[Question #8182] HSV-2 Risk Assessment/Possible Symptoms
 |
47 months ago
|
Hi Terri. My relationship just ended. The man told me at onset that he was HSV-2+ based on several IGg tests and his MD advised he's likely had it for a while (high antibody titer). He told me that he hasn't had any symptoms for years other than possible sores and foul-smelling semen 15 years ago (maybe unrelated). Either way, ON the day he started taking Valtrex 500 mg daily we had largely protected sex, with the exception of condom slipping inside of me, at which point he exited. On day 5 of starting Valtrex we had a few minutes of unprotected penetration and rubbing of genitals, but for the very most part penetration was protected and Valtrex 500 mg was taken daily. I did give him oral sex unprotected, no mouth sores to date. Prior to us starting to date I had an IGg blood work and tested negative both for HSV-1 and HSV-2. That said, for many years now I've had cottage cheese-like vaginal secretions during times of stress/after sex. I've always thought of it as being allergic/sensitive to condoms/stress. I also thought it could have been an yeast infection, but I was tested for that and the results were negative even though anti fungal OTC meds seemed to have helped throughout the years. Fast-forward, on day 5 after our initial encounter, I started experiencing what I have experienced many times before: irritation in the vulva, itching, tingling, cottagy-like vaginal secretions and overall discomfort. I also noticed a small fissure (ulcer?) that looks like broken skin near the urethra, but it didn't look anything like the fluid-filled ulcer images I've seen online for HSV-2 genital sores. It's not painful either, no scabbing, nothing is oozing. It looks like a small, round open skin which I may have had in the past, I can't recall. I've also been having lots of diarrhea, but then my nerves are through the roof given the break-up. Does this sound as possible HSV-2 infection in your prof. opinion? Is testing warranted given social ramifications? Thank you
 |
Terri Warren, RN, Nurse Practitioner
47 months ago
|
How long ago did you notice the ulceration? If it is still there, you should have it swab tested. The cottage cheesy stuff is not related to herpes and likely is yeast, regardless of the test and if antifungal medicines helped you.
Antivirals take five days to be fully effective, and that is not 100% effective at it's best, to reduce transmission to a partner.
The diarrhea is likely unrelated.
My advice, given the sore and the exposure to an HSV 2 positive partner when antivirals were not fully effective yet, would be to get an IgG antibody test when you are 6-8 weeks out from your last contact with this partner.
The fluid filled blisters that are classic for herpes most often break in the vulva area of women and turn into ulcers as the labia rub together with normal activity.
I don't want to alarm you - I have no idea if this is herpes or not but you certainly fall into a category of people who the CDC recommends test for HSV 2.
Terri
--- |
47 months ago
|
I noticed the ulceration (on vestibule, just above the urethral opening) about 10 days after the slipping condom incident and about 5 days after the short unprotected event (when my partner was on Valtrex for about five days). The ulcer remains unchanged in size (round), not oozing, not scabbing, not painful, just about the same it looked like 6 days ago. The fact that it's not painful at all has any bearing on whether it's HSV or not? If it is an HSV sore, how long does it take to heal on average?
For a brief second I even contemplated whether it's a gland, like Skene's gland, but the anatomical location is incorrect and it's unilateral. What alternative explanations can there be - can it be due to rubbing, yeast infection, bacterial? I guess I'm this perplexed because this ulceration seems nothing like what HSV ulcers look like based on suggested images online - which I realize are not indicative since everyone have different symptoms and many/most HSV-2 carriers are asymptomatic. Is this sore suggestive of HSV-2 or it's just a guessing game in absence of testing? I've never inspected my genitals as much as I have recently, which is why I noticed the sore. But all the others symptoms (discharge, itching, redness), I've had them many times before always attributing them to yeast. My most recent IgG test was negative for HSV-1 and HSV-2, but based on what you've indicated in past posts there's a margin of error with IgG tests as well.
|
Terri Warren, RN, Nurse Practitioner
47 months ago
|
Did you have this ulceration swab tested? Most herpes lesions are at least tender. A new infection can take even a few weeks to heal but a recurrence, more like 7-10 days to heal.
I'm sorry that I can't help with what it might be, but I can tell you that herpes lesions usually progress from one stage to another - blister to ulcer to scab (but in your location, it would just fill in). Given a non-tender ulcer, I think you should be sure to eliminate syphilis as a cause also. Syphilis lesions have a raised edge and are non-tender.
Terri
|
47 months ago
|
I didn't have the ulceration swab tested as I didn't have a chance to do it within the appropriate timeframe. Testing will be the way to go. I was essentially wondering if a non-tender ulcer has to be/is typically due to an infectious disease/STI or can be due to something else that isn't infectious in nature. After all, tests are not perfect as well, as they can either yield false positives or negatives. Either way, thank you for your advice.
|
Terri Warren, RN, Nurse Practitioner
47 months ago
|
I would say that most herpes lesions are tender, as I mentioned. Ulcerations of the genitalia are not all sexually transmitted, no, but we certainly want to rule out an infectious cause, both for you and for future sex partners. You are so correct - many tests are flawed. The IgG antibody tests can have false positives and false negatives, and swab tests can have false negatives if the timing if the swab isn't correct. However, PCR swabbing picks up a very small amount of virus and is far more sensitive than the old-style culture so a lesion could be swabbed later or earlier in an outbreak.
terri
---