[Question #83] Genital HSV-1

39 months ago
I have had oral HSV-1 since childhood/dealt with the occasional cold sore outbreak for many years.  For the past 3 years, I have experienced a burning/sometimes itching sensation on the left side of my labia intermittently.  Symptoms usually last several weeks- sometimes over a month.  I have never had any vesicles/blisters/sores, but have noticed redness occasionally (similar to the red line you see above your lips when they are chapped).  There are intervals when I am completely symptom-free, but usually there is some degree of "irritation" present.  Several blood tests show positive IgG to HSV-1, but never to HSV-2.  I have also had a PCR swab done, which was negative (although I have never seen an actual "sore").  Tests for fungal infection have also been negative.  Do these unilateral symptoms suggest genital HSV-1?  I am married and the symptoms cause a lot of distress, despite the fact that I continue to work full-time and lead an active lifestyle.  Having a constant burning sensation makes a healthy sexual life difficult and sometimes limits what exercise/activities I can participate in.  I just want an answer as to what is going on so that I know how to treat it.  Any suggestions?  Does this sound like herpes?  What are the chances that I could get genital HSV-1 when I already make antibodies to oral HSV-1 that I have had since childhood?  Please advise.  Thank you so much for your help!
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
39 months ago
Good morning Sarah,
I seriously seriously doubt that you have HSV 1 since you've had cold sores since childhood.  In 33 years of practice, I have seen that situation perhaps once, but even then, I was not convinced from the patient history that they actually had had cold sores and not something else orally.  Having said that, I'm not clear what might be going on there.  When you first described your symptoms, I envisioned them as slightly troubling, but later in your post, your describe them as interfering with your life quite a bit.  What have your or your health care provider tried to make these symptoms better?  If you could take HSV 1 off your list of worries for these symptoms, would you feel more free to have a healthy sex life?  Is this all physical or is part of it psychological worry? 

Terri
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39 months ago
We have tried a number of topical/oral therapies including: steroids, estrogen, antifungals, etc.  I'm not sure if this means anything but, my symptoms started after I discontinued my Yaz contraceptive pills- onset was about 6 weeks later.  I have had a Mirena since then but have discontinued that as well now.  I have tried to switch to all hypoallergenic/frangrance free products, soaps, and detergents.  I only wear cotton underwear.  Taking "HSV-1 off the table" would help ease my mind.  However, I think the physical symptoms bring on my anxiety and worry- not the converse.  I am concerned that I had HSV all along but never knew it b/c I have a long history of cold sores- hence always a positive HSV-1 IgG test.  I hate that this could/is affecting my husband and burdening my mind.  I also have related fears about becoming pregnant/passing something along to an innocent baby unknowingly.  I am in my 30s and would like to think about starting a family soon, but worry that I have some disease that could disable me from doing so.  When I am symptom-free for a few weeks, I am happy and feeling fine.  The return of the irritation is always a stressor for me- especially since it has always been left-sided and therefore makes more worry about herpes since it is unilateral irritation.  Thoughts?  Thank you so much for you input.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
38 months ago
Well, in my mind the chances that you have genital HSV 1 are slim to none.  your oral herpes is more transmissible to your husband through kissing or receiving oral sex  than it would be if it were genital infection as HSV 1 orally sheds more often than HSV 1 genitally.  but again, I don't think that's the case.  The fact that you've never had a sore but just irritation also suggests against herpes.  If you were my patient, I would send you home with a pack of PCR swabs to gather at home and return to the office to be sent to the lab.  I would encourage you to swab the area that you feel is irritated each time you feel it for about 10 times.  If all swabs were negative, I would reassure you once and for all that you don't have HSV 1 genitally.  And remember. if you did have HSV 1 genitally, which I don't believe for  second that you do, people with genital herpes have healthy babies every day, women with HSV 1 and HSV 2 genitally. 
Has your husband actually been tested to determine that he does not have HSV 1?

Terri
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38 months ago
My husband was tested when we were first dating- several years ago- everything was negative. He may have contracted HSV-1 by now given the fact that I get the occasional cold sore, but he has not retested. Is there a chance that I may have contracted a different 'strain' of HSV-1 genitally?  In other words, can you have a history of cold sores, positive HSV-1 IgG blood test, and still contract a different strain of HSV-1 through the genital tract?  Is it reasonable to request a pack of PCR swabs from my OB-GYN to take home?  I get very fearful of discussing these things with her, but really would like to take all precautions prior to thinking of conceiving.   Furthermore, should I take Valtrex prophylactically during pregnancy to prevent passing anything to a baby?  Thanks Terri for your input- I am glad to know that this forum exists.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
38 months ago
Is it possible that you have HSV 1 genitally, with a new strain?  I suppose anything is possible but extremely unlikely.  If you have symptoms and you would like to swab them to be certain they aren't herpes, you could certainly ask your OB for that, of course.  I don't think antiviral therapy is necessary for you but this is something you and your OB should decide together for sure.  The meds are harmful at the end of pregnancy so if it would settle your fears, you could certainly talk about that.

Terri
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