[Question #7357] HSV2

6 months ago
On Friday 9/24 I had what started out as protected sex with an ex (dated 4 years ago) but the condom broke and we didn't replace it. I don't know exactly how long we went unprotected but he did not ejaculate inside of me. On Wednesday Sept 30th, my current boyfriend and I had unprotected sex and I had some irritation, no bumps or lesions, just sore. My boyfriend and I had unprotected sex again on Friday October 2nd. I woke up with what looked like a yeast infection but it had a rash. I went to the Urgent care, explained my encounters, had them check me out and was told that I had a yeast infection and that the rash was just irritated skin. That is wasn't consistent with genital herpes and it looked more like razor burn. I took the diflucan and the yeast infection cleared but I still had a rash and some discharge.  I followed on Wednesday October 7th with my regular gynecologist, explained my encounters and he said that my rash didn't look like herpes at all and that he could bet it was BV. I did regular std screening and a pap smear.  The pap cam back normal, I was negative for Trich, Chlamydia, Gonorrhea, and HPV. Positive for BV.  He prescribed Boric Acid tablets for the BV.  My symptoms have cleared but my concern is that I don't want to have been misdiagnosed for a herpes outbreak. So many people have it and dont know it and I really dont know my ex's sexual behavior since we've dated. I asked I've read that it could be mistaken for a yeast infection. In your professional opinion, should I test for HSV2? I tested negative last year for it but positive for HSV1, asymptomatic. I had lots of psychological issues with my hsv1 diagnosis that I'm terrified to test again for hsv2, but if I need to, I will. What are the odds that I contracted hsv2, had redness, a rash, but no blisters? I didn't have any flu like symptoms either but I am also hsv1 positive so it could be masking severe symptoms. My index value for hsv1 last year was 30, so I believe I've had it for years.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
6 months ago
I agree that you've likely have had long standing HSV 1 infection. 
It's great that you were able to be seen by not one but two clinicians to evaluate your genital rash.  Since both indicated that it looked nothing like herpes, I would assume it isn't herpes.  The pap was normal also which is good because herpes can show up on a pap from time to time. 
While it is true that some people with HSV 2 don't get symptoms or recognize symptoms and type 1 can keep symptoms of new HSV 2 to a minimum, I do think one of the providers would have raised alarms about possible herpes if it was a concern.  For now, I don't think that you need to test.  Have you considered asking your ex to get tested for HSV 2?

Terri
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6 months ago
Thank you! You answered one of my follow up questions. I was going to ask if I was having an active outbreak, would my pap have picked it up?
To answer your question, I did ask him if he was up to date on his testing and he told me he didn’t have anything. When I asked what he was tested for, he acted as if I was being crazy or paranoid and insulting him. I truly don’t think he’s tested in awhile but I will leave it to rest. It’s past 20 days so I will wait to see if I ever get a questionable lesion and then test. 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
6 months ago
If you test at 3 weeks out, the IgG test only picks up 50% of those who will eventually test positive.  At 6 weeks out, 70% of those infected will test positive.

Terri
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6 months ago
Thank you! Lastly, I believe I read somewhere in your replies that getting hsv2 as an adult is almost always symptomatic?
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
6 months ago
No, that's actually not true.  If someone has HSV 1 infection, they may acquire HSV 2 without noticing any symptoms at all, or the symptoms would be minimal. If a person acquires HSV 2 as an adult and has never been infected with HSV 1, they are far more likely to notice symptoms.  Hope that is helpful.

Terri
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