[Question #845] HSV question

51 months ago

Last sexual encounter was 4 ½ years ago & involved only extremely brief unprotected oral sex (giving & receiving).  Possible kissing; I don’t remember. No visible mouth sores that I remember; no genital symptoms afterward.

I did develop a large lip pimple probably about 2-3 weeks after this encounter but didn’t think anything of it as I have an extensive history of cystic acne & had had lip pimples like that before. The only notable thing I remember is that when I tried to pop it, I couldn’t. But I hardly ever tried to pop any zits; I just tried then & couldn’t. My mom said that meant cold sore. So I thought, all along I guess I’ve had cold sores. I bought some Abreva but applied it maybe once. I don’t remember any tingling, burning, blistering, etc. – nothing outside of previous experience. I saw him again in that timeframe but there was no sex; not sure about kissing.

I saw him again about 6 weeks after the sexual encounter & he had what I remember to be splotchy red marks in the corner of his mouth. He told me, “I have mouth herpes; I got it from you.” He was a mean, sarcastic person & was promiscuous but lied about it. So I don’t know what to make of that & I don’t know what was wrong with his mouth. There was no physical contact then & none since.

I had a full STD panel done 4 months later; all clear. About 2 ½ years later, I developed some pimple-like things on my labia that would occasionally be sore. Seemed correlated with indoor cycling classes & they resolved without treatment. I worried when I later found out my STD panel didn’t include a herpes test & went in for an Igg test for HSV 1 and 2; both negative. I also had the genital pimples evaluated by ob-gyn when they recurred; diagnosed as inclusion cysts. Doc said no to herpes.

I occasionally still get lip pimples (sometimes big ones) but have NEVER had classic herpes symptoms– blisters, burning, tingling, open sores – anywhere on my body. All things considered, do I have reason to be concerned that I could have genital HSV 1?

Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
51 months ago
There are a few reasons why I don't think you have genital HSV 1.  First, you are antibody negative by IgG.  Unfortunately, the antibody test misses 30% of HSV 1 infection, compared to the herpes western blot.  So it's good that you are negative but not proof.  Second, and perhaps more importantly, you have had a clinician see the bumps that you are talking about and they don't believe that they are herpes.  Did the clinician do any swab testing for herpes, do you know?  Pimples and herpes generally are different in that pimples have kind of white pus in them and generally speaking herpes are water blistery things that break up open, form an ulcer in the skin, then crust over (not always on the labia though). 

I would say, if you were my patient and still worried about this, that if you get one on your lip or one on your labia again, you might ask for a PCR swab of the lesion.  To be even more certain, you could obtain a herpes western blot from the University of Washington.  I can tell this is concerning you still and it is reasonable, in my mind, to do whatever it takes to find out your actual situation.  I do, however, think that genital HSV 1 is unlikely in this case.

Terri
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51 months ago
Thanks for your answer.  No, the doctor did not do a swab test. She looked at it and said very confidently that it was an inclusion cyst and not herpes. I looked at it myself quite closely before the appointment and it was basically a hard, round ball that moved around under the skin. When it recurs (which it has a few times), it shows up in different places. At one point, I remember, it did sort of "come to a head" and then it was more painful but ultimately resolved. It never blistered, opened up, scabbed over or anything close to that. It really felt very similar to other pimples I've had (and I've had many over the years, in often very weird places, in my struggle with cystic acne).

The other thing I wonder about is, when I had that lip pimple back during the time I describe, it didn't seem like anything I hadn't had before. The only remarkable thing I remember is that I couldn't pop it. But then again, I hardly ever tried to pop zits and only did this time for cosmetic reasons. If that was indeed HSV 1, wouldn't it be likely I already carried the virus and thus wasn't susceptible to genital infection? Obviously that means by antibody test was wrong, but it sounds like that's certainly possible.

The other thing I don't understand is this seemingly changing accuracy rate for the HSV 1 Igg. I've looked up some results on my own (studies and what not from reputable places, not just the manufacturer's site) and it seems the accuracy rate at times is reported as quite high. Sometimes it was lower, for sure, but sometimes in the high 90s. Why is it now so much lower?
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
51 months ago
The presentation that you describe for the genital thing does not sound anything like herpes to me.
You could acquire HSV 1 genitally and orally at the same time, though the genital symptom, again, does not sound herpetic and the oral one really doesn't either.
The statistic I quote are from an ongoing study that we are doing with the University of Washington, comparing the IgG results that patients have obtained with results of the western blot that they took subsequently.  Though we have presented this data at scientific meetings, we have no yet published it.

Terri
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51 months ago
Thank you for sharing your expertise with me. If you were me, would you feel confident to conclude "no" on genital HSV 1?