Hi, I was intimate with a new partner 2 months ago. Two days after having intercourse I developed dysuria and clitoral pain. I went to urgent care the following day, although my symptoms had spontaneously resolved, and was found to have trichomoniasis on wet mount. My partner and I both got treated and were tested for chlamydia, gonorrhea, and HIV; everything came back negative. I got retested for trich 2 weeks after treatment via urine PCR and it was negative. We then had unprotected intercourse. That same day I developed significant vulvar pain. Of note, I have had vulvodynia since 2009, with well controlled symptoms with daily nortriptyline, though I occasionally have breakthrough pain and flare ups. The vulvar pain continued through the week and then involved my clitoris/urethra, which I hadn't really experienced before, though never had dysuria and actually some relief with voiding/straining. The second week I developed paresthesias of my lower extremities, mostly inner thighs bilaterally and sometimes buttocks that lasted for 1 week. Every day I was certain these were symptoms of herpes and would check multiple times a day, but no lesions or sores. The symptoms resolved after 2 weeks, but represented a week later after having intercourse again and lasted 4 or 5 days. This time again in my clitoris/urethra and with the neuropathy, but no lesions or sores. The pain has come and gone in the last month, usually developing a few days after intercourse or around my period, its now mostly nerve pain of my lower legs. The tingling and burning of my inner thighs and occasional shooting pain down my buttocks is painful and Im terrified this is herpes.  Or could this just be worsening of my vulvodynia or new pelvic floor dysfunction? 

well, it could be herpes.  Have you had any testing done for herpes at urgent care?  did they do an examination?  Have you seen any breaks in the genital skin?  Have you ever had herpes antibody testing done?  Do you know if that partner has ever had herpes testing done?  I"m wondering whey you had the vulvodynia diagnosed, was any herpes testing done then? 

Terri
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No I didn't have any herpes testing done because there were no lesions, breaks in skin, or sores. My pcp didn't think blood testing was necessary either because again no visible symptoms. My partner said he's never had a genital lesion and has therefore never been tested. My vulvodynia was diagnosed after a year of recurrent yeast infections after initially taking antibiotics for an infection after a dental procedure that eventually resulted in chronic vulvar pain. I didn't have testing at the time because again their were no lesions or sores. I had a pelvic exam done at urgent care recently and the doctor said my exam was completely normal. Most of my pain is now mostly burning and tingling of my inner thighs with occasional pain shooting down the front and back of my legs. It's usually best in the morning and then my symptoms progressively get worse towards the end of the day, often my legs feel sore and fatigued by the end of the day.

The reason I asked about testing was because you were asking if this could be herpes and the only way you could know for certain is if you had a lesion that could be swabbed OR you had a positive IgG antibody test.  It would be unusual for herpes to be daily and the symptoms worsening during the end of the day.  That sounds more muscoloskeletal to me, do you think that could be?

Terri
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Hi Terri, I don't really feel like it's musculoskeletal because I've never had any kind of back injury or any kind of injury. I had intercourse 1.5 weeks ago and again had burning thighs with intermittent shooting electric pain down my buttocks and and lower legs. It's almost daily now and so uncomfortable, but I still have never seen a lesion or sore. I'm going to see a vulvodynia specialist in a week to see if it could be related and will likely request IgG testing. It just seems so odd that I would have all these new symptoms acutely present after having unprotected intercourse. Have you even seen someone with herpes not have an outbreak but have chronic nerve pain of their lower legs and groin? 

well, I've certainly had people concerned about this situation but rarely has anyone tested positive.  I cannot say for certain that you are not infected, but I can say I think it is unlikely.  However, given all of this, if you were my patient, I would recommend that you get a baseline antibody test and repeat in 3 months, if negative the first time.  Does that seem like a reasonable course of action to you?

Terri
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