[Question #7689] Trying to find answers

2 months ago
I foolishly had unprotected sex with a one night stand four years ago and it has been haunting me ever since. 

Three issues here: 

1. I know I have or certainly had HPV genital warts. They were three tiny warts, I had them removed and haven't had anything visible since.  I did ALA-photodynamic therapy 3 times on all spots where I ever had warts and got three shots of the Gardasil vaccine because my doctor said it might help with infection clearance. I read that current research tends more to saying that even HPV that causes genital warts clears out eventually for most. How would you assess this situation in terms of probability of clearance? 

2. I possibly have genital herpes. If I have it, I only ever had one visible outbreak. At the time, I remember I had what looked like a genital ulcer on my penile shaft. However, being clueless about STDs at the time, I didn't go see a doctor because I thought it was some candida and that it would go away, which it did. I have been seeing STD specialists for four years now, none of them ever found any visible Herpes lesions (only some white spots from lichen sclerosus, which my doctor said, can also cause ulcers). So chances are, I might never get a 100% answer without a sore to do a swab on - right? How would you assess this situation? If I do have herpes, what frequency  (% of days) of asymptomatic shedding would be reasonable to assume with a single real outbreak ever? 

3. Ever since this incident, I have had recurring itching and sometimes also burning in my genital area, possibly caused by one or any of the things mentioned. However, I found out by trial and error that the itching was mainly due to folliculitus. Swabs found that I regularly have staphylococcus aureus infection down there. I had most of my pubic hair removed by laser, which made it much better. Can HPV/Herpes/Lichen be the underlying cause of this? I have been tested for all other STDs several times and it all came back negative.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
2 months ago
1.  That's a great question, actually, and I am going to ask Dr. Hook to answer your question as that fits with his area of expertise.
2.  I think you need to find out for certain if you have HSV or not.  Have you ever had a cold sore in your lifetime on your lip or in your nose?  If yes, then I would fully expect your HSV 1 antibody test to be positive.  If not, and you are HSV 1 positive, that could be oral or genital and there is no way to know for sure without a lesion to swab test.  If you test positive for HSV 2, we know with 95% certainty that this is genital.  If you are HSV 2 positive, we know that asymptomatic people shed virus on about 10 out of 100 days.  If you are HSV 1 positive, and we don't know the location, I can't help you with a more exact percentage.  Have you done an antibody test for HSV in the past, an IgG test?  The best antibody test is the herpes western blot done at the University of Washington only in the US.
3.  I suppose herpes or lichen sclerosis could cause itching yes, but the genital area is particularly prone to itches so it is very difficult to know for sure.

Terri
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2 months ago
Hi Terry, thank you for your answers.

Yes - I have had cold sores before all of this and as a child, but only rarely. The problem is, where I am from, there is no type-specific HSV test available. I did a blood test for HSV four months after this happened, IgM came back negative, IgG came back positive, but since type specific tests were not available, my doctor said the blood test doesn't really tell me which type I have and whether I have it on my genitals. However, ever since this happened, I have been getting cold sores more frequently on my lips- I also had herpes blisters on my chest shortly after the unprotected sex (diagnosed by a doctor), but only one time and never again since. 

So the conclusion so far is, also from what you write, that I certainly have HSV1 on my lips, but I don't know if I have HSV1 and/or HSV2 on my genitals. 

Is there any place where I can send in a blood sample for type specific testing from abroad? 

Could the fact that I only ever had one visible genital outbreak (if that's what it was) be indicative of the thesis that I only have HSV1? From what I read, people with HSV2 do tend to have genital blisters quite regularly,  which I certainly don't. 
Edward W. Hook M.D.
Edward W. Hook M.D.
2 months ago
Terri asked me to comment on your question regarding HPV. FYI, our forum is segmented and Terri takes our questions related to herpes infections while Dr. Handsfield and I take all of their questions related to other STI’s including HPV.  

Congratulations on having received the HPV vaccine. This vaccine will protect you from over 90% of common genital HPV infections and may reduce your risk for reactivation of the HPV infections you have had in the past.  The field of HPV is continuing to evolve rapidly. More recent data suggests that following successful treatment, small amounts of residual HPVDNA remain and me on occasion reactivate. That said, your risk for future transmission of HPV to others, as well as your risk of any sort of complication from your HPV infection is minuscule.  For all practical purposes, I would suggest that you consider your infection a past event and not worry about it going forward.

I hope that this information is helpful to you. This will be the only comment related to HPV is part of this thread. Take care. Please don’t worry. EWH 
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Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
2 months ago
So since you have ever in your life had a cold sore, you are always going to test positive on a non-type specific antibody test.  And I would be suspicious of you getting a herpes outbreak on your chest - not likely, and I would doubt it until you have another outbreak, if you do, that is positive for HSV.   That is an entirely different nerve group. 
The thing is, that since you've had HSV 1 since you were young, it is highly unlikely that you subsequently acquired it genitally.
Yes, anyone can send a blood sample to the University of Washington for the herpes western blot antibody test, the best test.  I can work with you to do that if you wish.  If yes, go to westoverheights.com and sign up for an evisit with me and we can work out the details. 

Terri
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2 months ago
Thanks to both of you for your replies - this has been very helpful to me so far. So taking in M.D. Hook's uplifting advice, I will consider the HPV issue dealt with, which leaves only the possible genital herpes. Yes Terri, I would like to take you up on that offer of getting a blood test and will head over to that site you mentioned. So if, in that blood test, it is found that I have HSV2 IgG antibodies, from what you write it would be reasonable to assume that I have genital herpes. What I don't quite understand would be the message of a test that says I only have HSV1 IgG antibodies, then I would be back at square one - not knowing if I have only labial or labial AND genital herpes - right? 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
2 months ago
You are exactly correct.  If your western blot is positive for HSV 1 (which half the population has), we could not know if the infection was oral or genital if you've never had a cold sore in your nose or on your lip.  But you could rule out HSV 2 or know that it is genital if positive.

Terri
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