[Question #716] Follow up question regarding post 708.

54 months ago
Hi, on my last post I was receiving info from dr hook on my last post via Terri warren and I was hoping dr hook had some more insight or dr Handsfield had some.

In addition to that info I already posted- when my tests at about a month came back negative my doctor (a new one) called me to confirm this but also asked me if I had a sore throat. When I told her no she told me that it was strange that my ASO (strep a) levels were high. Because strep causes skin infections, I was wondering if that could have been the cause. 

Additionally, I was asked in that post if I had ever had hair under the hood of my clitoris. A few weeks after the bump disappeared I noticed no more than 2 black hairs sticking out from inside of the hood. Could not wipe them away; they were naturally growing out. So yes I have had hair inside of the hood. 

Anyway just looking for some more insight. Thanks so much.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
54 months ago
Welcome back to the forum. I reviewed your other thread and am happy to add my perspectives.

In my opinion, it is very unlikely you have genital herpes. I cannot be completely certain, i.e. I agree with both Dr. Hook and Ms. Warren that you might have had a primary infection with HSV1. But it's very unlikely, based on the subtle initial symptoms, your doctor's initial uncertainty, and your negative blood tests at 7 weeks and especially at 3 months. Also, if I correctly understand your initial symptoms a year ago, the single "bump" felt unchanged over ~10 days before your doctor examined it. That's atypical for herpes. During that time, I would expect an intial herpes outbreak to develop more lesions and/or to become more prominent and painful over a several days. If it were a recurrent outbreak (despite your later negative blood tests), it would have healed before 10 days. So your initial symptoms don't fit well with either initial or recurrent herpes.

I'm not sure why your doctor did an ASO test; certainly strep is not a likely cause of your initial genital lesion, and we certainly never test ASO titers for suspected strep skin infections. I think that finding is entirely unrelated to any of your symptoms. Presumably she asked about hairs in the location of the lesion because she thought folliculitis (which could be caused by strep) might have explained the initial problem. That you have a few hairs in that somewhat atypical location is consistent with that possibility. But I still doubt it explains the ASO test or the later itchy skin rash. Strep can cause skin rashes, but not itchy ones that come and go quickly. I also doubt bed bugs. That sounds like an allergic reaction to something. 

Back to herpes:  People can have atypical responses when infected with HSV. Symptoms can be subtle (or absent); the clinical course can be highly variable; and blood tests can be falsely negative. However, the odds that all those factors would all break the "wrong" way are very, very low. Given the atypical symptoms plus your blood test results, I am quite confident you did not and do not have genital herpes. And I am 100% confident that if you do have it, you have HSV1 and not HSV2. (The HSV1 blood tests sometimes remain negative, but that is much more rare with HSV2.)

The only way to sort this out with greater certainty than you already have would be a PCR test for HSV in the event of recurrent genital symptoms that suggest a recurrent outbreak. My bet is that it won't happen, but you should discuss the possibility with your doctor and attempt to secure her agreement that you would be seen immediately (within 24 hr) if something shows up, and that an HSV PCR test would be done.

Finally, a perspective on genital HSV1 vs HSV2. If I'm wrong and you do have HSV1, you may have seen the last of it. While nobody wants genital herpes, if it happens, HSV1 is the "preferred" type. Genital HSV1 infections usually recur infrequently (40% of persons never have another outbreak), asymptomatic viral shedding is uncommon, and transmission to partners is rare. In my 40 years in the STD business, I've never had a patient with genital HSV1 acquired by genital contact with an infected partner, and that's what the research shows as well:  genital HSV1 is acquired virtually entirely by oral sex. (I think I recall Terri and Ned have had the same experience.) In other words, in the unlikely chance you have genital HSV1, it may never recur and probably carries little risk for your current or future sex partners.

I hope this has been helpful. Best wishes--

HHH, MD
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54 months ago
Dr. H: 
Thanks so much for the insight. About the bump- it did not change at all. I woke up on Sunday morning and (possible tmi) brushed past my vagina through my underwear and it hurt a bit but without a mirror I couldn't see anything so I attributed that to possibly cutting myself while shaving (sometimes I'm not as careful as I should be) 

Additionally, when the bump didn't go away within a week I showed my mom who looked at it and asked "Did you do that while shaving?" 

The bump never changed. It was very white and I think it may have had a dimple in it. It was only a bit red on one side of the bump which may have been due to me messing with it. I at times was able to pick off the skin from the bump which would remove the white part but literally no more than an hour would pass without the white top being right back on the bump. It also never scabbed. It stayed for 14 days exactly and on day 14 when I woke up it was just gone. No scab, no scar, no white bump, it literally disappeared. No recurrences since. Also the pain did not change. It would only hurt if I pressed on it or bothered it.

After I was seen- the doctor gave me antiviral cream which did absolutely nothing for me so I stopped using it. However when I did rub the cream on the bump it didn't hurt while I was touching it (it wasn't a numbing cream; had "vir" at the end of it. 

In relation to a possible hsv diagnosis- since the bump has gone (prob about a month later) I started experiencing pain in my legs/joints/butt/tailbone. None of this happened while the bump was there but almost 4 weeks after. Is this at all related to hsv? I've heard people say nerve pain is likely when you have gh. I'd also like to add that I have arthritis (juvenile) 

Any advice regarding this? Once again thanks for your speedy response and input.
54 months ago
Dr. H: 
Thanks a million for your responses. They have really helped to put things into perspective and are finally helping me realize that more likely than not I don't have hsv. 

I know this is my last post so I'll be quick. I'm calling it a bump because it was a bit raised. In all honesty it could've been an ulcer or something; but like you said it doesn't fit the typical primary ob.

Lastly, i want to add that my first type 1 test was <.2 while the 13 week test was at .8, though both obviously negative. Do the numbers if they are negative matter?  Terri told me that patients who aren't testing positive sometimes have high negatives. However I really don't understand that because isn't there proof that low positives (1.2-3.5) are often false positives?

Final questions: 1) you're still (with the additional info) almost certain that I don't have genital herpes? 2) what do you think the bump could have been? 3) since I have not had a physical reoccurrence, do you think I should get tested one last time ?

Thank you for all of your help and work. Thank you also for the detailed information. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
54 months ago
With this additional description of the initial lesion, I am even more convinced it was not herpes.

Neither herpes nor any other STD causes pain in the legs, joints, etc. There is a lot of misinformation online about such pains in association with herpes, but the truth is that aside from prodrome -- tingling, pain, discomfort, etc prior to a recurrent herpes outbreak, generally in the area where the outbreak will appear but perhaps sometimes down a leg or in the back -- genital herpes does not cause such aches and pains. And prodromal pain doesn't last more than a few days, going away when the outbreak itself appears. If there is anything physiologic going on to explain the discomfort you describe, something related to your past JRA is more likely.

All in all, I am even more you don't have genital herpes. Otherwise my opinions and advice are unchanged. All is well!

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H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
54 months ago
I edited and reposted my last reply -- while you were writing your latest one. Sorry for any confusion.

I already speculated that the bump might have been follulitis, or maybe just a pimple. I would add molluscum contagiosum as a possibility (you can google it for more information), because it causes pink bumps with a white core. But it is unlikely with only a single lesion. Otherwise, I have no further thoughts about it.

It is conceivable that the change from <0.2 to 0.8 means you are seroconverting to HSV1. However, that much variation also can occur naturally with the HSV antibody tests. You could consider yet another test to see if it becomes truly positive. But my bet is that it will not.

So I guess I would say that in thinking about these test results, there might be a greater chance you had a new HSV1 infection than implied above. But I still think it is unlikely. And if you do have genital HSV1, I don't think it will have much impact on your life in any way, including romance, love, and sexuality.

My final advice is that you must not rely on this or any distant online forum for definitive medical care. All our comments on both threads need to be interpreted as probabilities and general advice. We make no attempt to make a definite diagnosis in anyone.

Best wishes.

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54 months ago
*am willing to pay for additional post if necessary /*
Dr H: 
I'm not sure if I made this clear in the post before this one; but do very many peoples results change between 12 and 16 weeks?
Thanks once again, I'm a bit all over the place so forgive me if you've already made this clear. So with all of the information I provided, it is still your opinion that I did not contract genital hsv? 

Sorry for the extra post 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
54 months ago
It is uncommon for HSV antibody test results to change any time after 12 weeks, but it happens from time to time.

My opinion is unchanged:  it is unlikely you contracted genital HSV, but there remains a slight possibility. It should not significantly effect your life if you have genital HSV1.

That will end this thread. Before considering yet another one, I suggest rereading both threads in detail. Regardless of new information, including your test result, it is unlikely that our opinions and advice would change. If concerns remain, I suggest you ask your doctor to refer you to a specialist, such as an ID specialist or a gyn who subspecializes in infectious diseases.

Best wishes.

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