[Question #5797] Risk for herpes infection

21 months ago

35 year old who is terrified of hsv2. I avoid relationships because of it (5 past partners, 2 recent).  I am hsv1 positive, tested hsv2 negative in my early 20s and never had gh symptoms.

 

I lost a LTR earlier this year. Got a new gf 3 mo ago. Relationship lasted a month. We had sex 8 times, unprotected twice. She said she didn’t have “anything.” I was taking daily 500mg Valtrex at the time to prevent oral sores and I figured couldn’t hurt in lowering hsv2 risk, even though I know there’s no data for that.

 

I’m seeing a new girl who I think has had many partners. I’ve slept with her 4 times always protected. She said she was “tested for everything a few months ago.” Also taking Valtrex with her. She had some bleeding she blamed on restarting periods from an IUD being 5 years old. Last sex was 8 days ago, and 2 days after she told me she “had a little bit of a yeast infection that hurt” and declined sex. This scared me. 2 days after this I developed tingling and burning sensations in my feet and lower legs, mostly on the left. Also had a stiff neck. I increased Valtrex to 500mg BID. The next morning the leg symptoms were gone but I noticed there was a discrete ~3mm red spot on the corona of the penis at midline. It was painless, flat and I couldn’t see any blister or cut. This faded throughout the day, but there’s still a purple discoloration that slowly became more flesh colored. I stopped Valtrex 3 days ago to see if anything got worse. It hasn’t.

 

I’m terrified that she was having an outbreak, then I had a prodrome but the sore formation was aborted from the Valtrex and my hsv1 antibodies. Or I caught it from the first girl and was having my first recurrence. How likely is this and what should I do about testing? I’m barely functional and can’t continue my relationship or date anymore. I want my ex back but worried I have hsv2 and she will never marry me. I know I need to see a therapist.

21 months ago
I re-read my post and just want to clarify the Valtrex usage as that's what's really concerning me as I don't know how much it has screwed up any typical presentation of a new hsv2 infection:

Girl #1 in late April, Early May. I was taking 500mg Valtrex on days I had an encounter with her. I continued 500mg daily Valtrex for about 3-4 days after our last encounter and did not use it again from Mid May until Early July.

Girl #2. I was consistently taking 500mg daily since mid July mainly to prevent giving her hsv1. I thought I was having an oral outbreak and took 2g BID once. Over the past week when I put the pieces together about her "infection" and became scared, I increased to 500mg BID. I stopped Valtrex completely on Saturday.

I realize I should not be self-medicating and this has muddied the waters and can potentially affect an antibody response. I will not continue to use Valtrex without any symptoms. Hopefully you can clarify this and what, if any, effect this has had and how I should go about testing.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
21 months ago
I think it is mostly unlikely that the valtrex is impacting your herpes test.  So your main concern is girl #2, right?  So it sounds like you've taken it for only a couple of weeks then, is that correct?  Two weeks is not going to be enough to mess with testing.  So with person #1, it looks to me like you took it perhaps for 11 days in May?  So you had about six weeks of not having any Valtrex in between, is that correct?  It's not ideal but isn't not terrible.  A discreet 3 mm non-tender red spot does NOT sound anything like herpes to me.

I think, and you probably know, that your fear of getting herpes has had you leaping to some conclusions for which there is no evidence.  I personally don't think you need to test but if it can reassure you, I would do the blot and not the IgG test and I wouldn't do it until 12 weeks from your last encounter.  Your encounters were condom protected so I see very little risk here.

Personally, given these fears you have, I would not have sex with anyone until they have been tested.  You are going to worry like this every time!

Terri
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21 months ago
To clarify, I have NOT had any recent herpes test. I was just asking how the Valtrex would impact it if I get tested and how it would impact an initial episode if I was on it at the time of the encounter and afterwards. It sounds like I need to wait 12 weeks. Why the western blot? I thought a negative result on the IgG test was reliable.

Yes, my concern is mostly the second girl due to the timecourse of her "yeast infection" and me developing these leg symptoms a few days later followed by this weird red discoloration on the corona. I've never seen anything like that and am spinning that maybe there is some microscopic abrasion caused by virus and that's surrounding erythema. But I can't remember if there was also always a slight discoloration there and I just irritated it with friction or something.

And, no not all my encounters were condom protected. I had two unprotected encounters with the first girl as she said she was tested (I don't know for what though) and we were monogamous. I was taking Valtrex at the time and am worried that I had an asymptomatic primary infection and now this is the first recurrence a few months later, which sounds typical. I should also mention that I was freaking out a few weeks ago just before I hooked up with the new girl because I had a number of itchy raised red bumps on the bottom of my butt on the left side (where I sit). They do not hurt, just itch a lot. I couldn't really see them well so I couldn't tell if they were vesicular. One of them I tried to pop and it went down but I saw no pus. I keep getting these things this summer and think it's folliculitis/heat rash. They didn't really seem to respond to the Valtrex when I was taking it. They've been coming for at least a month, really ever since May.

I am hypersensitive to my symptoms and feel every little tingle. My feet are constantly tingling again today and I've experienced brief electrical like shooting pains in the urethra a few times a day for the past few weeks, but urination is totally normal.

You are absolutely correct and I've learned that "normal" dating is not for me and if I somehow get through this unscathed I will just have to tell future partners I have issues and if you want to be with me, this is the only way. I tried to ignore my issues and purposely plow ahead to try and be "normal" and the result is I feel like my world is crashing down. The first relationship ended over similar concerns about risk. I don't understand how so many people jump into bed after a date or two on Tinder and don't worry about this like I do.

Any advice on how to talk to the girl I'm seeing about what's going on with me? I realize I have a non-zero chance of contracting herpes when having sex, but I also realize most people don't think about these things and I probably have a mental illness. I'm afraid to ask her about her symptoms and status as I don't want her to think I think she's promiscuous. I'm sure she will be able to tell something is up as I am on the verge of tears throughout the day.

Thank you for your help.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
21 months ago
I'm just thinking, and maybe I'm wrong, that you might have trouble trusting the IgG but if you can, that's far cheaper and easier to obtain.  If you are going to test, I would wait 12 weeks, yes.
You are not the only person who has some "extra" worries about contracting herpes.  It's actually pretty common, at least in my world (admitting a weird world). 
I find the best way to discuss this is head on.  "There's something I need to talk to you about before we go much further........."  I would suggest fully honesty - "for some reason I don't completely understand myself, I have a substantial fear of acquiring herpes.  It would mean so much to me if you would agree to be tested for herpes so I can relax about this issue.  I'll be happy to pay for this and go with you if you like.  We can do this online without a provider order and it should be really simple.  I trust you enough now to share this fear that I have with you and hope you can work with me on this.  It's not about your specifically at all - I have this fear with everyone so please don't feel like I have some particular worry about you."  How about that?

Terri


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21 months ago
I want to ask you about the sores on the back of my lower butt/thigh crease. I first noticed a very itchy bump there on July 12th. I had some itching there before, but am not sure for how long. My last sexual encounter with girl number 1 prior to this was May 17, and it was unprotected. I was taking Valtrex at the time and continued to take it for a few days afterwards, but don't remember how long, certainly no more than 4-5 days. I never had any symptoms that I know of, but lots of but itching I attributed to bug bites.

On July 12th, I had sudden itching and noticed a raised bump in the left thigh crease. It felt kind of firm, but I didn't see any pus. I tried to photograph it, and became convinced it was folliculitis. I started taking Valtrex at this time. I continued to have some itchy bumps in this area since then, but not that bad. If I scratched the surface off, they would burn a little bit. I first had sex with girl #2, all protected, on July 15th, continuing to take Valtrex. Valtrex dose was mostly 500 mg daily, but was 2g daily for a couple of days and 1g daily for a couple of days last week. I stopped it altogether on July 27th.

Yesterday, I noticed again an itchy bump in the thigh crease on my left side. I am unsure if it was new or recurring where I felt bumps over the prior few weeks. Today it was burning somewhat, not really itching. I was able to take photographs and could see it had a small amount of white pus on top, that immediately came out when touched. The overlying skin felt soft, not firm like a pimple. There were multiple smaller surrounding red bumps, a couple of discrete ones below it without any whitehead. But I was also surprised to see about an inch below it, on my upper thigh a dime sized area of erythema with a red bump in the middle. This felt more like a blister when I rubbed my finger over it. Soft, but not really painful. The painful one was the one that was popped. Surrounding the erythematous patch were multiple (~20) smaller discrete red bumps, looked like hair follicles were coming out of them but I can't tell.

I asked a friend who is a dermatologist and told me to apply antifungal, antibiotic, and do vinegar soaks, but he wasn't able to look at the rash/lesions. It hasn't helped so far.  I applied clindamycin and ketoconazole.

Given the soft, bubbly feeling of the one cluster on the thigh, and the fact that this has been going on for at least 3 weeks now and seems to have kicked back up after I stopped Valtrex, This is only on the left side, not the right. I am very hairy and sweat a lot, but if it were truly folliculitis/heat rash, I would expect it on both. I am horrified that this is either a delayed primary outbreak from my May 19th encounter, or a first recurrence after an asymptomatic infection in May while on Valtrex. The discoloration on the penis is not allaying my fears.

I am going to the family doctor tomorrow to have him take a look and swab it and do the IgG test.

My question is does the timeline of this make any sense at all? Do you see primary outbreaks on the lower butt/thigh crease/ischial tuberosity area, and do you see them show up 8 weeks post-exposure in the setting of Valtrex at the time of exposure and persist at least 3 weeks through intermittent (mostly) low and high dose Valtrex?

Does this make any sense at all?

Will my intermittent Valtrex use from July 12th-July 27th affect the results of the swab and/or the IgG test? Should the swab be viral culture or PCR?

The pictures I took are scaring me to death and I just want to get past this.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
21 months ago
I'm glad that you are going to have someone look at this in person.  It just isn't possible to know for sure, but this sounds absolutely nothing like herpes to me.  And you would have a primary outbreak on the penis, though the thigh crease.  and it wouldn't be 8 weeks past the encounter.  IF symptoms are going to be present with a new infection, they would normally appear between 2-10 day after the exposure/infection.  I hope you get resolution of your concerns when you see your family doctor.

Terri
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