[Question #708] Questions about Herpes.

45 months ago

So (stupidly) I had unprotected (oral and vaginal) sex on the 28th of May 2015 (which is my birthday, ironically). Anyway, I  felt fine with no issues until that Sunday the 31st. I woke up and I noticed what looked like a white bump underneath the hood of my clitoris that only hurt when touched. It was really deep in there and I had to pull the skin up to see. I figured I had cut myself while shaving and decided to leave it be. There is no irritation otherwise, no other bumps or sores or anything, and no itching or burning. So when it hasn't gone away in 11 days, I go in to see a gyn. She, at first, can't find anything but when I tell her to look underneath the clitoral hood she goes "oh okay" then pokes it, which hurts, then says "oh, this looks like herpes" this sent me into a complete panic. Of course she doesn't do a swab so I'm given a blood test and sent home. I get the blood test back and both types are negative. I retest again at 7.5 weeks with negatives, then finally I test one last time in August at 13.5 weeks and still have negatives (<.2 for type 2 and .8 for type 1).

I put this all behind me until last Thursday when I noticed what looked like a pimple in my pubic hair on my left thigh. I tried to pop it but it didn't pop so I picked off the scab. Above that looked to be a flesh colored bump which didn't hurt (neither did) until I "popped" that by removing the skin. Both scabbed up less than 2 hours after popping and are barely noticeable. I've showed both a dermatologist and a nurse the bumps and they both said it looked like folliculitis.  I haven't been tested since August and have had no other visible symptoms besides the initial bump and last Thursday. I was hoping to gain some insight in order to either accept this or to let it go.

My questions are as follows:

1) Does what I described sound like an outbreak? Especially a primary?

2) Is 13.5 weeks enough time for antibodies to show up?

3) Should I retest?

thanks.

Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
45 months ago
Could this be primary herpes?  Too bad she didn't do a swab test.  Yes either type 1 or type 2.  If I had to guess here and it would be just a guess, you could have HSV 1 genitally.  The low HSV 2 value at 13.5 weeks suggests this, if it is herpes, is it likely NOT HSV 2.  Though your HSV 1 is negative, it is a high negative and this test misses about 1 out of 4 infections and sometimes when it misses an infection, we see a higher negative value.  Having said all of that, have you ever had a cold sore on your lip or in your nose?  If you happen to have HSV 1, it could be oral as well. 

To get a somewhat clearer picture here, you could do a herpes western blot which is far more sensitive for HSV 1 than the IgG screening test that you had done.  However, if it is positive, it doesn't tell you WHERE it is, only that you have it.  And the other complicating issue here is that IF it is positive and you happen to have it genitally, HSV 1 genitally recurs infrequently so you might not have a recurrence for a long time, if ever. 

Sure wish my answer was clearer.  Please let me know further questions that you might have.

Terri
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45 months ago
Hi Terri, 
Thanks for the response. 

So you do think that this could be a primary outbreak? I've been told by multiple doctors that primary outbreaks particularly those without any antibodies would be classic and have really bad symptoms. The only thing I had was the bump I thought was a cut from shaving. 


Initially,  I went to your forum to ask this question under the same name and you told me that I was 75% in the clear. 

To answer, no I have never had a cold sore anywhere  and as a college student I really don't have the money for the western blot.

Follow up questions 
1. So you do think this was a primary outbreak ?
2. What do most primary outbreaks look like with patients with no antibodies for either? Or does that not matter? 
3. I was told that the negative numbers on the test didn't matter as long as they were negative. Was that incorrect to assume?
4. Would you recommend a retest with no further symptoms? 
5. I'd like to mention that my gyn gave me topical acyclovir to put on the bump which did nothing so I stopped using it and after a few more days it disappeared. No scab or anything. Do herpes sores just disappear that way? 
6. I am not sure whether or not my ex partner has hsv 1. He has never had a cold sore and has a compromised immune system (not HIV) so I would think he would show signs or symptoms of something, no?
7. I also had a very bad breakout all over my body of red bumps that itched like crazy and would only happen if I went to his house. He may have had bed bugs, could that be the cause of the bump?
8. If this is not hsv what do you think it could have been?

Sorry for the long reply. Thank you. 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
45 months ago
I have no idea if it's herpes or not, honestly.  If your doctor said she thought it looked like herpes, then perhaps it is. 
The thing about having a bad primary is that if 80% of people who have herpes don't know it, then how could all primary infections be terrible? Wouldn't everyone notice?  Some people with a true primary will have many lesions but I think other people really don't.
I disagree that the negative numbers don't matter.  Especially in the case of HSV 1 infection where the test misses so many infections.  Often I have seen a higher negative in someone that goes on to confirm with western blot as infected with HSV 1.
Herpes sores on the clitoris or near it don't scab, they just kind of fill in.  so that could have happened with you, or, as you mentioned earlier, it could have been a cut from a razor.  The clinician who saw you is the best person to make that judgement, honestly.  So do you normally shave that close to the clitoris?
About 70% of people with HSV 1 infection don't show symptoms, and then we have the poor test for HSV 1, so difficult to say if he has HSV 1 or not. 
The red bumps all over the your body sound nothing at all like herpes. 
I'm so sorry I can't help you more to sort this out.  I think all you can really do is either do or not do a western blot to find out if you even have HSV 1.  If you don't, then you know it isn't herpes, with the best test available.  If it is positive, you would have to wait and see if you get an outbreak either orally or genitally. 
I suppose it could have been a cut or an abrasion from friction perhaps?

Terri
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45 months ago
Hi Terri, 
Thanks for your response. Unfortunately I feel as confused as I did before I asked the question. I'm not sure if you can have this done- but I tried to contact ASHA to see if another expert could provide some insight but I'm unable to get through. Would any of the other experts like to provide insight?

Thank you for what you have provided Terri. 
45 months ago
Wondering still if anyone else has any insight.

Thank you.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
45 months ago
I've asked Dr. Hook to read over your post.  We're talking about it at this time
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Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
45 months ago
Here is what Dr. Hook said about this:

I agree that the total body rash she has sounds nothing like HSV (or bed bugs for that matter). 

I absolutely agree with you that we cannot give this woman complete assurance that she doesn't have HSV.  On the other hand, I also think it is more likely than not that this was not HSV which is what I would have told her, also suggesting that she make sure she gets a PCR test performed an any future lesions (I would also tell her than she may need to tell her health care providers that she does not have to have vesicles or recent ulcers for a PCR test to be helpful). 

He believes the clitoral one could possibly have been folliculitis as well - do you have any hair in that specific location?

This is our final post on this thread.  If you have more questions, feel free to renew your subscription.

Terri

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