[Question #2723] Symptoms, asymptomatic, or misdiagnosed?

42 months ago
34-yo w HSV-2 by IgG test (5.4) diag Jul-17. Swab of suspected genital lesion came back neg. Have returned many times for add’l swabs. All (-), either swabbed or visual diagnosed as zit or cyst. No itching, burning, or blisters. 

I’ve never had pain/lesions in the vaginal area, but I now understand it's possible to be asymptomatic, or symptoms that arent blisters. 

3 symptoms of concern. 1. Facial tingling. Happens periodically but I suffer migraine w aura & this has been a symptom. While I don't remember it ALWAYS being a symptom that presents w/out headache, I've been chalking it up to that for 3-4 years. It was about this time I first had aura in both eyes at the same time, so it seemed related. Now that I've tested (+) for hsv2, I wonder if the face is where I'm infected/shedding. No blisters. 2. Low back pain usu. alleviated by exercise, not persistent for days. No correlation to vaginal discomfort. Seems random. 3. More discomfort at the start of a menstrual period. Mild vaginal burn, plus an ache. Not vulvar. Doesn't happen every time. I visited the doc, she couldn't see any blisters, did not swab b/c of blood & inability to obtain lesion fluid (again, she saw none.) 
None correlate to others & none are new. I don't know if I'm shedding, from where, and I'm esp concerned if my face is shedding that I could infect family by brushing faces when hugging or kissing cheeks.

So, based on + test & desc. of possible symptoms, question is to do w whether these sound possible/likely that I'm shedding &how to confirm. Can the sensations be tested for virus if I visit the doc the next time I have a tingly face? Would the virus live in menstrual blood long enough to be tested? Or, possible misdiagnosis? Idk if it's imp. but I had mono severely 16 yrs ago. I'm desperate to understand so I can protect my loved ones, & also myself from autoinfection. I don't want to infect my fingers if I shed during menstruation--I use tampons w/out applicators. Or scratch my face &rub my eye.

Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
42 months ago
With an index value of 5.4, a false positive is unlikely but just last week, I had someone with an index value of 5.07 not confirm as positive when tested by western blot so I guess you could confirm with the blot if you were so inclined though I think there is an strong change it would confirm.    It is possible of course that your HSV 2 is oral if you gave oral sex to someone who has HSV 2 genitally. But HSV 2 oral infection rarely recurs and rarely sheds. And yes, you could have your mouth swabbed with a PCR swab, even if you have no sores, if your provider would agree to do it. And yes, most certainly, you could have genital swabs done while on your period.  Again,PCR is the most sensitive type of swab vs.culture which is an older less sensitive method for swabbing. 

I wouldn't ever worry about brushing up against people and infecting them or autoinoculating yourself at this point.Once you have infection at one location well established, is it extremely unlikely that you will get the infection at a new location on your body.

Terri
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42 months ago
Thank you, Terry. I am probably confused about what exactly happens with prodromal symptoms. Why swab my mouth if it's my face that is tingling? Wouldn't the shedding be at the site of the tingle, which is most definitely external? And you're saying well-established based on the 5.4, right? But I have no idea where I am infected. If I hadn't had a panic over the bump that turned out to be nothing, I'd be living as blissfully as before. I'm looking for reassurance, I guess, that tingling does not equal shedding from that very spot.  It sounds unlikely that I'm a false positive, so I feel much better about not spreading my infection to other nerves in my body but I'm not sure I understand why not to worry about shedding on others from my face (or elsewhere). Can you please clarify? Thank you! 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
42 months ago
The face does not shed - the skin is too thick for virus to get out.  So you are not a risk of infecting people by brushing your face up against people. So if any shedding is occurring, which we don't know, it would be oral.  The face is innervated by the nerve that supplies the mouth,does that make sense?  If I had to guess, I would guess that the facial tingling is unrelated to herpes. Let me know if this is not clear. 

Terri
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Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
42 months ago
BTW, 95% of people who test positive accurately for HSV 2 have this infection genitally.

Terri
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42 months ago
Yes!!! That helps immensely. Is it safe to say that unless there are blisters present, you don't shed from any skin--face, hands, legs--just mucous membranes? Realize it's unlikely I'm infected in those locations but it gives me so much piece of mind. I'll get my mouth checked for sanity but then back to trying to figure out genital symptoms. I may do the blot. Thank you again! 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
42 months ago
You are most welcome.  Yes, without blisters present, you don't shed from face, hands or legs.

Terri
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