[Question #5993] Dr hunter h
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71 months ago
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I was hoping for doctor handsfield for a second opinion. I have had chronic vaginal irritation for 5 years , almost every day ..starting with a blistering outbreak , I had the outbreak swabbed before the bumps turned to blisters and came back neg . IgG blood test : hsv1 20.2 hsv2 0.5 . Now I never get more than a week of relief, everything red and raw (aggravated by sex) . I also get skin sensitivity around the bum area , and tingling . It responds well to antivirals . Since hsv 1 is supposed to be milder genitally , why do you think after 5 years I can't get a break more than a week ? I have been tested for HIV , every other std, vitamins , BV, yeast , and lichen schlerosis. Tried eliminating every single irritant including toilet paper . I am a very anxious person , maybe stress? But I don't think I'm so stressed it should be this constant . This is ruining my life , please help or refer me to a doctor that will help me . Thank you
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Edward W. Hook M.D.
71 months ago
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Welcome to our Forum. Thanks for your question. FYI, on this Forum Dr. Handsfield and I share the non-herpes sexual health questions while Terri Warren, a well known expert on herpes infections answers the questions on herpes. We wondered if you might have interreacted with Terri through her other web site. Irrespective, after conversation between the three of us, we agreed that I would take your question. As an FYI, Dr. Handsfield and I have worked closely together for over 35 years and have never differed in the facts of our assessments and recommendations although our verbal styles differ from one another.
Thanks as well for your concise and detailed description. Might I ask, do you ever have times when you are outbreak free and if so, how long those intervals might be. Dealing with the information you have provided, let me make a few additional comments:
1. Your herpes blood tests. Your blood tests seem to indicate that you have HSV-1 somewhere (the test does not tell you where and most people with HSV-1 have oral infections, most often acquired during childhood) and that you do not have HSV-2. I note as well that you state that the lesions were swabbed and found to be negative. Might I ask what sort of test was performed? The most accurate swab tests for herpes viruses (1 or 2) is a PCR tests- cultures can certainly miss infections and the PCR tests have only become widely available in recent years. If you have not had a PCR test, you should have on to be sure, preferably in the first day or so of an outbreak.
Also with respect to what you describe as your response to antivirals, could you describe the time course of response as well. When you take antivirals, are they the only thing you take?
2. Alternative diagnoses. This does not sound like another STI. There are however a number of other dermatological problems which can involve the genital tract. Such processes are sometime endogenous and represent allergies or other manifestations of rheumatological disease in which a person's body "fights" with itself. To address this possibility, if you have only seen one dermatologist, I might suggest seeking a second opinion with a dermatologist who has much experience with genital dermatology. The list of dermatological conditions involving the genital tract is huge.
I hope this is a useful start to this exchange. My sense is that this is not an STI although your response to antivirals may suggest otherwise. I look forward to your follow-up. EWH
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71 months ago
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Thank you so much, I have been speaking to Terri on Westover heights , she is very helpful I just wanted to see if you had any extra insights on what this could be . When I have relief between outbreaks it is never much more than a week or two max . When I had the swab done they said it was a PCR although I'm not sure if they just said that and weren't sure , I will swab again . When I take antivirals I am not taking anything else , and I find I get relief within an hour or two from the main "itch" symptoms and tingling .the rawness remains a few days . If I stop antivirals a couple of days things return. Maybe this is just a coincidence but I was on antivirals for a few weeks at the end of my pregnancy and have never felt better . Thank you so much for your response
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Edward W. Hook M.D.
71 months ago
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Thanks for the additional information. The fact that you do respond to antiviral therapy makes me wonder if you have tried chronic suppressive therapy. The frequent, severe outbreaks you have experienced are VERY unusual for HSV but it makes me wonder whether you might benefit from daily, chronic suppressive therapy using daily valacyclovir or a related drug. We have had patients who have taken suppressive therapy for years - they are well tolerated, have few side effects and might help. EWH---
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71 months ago
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Yes I think you are right , I guess my main concern is whats wrong with me if I can't suppress it ? I eat healthy and exercise, I suffer from generalized anxiety but didn't think it could cause this . I am worried about some underlying problem
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Edward W. Hook M.D.
71 months ago
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With all due respect, I think the first thing to do is to try to be sure that you have a firm diagnosis so that you can treat a known process. This may be herpes. If so, a PCR swab test, taken at time when you have been off antiviral therapy for a while and at the beginning of a recurrence will most probably be positive. This would also be a good time to get a second opinion from a dermatologist if you have not already done so. Then I would start therapy and after your symptoms have resolved on therapy consider immediately transitioning to suppressive therapy. All of this should be done under the observation of a health care provider whom you have confidence in. I would do all of this before I begin looking for a specific, underlying problem.
I hope my thoughts and suggestions have been helpful. As you know, we provide up to three responses per question and this is my 3rd response. Thus this thread will be closed shortly. Take care. EWH
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