[Question #6797] Rash - confused

12 months ago
Hey I want to start out saying I am an extremely anxious person. I tend to hyper fixate on issues. Firstly, I have been experiencing redness and chronic yeast infections. In January I noticed I had a yeast infection and I had little tears that healed within a few days of treatment.  I figured I’d get tested and everything  came back negative besides being positive for hsv 1 at 1.26 igg I don’t remember ever having a cold sore ever in my life so I convinced myself it was genital I decided to go on valtrex daily suppression  because I was so freaked out about passing it on. . I’ve been examining my genitals very closely.  Feb 24 I noticed a reddish rash on my entire vagina is went away in a week no sores no blisters just seemed like redness. Doctor wouldn’t swab they said it was folliticus. Two weeks later I noticed the redness again. It went spread and went away within a few days. 
I went to the doctors and they said it was folliticus and normal wouldn’t swab. 

Now on Thursday this week four days after my initial redness I am experiencing two large rashes on my labia majora. They are both about an inch long and on the same exact spot on both sides. It’s been two days with little change. I do not see blisters or ulcers.  They are raised and semi sore when I touch. Not itchy.  Just slight pinches here and there. I’ve been having a hard time freaking out convincing myself it’s herpes. My doctor is unavailable due to covid 19. 


My question is. 
1. Could I potentially have hsv 2 ? And this is a primary outbreak? (I only have one partner for almost a year. He never has experienced outbreaks or any signs of hsv) 

2. Would hsv 1 or 2 present this way on valtrex?  Meaning constant outbreaks of just redness and coming and going. 

3.  Does herpes present in two symmetrical rashes that are slight raised seem scaly in nature, with little pain or itching? 

4. What are your honest thoughts ? I have extreme anxiety around this herpes issue and I’m not sure what to do or what to think. I woj
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
12 months ago
So to start with, your index value of 1.26 on your HSV 1 antibody test could be a false positive.  It is just barely positive and you may wish to consider obtaining a confirmatory test since this is quite a worry for you.  However, if you want an accurate antibody test, or even a swab test if you wanted that, being on Valtrex without a diagnosis may interfere with the accuracy of further testing of either kind.  I would strongly ask that you consider this and speak with whoever prescribed it for you. 
Has your current sex partner been tested for HSV? If not, it might be beneficial for your peace of mind.  If he is not positive for HSV 2, then either the IgG test missed HSV 2 in your or it missed it in him (both of which are unlikely) or neither of you has HSV 2.
The description of your current symptoms does not sound like herpes to me, not HSV 1 and not HSV 2.  Not at all.  And no, herpes does not present in this way.  It can certainly be on both sides of the labia, but with ulceration, usually some pain and itching and not scaly.
My honest thought is that you don't have HSV 2, you may well not have HSV 1 either, but you would benefit from having that low positive confirmed by a better test.

Terri

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12 months ago
Firstly, Thank you so much for having this service. You are amazing. Here's my follow up. So, my partner has been tested and His results came back positive for HSV 2 not HSV 1. He was shocked he has never had any symptoms and was married for 19 years prior to having intercourse with me.  So here is my question. We have been having sexual intercourse unprotected since September a few times a month, around 4 times a month roughly.  

I tested October 22, HSV2 IGG Negative
January 8, HSV2 IGG Negative HSV1 Positive 1.23
Jaunary  HSV1 Positive 1.26
Now, April 8th HSV2 negative. 

We stopped having intercourse March 8th.  Now, I usually would be delighted that my test shows negative however, as i mentioned before. I have been on Valtrex since January 27th.  I am stopping valtrex now. and going to wait a few months to get tested again. My questions are... 

1. How long does it take you to seroconvert on valtrex. Am I safe to say I have no contracted HSV 2 during the months of October-January. with my current test in April.
2. Since, he has probably had a long standing hsv 2 infection and never has had a recognizable outbreak. Does he shed less often. what are my chances of being infected with say about 10 unprotected sexual experiences within 6 months. 
3. Am i basically doomed to have HSV 2. My anxiety cannot control itself. I feel completely devastated. 

Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
12 months ago
First, I would suggest that he look at his test results and see what the index value of his positive HSV 2 IgG is.  If below 3.5, he should see a confirmatory test.
1.  I have seen someone who was on daily Valtrex since a new infection was diagnosed for two years, and they did not yet make antibodies.  I think it is safe to say that if you contracted HSV 2 between October and January, you had time to make antibody without the influence of Valtrex. 
I'm not sure why you think you are doomed to have HSV 2 - you are currently testing negative and will repeat off Valtrex.  with only  10 encounters, and I'm sure some were between October and January, I think the chances that you don't have this, especially from an asymptomatic partner, are excellent. 
Let's be sure he actually has herpes by looking more closely at his IgG results.

Terri

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12 months ago
Thank you for your response. His IGG was 7.92 for HSV2. So it was a well established infection... I have narrowed it down that from December to March 8th We had unprotected sex 8 times. So what do you think my odds are. I am so upset, I do suffer from obsessive thoughts and extreme anxiety. I understand he did not know and that is the risk we take. I just wish I could have had more knowledge when it comes to turns to my body and health. Lesson learned. 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
12 months ago
OK, well, then you can be sure he has HSV 2. 
Do you still have the raised areas on the labia?:  Have you had anyone look at them or swab test them?  They don't sound herpetic but I just don't know from the internet.
So if the transmission rate is about 10% with no condom and no meds in the infected person, with about 104 intercourses per year, you can do the math with 8 intercourses, unprotected.  Seems very low to me, how about to you? 
So if your last intercourse was early March, you could do a test at 6 weeks out from last intercourse.  70% of those infected will make antibodies within 6 weeks, but Valtrex may influence that.  However long you take Valtrex, it will influence the testing.  I would suggest that you consider not taking it for around 10-12 weeks and then re-do the antibody test for the greatest accuracy.

Terri
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