suffered a great deal of anxiety over this due to my online research and the constant description of "tingling" as a symptom of genital herpes. 

If my symptoms continue to subside, should I assume the issue has taken care of itself (assuming this is not herpes), or should I make an appointment with my doctor ASAP and request to be tested for the other infections you mentioned? 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
53 months ago
If you were my patient, I  would test you for the other things, absolutely, and probably do one more herpes IgG only (never IgM) at 12 weeks - if negative, call it good.  If your symptoms go away, you don't have to test further if you don't want to - it's not essential but if it continues to be very troublesome, I would retest, yes/

Terri
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53 months ago
If this were a herpes outbreak, is it correct that this would be a rather long outbreak? What is the usual timeframe for the tingling sensation to last before sores or lesions appear?

At this point, the majority of sensation I am experiencing is increased sensitivity of the skin around my genitals, the outer labia and mons pubis specifically. Occasional tingling occurs throughout the day, but mostly just hyper sensitivity. Especially around my pubic hair. What do you make this? 

Could all this be related to HPV?

I realize this is my last permitted reply. Thank you again for taking the time to answer my questions.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
53 months ago
oh yes, an exceedingly long outbreak!  I really don't think that's what is happening here.
Normally people with herpes may have these tingles for a day or two before an actual outbreak.  I'm just not clear why you are having all this increased sensitivity.  But you will be abel to rule herpes in or out at the 6 weeks follow up testing.
I don't feel that these sensations are due to HPV no.  HPV just mostly sits on the surface of the skin vs. herpes which involved the nerves 

Terri
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