[Question #743] concerned.

100 months ago

Hi there,

first off, I would like to thank you doctors for your expertise advice in advance! I do not sincerely trust or value anybody's opinion, as much as I do your guys'. Here is my situation: I had been dating the same man for about 5 years and he cheated on me twice, and gave me chlamydia. Both times when I contracted it, I had symptoms rather quickly and got treatment at least within the first 2-3 weeks. In addition, my partner got treatment as well as soon as I found it and we abstained from sexual activity until everything was clear. I have been freaking out lately, as I know that this can make you infertile and the more times you contract it will increase your likelihood of being sterile. I have never had symptoms of PID or anything like that. I also have ovarian cysts and my gyno has done ultrasounds to monitor these, but has never mentioned anything else unusual like scarring. Also, I keep up to date with my papsmears, except my papsmears have come back with ASCUS for the past year or so. No HPV has ever been found, and my gyno says my cells are just slightly different looking, but she wouldn't say they're abnormal. I don't know if this means i'm infertile. Here are my following questions:

1. How likely is it there i'm infertile?

2. Do you guys typically see women become infertile if they've gotten treatment right away, even though they've have it once or twice?

If I could also add something really quick. In my class we are learning about STD's, and i came about something that scarred me. My teacher stated that you can give yourself genital herpes by touching your cold sores and then you're genitals. When I first got tested a few years ago, I tested positive for HSV 1 with a value greater than 8.0. While awaiting my results, I was picking at my cold sore because at the time I did not realize this was herpes. I stupidly touched my cold sore and then my genitals.

1. what is the likelihood i gave myself genital herpes?

2. have you ever seen this happen?

H. Hunter Handsfield, MD

100 months ago

Welcome to the forum. Thanks for your kind words and your confidence in our services. Directly to your questions:

1) There are no firm data on the risk of female infertility after any single chlamydial infection, or two or more of them. However, almost certainly it is quite low, especially in the absence of symptomatic PID (pelvic pain, fever, etc). Certainly the human race continued to expand, without significant limitations on female fertility, for the tens of thousands of years before antibiotics were developed. And in your case, the chance of infertility probably is even lower than average because you have had pelvic ultrasound exams apparently without evidence of tubal blockage or scarring. In addition, it sounds like you were treated promptly both times, which also should reduce the risk of tubal scarring or blockage. All in all, I would guess the chance you have a fertility problem due to these infections is under one percent. However, this is something you could discuss with your gynecologist.

2) STD care is typically separate from the gyn practices that see women with fertility problems. We see patients with or at risk of STDs, but generally have little contact with those with long term complications of this sort. Clearly some women develop overt PID within days of acquiring chlamydia -- perhaps more often after a second or third infection than the first -- but how quickly tubal inflammation and scarring might result in infertility in the absence of overt PID just isn't known.

As for herpes, your course instructor is simply wrong. I suppose I should give him the benefit of the doubt and suggest you misunderstood -- but this doesn't seem likely. The fact is that once somone has been infected with HSV (either HSV1 or 2) more than a few weeks or months, she is highly resistant (probably completely immune) to new infections at new body sites. The immune system is unable to eradicate the original infection, because the virus survives in nerve tissue, which is immunologically isolated. But it's highly effective in preventing new infections. For the same reason, couples who share the same HSV infection do not "ping pong" the infection back and forth, and need take no precautions against new transmission to each other. So the direct answers to these two questions are 1) zero, or close to it; and 2) no, neither Dr. Hook nor I have ever seen such a case.

I hope these comments are helpful to you. Best wishes--

HHH, MD

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100 months ago

Dr. Handsfield,

Thank you for answering my questions, they were extremely helpful. I'm not as worried about infertility, as I was before.

I have one last question.

My teacher also stated that women may never know if they have genital herpes on their vaginal walls or cervix, unless a doctor sees it during an exam.

Is this true?

I've read discussion threads where Terri has stated that if you have herpes on your vaginal walls or cervix, it would be painful just like it would be anywhere else.

H. Hunter Handsfield, MD

100 months ago

Your teacher is sort of right, but for the wrong reason. And I'm pretty sure you have misinterpreted something Terri said about herpes. Genital herpes is often asymptomatic -- in fact, most people with positive blood tests for HSV2, meaning they have genital herpes, have no recollection of outbreaks of blisters, sores, pain, or anything else. Some of these in fact have mild symptoms they didn't recognize or that weren't bothersome and not noticed, but many are truly without symptoms. Nevertheless, they periodically have active infections and the virus is present and can be transmitted to partners. (This is called asymptomatic viral shedding.) For these reasons, most genital herpes is caught from partners who don't know they have it.

However, asymptomatic infections are not primarily because the infected site is primarily in the vagina or on the cervix. Most asymptomatic genital herpes primarily involves the external genitals -- labia, vaginal opening, etc. In fact, the linings of the vagina and cervix have few nerve endings and little pain sensation at all, whether from herpes or anything else.

I'm glad to have helped on the first question. Let me know if anything isn't clear on the second.

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100 months ago

Thank you Dr. HHH for answering my questions! You have been extremely helpful!

I am a bit confused as to what you said, but maybe if you answered this question, the other information would not matter..

As you can probably tell, I have health anxiety and when I first got tested, I didn't think of anything when I was hsv 1 positive. But as I started to think about, I rarely get outbreaks so I started to wonder where my infection site was at. Between my mouth and genitals, I have only gotten blister-like rashes under my nose; between my mouth and nose. Which makes me believe I only have it orally. However, one time after I had intercourse and oral, I got what I thought was a yeast infection. My vagina was sore and a little itchy, but mostly sore like a true YI. I then used monistat and it went away in a day or two & never thought about it again. Now I'm questioning it though. I have never had my blister-like rashes under my nose tested before so I will do that next time I get it.

Based on the data, would you suggest that my infection site is only orally?

Am I overthinking this or should I be worried?

H. Hunter Handsfield, MD

100 months ago

The symptoms you describe are not typical for genital herpes, and the large majority of positive HSV1 blood tests are from oral herpes. Most oral herpes is acquired in childhood and causes no symptoms in adults -- so lack of symptoms consistent with oral herpes doesn't mean much. And genital herpes due to HSV1 rarely recurs and is rarely transmitted to partners. So even in the slight chance your infection is genital, it probably will never cause you any problem.

For those reasons, I do believe you are overthinking it. I really don't think you should worry about this.

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