Hi, Here's my situation: In the morning of Dec. 18, I had unprotected oral and vaginal sex with a new partner of unknown herpes status. It was fairly rigorous and I anticipated being moderately sore. By later that evening, I was experiencing some prickling sensation discomfort and what felt like throbbing. By the next morning, I experienced further prickling pain, itchiness, and occasional sharp pain when urinating. I suspected a yeast infection and used Monistat that evening. The next morning, my symptoms had not improved, and when I looked I saw two ulcers on either side of the introitus. I had an appointment that afternoon (approx. 56 hrs post exposure), where the Dr. told me it would be a fast herpes outbreak. She took a culture and a week later that came back negative for both types of HSV; my urine culture was positive for gram-positive bacteria. Negative for all other STDs. Both ulcers resolved within 5 days. However, I showed my mother, who is a retired OB/GYN, photos of the ulcers and she believed it looked like herpes. I had nothing recur until the end of February when, after approx. 4-5 days of daily protected vaginal sex with my long-distance boyfriend, I noticed a fissure in my posterior fourchette. It did not look like the previous ulcers - more like a tear with a little spotted bleeding. I believed it may have been trauma from not having sufficient lubrication/repeated sexual activity. The fissure resolved within 3 days. The same fissure occurred, however, at the end of March - again after repeated sexual activity, and again without an ulcer, just spotted bleeding.

I had a full panel of STD tests done on April 6th. They came back negative for everything except HSV1 (history of cold sores approx. once a year since toddlerhood). I was taking Valtrex at the time of the fissures to prevent oral-genital HSV1 transmission.

 

ELISA results:

HSV1: 47.1 (positive)

HSV2: .0501 (negative)

 

 

I am now going to be seeing my boyfriend again at the end of the month and am concerned about passing something to him, even if we use protection. Is it likely I have HSV2 despite being tested 108 days post symptoms? Could I have contracted HSV1 genitally after having it orally? How would you counsel a patient in my current situation?

It is very UNLIKELY that you would acquire HSV 2 and still test negative at 108 days post exposure.  And it is also extremely unlikely that you would contract HSV 1 genitally after having it orally since childhood. 

here are the thing speaking against you having herpes:

1) your culture from  newly erupted area was negative
2) the symptoms showed up too quickly for it to be herpes
3) you already have HSV 1 orally so getting it genitally would be extremely unlikely

The thing that makes this questionable is your mom's experience as an OB, thinking this might be herpes. 
What did the clinician say who saw you?  Did they think it was herpes?
A herpes western blot is slightly more accurate than the IgG test is you want the best test and the greatest ability to confirm you don't have HSV 2.

Terri
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Hi Terri, 

I have seen recurrences of herpes at posterior fourchette though not often - but are you thinking this is a recurrence?  The straight line presentation speaks against herpes, I think
I seriously doubt that this has anything to do with an HPV diagnosis but a change in birth control pills as you describe cause lead to irritation with sex, yes, and possibly more vulnerability of the tissue to tearing.
I think you've gotten as good an answer as you are going to get with the IgG - your timing is good, and certainly a swab test with any recurrence of this presentation.  Alternatively, you could do the western blot at 16 weeks.

Terri
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Hi Terri, 

1.  No, I don't think you have to  get a western blot if you can relax about this - it would be more for peace of mind at this time, I think, though I have to tell you that your mom's thought that it looked like herpes does bother me a bit
2.  I think your negative IgG test and negative swab test suggest strongly that you don't have herpes and if all other STI tests are negative, I think it is reasonable to have unprotected sex
3.  I don't think you need to disclose this history, no

I would suggest that you talk about this with your mom - the western blot - don't know if she knows about it, but you could talk to her about it and see if her suspicions are strong enough that she would recommend the blot in spite of the negative IgG.  I think herpes is unlikely here but I also value her thoughts as I'm sure you do too.

Terri
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