[Question #197] Dr. Handsfield or Hook input

37 months ago
Hi! I have asked 2 questions about the fear of having herpes. Ive been getting a recurrent pimple for 2 years now in the same location (between labia minora and majora). The first time it was December 2013. I went to the ER and the Generalist saw a pic of what I had (i wasnt sexually active with intercourse so I was so ashamed). He prescribed me antivirals and antibiotics at the same time even though he said I had "vulvovaginitis". I freaked out with the antivirals I thought it was related to a chickenpox I had administrated 8 days earlier and got infected with a cellulite on my arm (naive me huh?). The second time I got it in December 2014. I went for the first time to an obgyn, he looked at me, said he didnt saw anything (even though I felt some pain) and sent me to do an herpes blood test. The next day I went to my current obgyn she examined me and told me "i see like something is gonna come out lets wait 2 days and see how it develops". 2 days later as soon as I opened my legs she told me "thats definetely a pimple or an abscess". It was filled with a lot of puss and you could see a head (like the first time). She popped it and I was instantly cured. I was worried because my boyfriend that time used to get cold sores (maybe 1 per year or so) and he sometimes practiced oral sex to me. I dont remember him doing it while having one because I didnt even kissed him while having them. By the time I had the 2nd pimple we were not together anymore (6 months later). I told that to my obgyn and she told me "dont worry this is not herpes". I did the blood test (Igg)  and it came out negative. Now Im in a new relationship with the man of my life, sexually active he was my first one and taking bc pills. We always use condom for intercourse but not for oral. 
Exactly 1 month ago before my period my vulva got really itchy and I started feeling some discomfort inside my vagina. My period came and I felt like something bloated inside my vagina. I went to my obgyn she didnt examine
37 months ago
Examined me or anything and told me I had a yeast infection. I took one dose of Difulcan which caused me fever. 5 days later I was seated and I felt like something popped inside my vagina (I felt relief from the pressure but the discomfort continue), went back to her she examined me and said everything was ok. 4 days later I came back and she felt a bump inside my vagina but because of the location she couldnt see it. She said it was another abscess, hospitalized me for 4 days with antibiotics thru my veins, did an mri, blood tests and cultures and everything came back negative. I had another blood test for herpes now and it came back negative (0.2) for both types. She examined me again and said the "bump" was gone. Its been a whole month now since my first symptoms and I still feel discomfort and my vagina is always burning. Im going to another doctor Tuesday morning. Could this be herpes? How accurate would be a culture by this time? Im going crazy, cant eat, sleep or concentrate. I cant lose my actual relationship. My obgyn keeps saying its not herpes even though she havent swabbed anything. She just keep saying "i dont see anything you are just swollen and irritated". I've been feeling my vagina swollen shut. In 2 years my ex practiced me oral sex maybe 10 or 12 times. We kissed a whole lot, which are the odds of being infected?, does it sound like herpes for you? Help me! 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
37 months ago
Joy, sorry, but you can't request a specific responder on this board and I am the herpes expert here.  I have 31 publications in excellent journals on the topic of herpes and you can feel confident about my responses.  So let me be sure I understand your situation.  You were with a boyfriend who got cold sores and he was the giver of oral sex to you six months prior to you getting your first herpes antibody test.  Is that correct?  So you had six months from the last time you received oral sex to the time you tested?  And you were negative for both HSV 1 and HSV 2? Is that correct?  Now you are in a relationship with a new man with whom you use condoms for intercourse but not for oral sex.  Is that correct?  So was the "exactly one month ago" experience of itching and discomfort in the vagina prior to or after your relationship began with this new partner?  And then you were hospitalized for four days for a vaginal abscess?  I seriously doubt with a hospitalization that an abscess would be mistaken for a herpes outbreak.  The herpes you are most vulnerable to, from receiving oral sex, is HSV 1.  So far, you are testing negative for the herpes antibody, both types.  The HSV 2 antibody test is very accurate and the HSV 1 screening test picks up 73% of infections.  So the odds are huge that you don't have HSV 2 and good that you don't have HSV 1.  If you did happen to have HSV 1 genitally, the symptoms would NOT be constant burning as you describe.  HSV 1 genitally recurs 0.7 times per year, on average.  That's about every other year.  It seems that your symptoms don't really fit with that pattern either.  In my opinion, an exam might be useful but I"m not clear that a swab test (and PCR is about 3-4 times more sensitive than culture for swabbing) would be useful this coming Tuesday if indeed this is a herpes outbreak.  Honestly, your symptoms don't sound like herpes to me but the unlikely possibility that you have HSV 1 is there.  A herpes western blot antibody test is a lot more sensitive than the screening test you have been having done.  The University of Washington can send you a test kit if you are interested in obtaining this test and it might help set you mind at rest, though it would not take away your bothersome symptoms. 
Let me ask -  has your new partner been tested for herpes as you have? 

Terri
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37 months ago
Im so sorry if I gave you that impression. I know you are very well educated and experienced in the subject and I trust your responses. Yes you are correct, there was a 6 to 8 months window between me receiving oral sex and having my first blood test. Then a 9 months period between my first and second blood test (both negative). What scares me is that Ive read a lot from people who keeps testing negative in blood tests (even years after they test positive with the swab test). What if Im one of the people that doesnt develop antibodies? . Yes with this new partner I dont use condom for oral and I dont know if he has been tested. What about the popping that I felt inside? My obgyn says my vaginal canal looks clean just swollen and irritated and she said it was an abscess because she couldnt see what it was (it is located in a place inside where her sight cant reach). How common are internal breakouts? How long they last? Do people always get their breakouts in the same place? I dont have anything on my vulva (not pain, blisters, itching). The burning started after I started my new relationship. If you were in my position what would you do? The burning feeling inside my vagina and anxiety is killing me. What can be causing this if not herpes? It all started September 16 and here I am still feeling the same :(. Which other test would you recommend if not a swab test?, the last blood test was made a month ago when my symptoms started. I've read so many things that if you asked me I would tell you I do have herpes with symptoms lasting 1 month and 4 different antibiotics that hasn't worked. Thats how anxious I am, it even scares me going to the other doctor because I wanna believe what my obgyn says.  Help me! 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
37 months ago
You didn't give me that impression, no, I just wanted to reassure you that I'm well versed in the topic. 
The popping inside is puzzling.  That really doesn't fit anything that I know about assuming you didn't have anything in your vagina, like a cervical ring or diaphragm.  I'm thinking  you would have told me about that.  And nothing came out of your vagina right?  In my personal experience, herpes outbreaks in the vagina itself are not common.  I think they are far more common on the cervix, and frequently those are accompanied by external lesions as well.  Research shows that about half the people with herpes have outbreaks in the same locations (or near the same locations) and about half have outbreaks scattered throughout the boxer shorts area.  If you still have your symptoms on Tuesday when you go in, a swab test can't hurt of course, I'm just not sure how reliable a negative will be at that time, but if you still have your symptoms then, I'm guessing if your ask your provider to do a swab test, they might do that. 

The thing is, if you were in the hospital for a vaginal abscess, no one is going to get that mixed up with herpes.  Are you wondering if that is possible, that maybe that is getting mixed up?  I would say not.  It sounds very much like the abscess and the symptoms of burning that you are having now are totally different things.  Is that your impression as well?

So what is going on in your vagina?  Herpes would definitely not last that long.  We are at over a month now that you've had this and herpes just does not behave in that way.  It would run its course sooner and the symptoms would peak and recede.  You mentioned that you think you could have herpes lasting one month and 4 different antibiotics didn't work?  You know that herpes is not treated with antibiotics, right? It is treated with antiviral medicines, which are different.  Maybe you were just mentioning these two things in the same sentence but know that they aren't related?  Do you know if the condoms that you are using with the new partner are different than those you have previously used?  Could there be lubricant on the condoms that you are sensitive to?  Are you using any other products in the vagina that are different for you?  Have you changed soaps or detergents at all?  Could your new partner have something on his hands that you are sensitive to and then touching your genital area? Have you been swab testing for bacteria like strep?  Of course, if you had that, an antibiotic would likely have taken are of it.  I'm also thinking with that with that many antibiotics, yeast is still a very likely cause of irritation and swelling.  The diflucan you said caused you a fever?  Did you try any intravaginal yeast treatments?  Sometimes those can be quite soothing for a yeast infection.

This all sounds so frustrating to you, and I can certainly see what!  I hope your appointment goes well on Tuesday and that they can find some resolution for your burning. 

So on this board, your payment covers three posts and your first one, a long one, which was split into two, counted as two, and the one above was your last one.  If you would like to talk further, please feel free to renew.  I"m hoping that the clinician that sees you in person and can to lab tests and more closely evaluate you can bring you a solution and symptom relief. My best to you!

Terri
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