[Question #407] HSV1 symptoms? or Something else?

34 months ago
Hello,
I was diagnosed with genital HSV1 last spring by a biopsy test. I had bumps that were irritated and a little bit itchy in the vaginal area. After maybe 2 weeks those symptoms went away without any medication. Then about 3 and a half weeks ago I noticed a few (less then before) bumps on the inside of the top of my thigh (almost near my labia). At first I though they were razor burn bumps since they were so much smaller than the herpes outbreak I had the first time. They looked like little pimples and had no irritation or pain. However after a week and a half and they hadn't gone away I started taking Valacyclovir. Now I've been taking it for 7 days and though the bumps were already so minimal, they're still there and haven't significantly changed. Because the medication hasn't affected these bumps, and my first outbreak went away after about 2 weeks, does this mean these bumps are something else? I'm afraid that it could be HPV - though the 2 people I've slept with in the last 8 months said they don't have any STDs (I suppose they could have it and not know it for sure). Is it possible that this is still just herpes but a different sort of outbreak since it is not my first? 
Also, I had another question: I read an article from 2013 that said according to Dr. Handsfield, HSV1 genital to genital transmission is very rare. Apparently asymptomatic shedding isn't very likely with genital HSV1? in the article Dr. Handsfield stated that disclosure of genital HSV1 could be validated as not necessary when there isn't an outbreak because the risk of transmission is very, very low. Is this true? If I'm not having an outbreak than disclosing would be telling my partner of only a hypothetical risk?
I'm asking because I want to make sure this information from 2013 isn't outdated.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
34 months ago
If I had to guess, I would guess that the bumps are something else.  I seriously doubt that a second HSV 1 genital outbreak would last two weeks and still be there, hanging around.  If you still want to know what it is, I would see a clinician for an opinion.
I would agree that the risk of transmission of HSV 1 through intercourse is quite low, yes.  Asymptomatic shedding is far less common with HSV 1 than with HSV 2.
Should you tell a partner?  That's a tough one and not even experts agree and I'm not even positive about this.  But what I see in my practice is not so much that partners of people are so worried about transmission but that when it comes up AFTER a sexual relationship has begun, then comes out, trust is the big issue.  Why didn't you tell me this?  What else have you not told me?  I think you need to consider this aspect of whether to disclose your HSV 1 status or not and then make your decision.  Remember that if your partner also has HSV 1 (like a history of ever having a cold sore in his lifetime) then you are not infectious to him genitally.  You might try finding that out.  If he has had cold sores (and remember that canker sores are different than cold sores), then I think you do not need to disclose your genital HSV 1 status. 
This is not a straightforward question compared to should you disclose HSV 2 status.  It is more nuanced, more complicated and requires a bit more thought.

Terri
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34 months ago
Thanks Terri thats a really good point. At least when i do disclose, I can say it is extremely unlikely to infect my partner through sex. So thats a relief! As for the bumps - I'm out of town till next week and when I return I'll be going to the gynecologist to get checked out. In the meantime, do you have any ideas what possibly could cause bumps like this? They're very small, painless, no itchiness, but definitely raised from the skin.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
34 months ago
They could be many things.  Some possibilities are folliculitis, molluscum contagiosum, and warts.  Also skin tags but I think that is less likely. 

Terri
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34 months ago
I see. Terri, I read somewhere that if you contract HPV it usually takes 8-10 months to show genital warts from it..is that true? I was tested for HPV around 8 months ago and it was negative, and I only recently started sleeping with someone (as in september to now). Because of that timeline - would it be too early to be showing symptoms of genital warts? Since I would have had to contracted it within the last four months? Does that make it more likely to be something else other than genital warts?

since this is my last follow up , thanks for the help  you've provided Terri!
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
34 months ago
I think your information is incorrect.  Warts can show up much much sooner than that.  But honestly, I rarely see them on the thigh.  I can't even recall seeing them on the thigh in the last year, and I see a ton of warts ;-)

Terri
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