[Question #2523] Logical vs intuitive reasoning

43 months ago
Good morning,

I'm having some problems w inuitive vs logical thoughts following two exposures.  I would really appreciate some assistance in thinking this through, and I understand we can't request who responds but if Dr. Handsfield is at all available to respond I would so appreciate it as I am hoping to look at this in the systematic manner characteristic of his responses.

Previously neg hsv 1&2 igg.
Exposure 1 vaginal protected sex. 1 week later felt body aches, fatigued, skin crawling feeling on genitals.  Irritation on inner thighs no blister.
3 weeks later tested pos bv, neg hsv 1&2 igg/igm.
5 weeks later exposure 2, vaginal unprotected sex w regular sex partner w other long term sex partners.  This partner tested six months ago and pos hsv 1.  Claims only oral, is very aware and careful of it. Contracted it ten years ago. Claims no new sex partners in past six months, all other partners tested as well six months ago and neg.
4 days later somewhat itchy blister 1/4 inch out of pubic hair region on inner thigh/butt area.  Lasted two days as a blister, then maybe a few more days as a pink spot.  Couldn't have it swabbed bc out of country.  Now, two months later seem to be having another possible blister form within an inch of first.
8 weeks after encounter 1 and 3 weeks after encounter 2 tested neg hsv 1&2 igg.

I feel that this cant be anything else but herpes, given the blister and its recurrence.  Logically, this seems like it would be very unlikely though, given for exposure 1 it's too far out of the window for a primary ob and too soon after the minor irritation around legs and tiredness (if that was primary ) for it to be a secondary ob.  Also seems rare if it was from exposure 2, to have first ob be a singular blister w no others around labia minora or vaginal opening, esp bc no condom used.  Even though I have read info that makes me think either of these cases would be a pretty 

Please help, I am waiting for the sixteen week mark but am struggling psychologically.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
43 months ago
Sorry, I answer the herpes questions on this website.  I think Dr. Handsfield and I, colleagues and friends for 30 years, answer questions very similarly. 
It's good to know that your vaginal intercourse was condom protected because condoms reduce the risk of transmission from an infected male to an uninfected female by 96%.  That's a relatively new study and a HUGE reduction. 
I think the greater risk here, if there is any risk, is your partner who is HSV 1 positive, giving you oral sex.  But you don't mention if you receive oral sex from this partner.  The lack of sores is not indicative of transmission risk as people who have HSV 1 with outbreaks shed virus on about 25% of days measured. 
I understand that you were out of town for the first blister.  Are you able to get this one swab tested?  That is by far the best thing that you could do at this point.  And if you are able to do that, please ask for PCR or NAAT testing - it is far more sensitive than the culture.  But please do have it evaluated in person if possible, please.
I would not jump to the conclusion that is is herpes.  It is, as you said, very unlikely, and as you seem to know, usually the first outbreak is in the area exposed, rather than an extragenital site. and exposure 2 was with regular partner who tested negative for HSV 2, correct? 
I think you had a sentence there that you meant to complete but didn't.  Would you like to complete it?

Terri Warren
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43 months ago
Thanks for your response.  No oral sex from partner 2.  Last had sex with this partner six months prior, immediately after testing.  This partner was neg for hsv2, positive only for hsv 1.  I am thinking maybe one of this partner's other partners had a new partner in the past six months that maybe he wasnt aware of, then they infected his partner, then he was infected, then I was infected.  Though certainly all these people would have noticed primary outbreaks?  Im certain if he experienced a primary ob during that time he would have informed me, if he was aware of it.  
Or, he could have been genitally infected w hsv1 at the same time he was infected orally, then passed it to me?
The sentence in my last post was going to say that while all these scenarios seem rare (either being infected from partner 1, even though tested neg at 8 weeks and condom was used and primary ob was either no noticeable blisters or outside the standard 22 day window; or being infected from partner 2 w hsv1 from genital to genital contact, or hsv2 from partner 2 who somehow didn't notice a primary ob; and in either scenario having the primary ob without any other symptoms besides a single blister just outside of pubic hair area), it seems even MORE unlikely to have a blister sitting atop the skin (definitely not a pimple) in the genital area following sex from anything other than herpes.  I guess I would be able to calm myself by saying these scenarios seem unlikely, but the fact that I had a blister makes me think maybe I am just the one in a thousand person who somehow got it in one of these unlikely presenting ways.  Do you have any thoughts on this?
Cant get this recent blister swabbed due to traveling again and health insurance/money.  Have to wait the six weeks longer for the blood test, which is why I am seeking guidance online in the meantime rather than just consulting my gp.
Thanks again for your assistance.
43 months ago
Or, I kissed partner 2 then gave oral, then had unprotected vaginal sex.  Could I have transmitted his oral hsv1 via my mouth to his penis to my vagina? This also seems unlikely.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
43 months ago
I seriously don't think that you gave yourself HSV 1 genitally through the method that you might propose. 
My wild guess is that this is not herpes, but I could definitely be wrong.  The timing is wrong for the blister to appear as a brand new infection, the testing doesn't fit with your having a blister and the results are negative, your partner's testing doesn't fit either. 
without swab testing, we are all guessing here.  Speculating and guessing. 
So the IgG test for HSV 1 is quite poor - misses about 30% of new infections.  You could have had HSV 1 for a long time and didn't know it and the test missed it.  But then I'm speculating as well, just like you might be.
I understand that finances and travel keep you from getting the blisters swabbed, but they are the source of your best answers!  I would encourage you to reconsider having it swab tested if it shows up again, and forego the blood test in favor of the swab test if at all possible.  I do understand that life is what it is and this may not be possible.

Terri
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43 months ago
Thanks for the response, I understand this is my last submission allowed so I just wanted to say thank you again.  If you would like to leave this open, I can post my igg results when I get them.  I will go to the dr next week. The most recent blister disappeared in less than three days, so certainly that cant be swabbed anytime soon, but yes if I get any in the future I will have them swabbed via PCR.
I understand why you might suggest a prior undetected hsv1 genital infection not knowing my entire previous sexual history.  I have had all partners tested for hsv1 and 2, and have only allowed hsv1 negative partners to perform oral sex.  I understand they could have had undetected infections themselves, but in the absence of an obvious primary outbreak on my part following these exposures, or even any lesions ever until this one, I find this possibility very unlikely.
You mentioned that the testing negative was a possible indication that this isn't herpes.  I understand why for exposure 1 a test eight weeks later is possibility reassuring, but it was only three weeks following exposure 2.  So to recap, following exposure 2, I had a blister four days later, then tested negative 20 days after exposure.  Is there any literature or study, or in your experience, is a negative igg test at 3 weeks at all reassuring? You seem to indicate it is, but from what I have read it seems like seroconversion often occurs after this point, and this is too early of a test to be any indication of not having contracted herpes from encounter 2? Also you said the timing was wrong for the blister to be a brand new infection- isnt 4 days following exposure 2 exactly the average time for a new infection to present with symptoms following exposure?
Thanks again
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
43 months ago
Here are what I think are the possibilities for you:
Partner 2's IgG test may be inaccurate for HSV 2.  It would be good to have him retested to try to sort through this.  This seems a bit unlikely as he reports no symptoms but it's possible for sure. 
Your HSV 1 and/or HSV 2 testing is inaccurate and you were infected long ago and didn't know it.  The IgG for HSV 1 misses 30% of infections.  This fits better with a single blister in a non-labial location which is more common for recurrences than first infections. The speed of healing is also not typical for brand new HSV infections but again, not everyone is typical
The blisters that you describe are not herpetic.
I will leave this open for you to post your IgG results

Terri


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