Hello, 

Last September, I was treated with a round of antibiotics for strep throat. A handful of days into the antibiotics and I developed some lesions in the vaginal area. The doctor felt it was due to a fungal infection and sent me home. 

Since then, I've had a recurring issue (see log below). During the 3rd incident, my gynecologist gave me Fluconazole which didn't clear up the lesion, leading her to believe it was not fungal. At that visit, we did both a PCR and blood test. The PCR returned negative, but it was eight days after the lesion had appeared. The blood test returned positive for HSV 1 (confirmed by a follow-up Western Blot test). 

From there, we treated recurrences with Valtrex, moving to a daily suppression regimen after the 5th incident. I am unsure if the medication is helping as symptoms have consistently been around for 7 to 10 days. I am also very concerned that I have a misdiagnosis as my experience doesn't seem to align with what is described for typical HSV-1 cases.

We are waiting for the next recurrence of the symptoms described below to happen to do another PCR. In the meantime, I've experienced other symptoms that could be HSV-1 (e.g., burning sensation in the mouth, mouth tenderness, pimple-like lesions appearing on my butt). I've been very confused about if these are additional occurrences of HSV-1 or if I am now paranoid.

I do have a monogamous sexual partner and it is very important to me to understand the characteristics of my outbreaks to prevent transmission.

I would appreciate any guidance you have on how to best figure out what is happening and how to prevent transmission. I've received conflicting information between a PCP I was seeing, my gynecologist, and expert information that I'm not sure what to do at this point. I would happily accept any provider recommendations you might have for my area.

Log -

The symptoms are usually fairly consistent with discomfort while wiping or running water over the area. No other discomfort. There is typically some type of discharge associated with it.

1. Initial incident: Multiple small sores appeared after starting the antibiotic, cleared in a week

2. Two weeks later, a single sore appeared, cleared in a week

3. Four weeks later, another single sore appeared, cleared in 10 days

4. Four weeks later sore appeared, started taking Valtrex within 48 hours of initial sensitivity, and cleared in 8 days

5. Six weeks later, a sore appeared, started taking Valtrex immediately, cleared in 9 days

- Taking daily Valtrex prescription -

6. Three days later sore appeared, cleared in two weeks

7. Four weeks later, a sore appeared, cleared in six days

8. Three weeks later, a sore appeared, cleared in four days

9. Four days later, a sore appeared and is still present 8 days later but this one has felt like it healed with no soreness while wiping and sensitivity to water one day to have it return the next.

Throughout this whole time (since October), there have been a handful of instances of sensitivity and discomfort, but no lesions appear.

1. Initial incident: Multiple small sores appeared after starting the antibiotic, cleared in a week

This could definitely be related to the fungal treatment .

2. Two weeks later, a single sore appeared, cleared in a week

3. Four weeks later, another single sore appeared, cleared in 10 days

4. Four weeks later sore appeared, started taking Valtrex within 48 hours of initial sensitivity, and cleared in 8 days

5. Six weeks later, a sore appeared, started taking Valtrex immediately, cleared in 9 days

- Taking daily Valtrex prescription -

6. Three days later sore appeared, cleared in two weeks

7. Four weeks later, a sore appeared, cleared in six days

8. Three weeks later, a sore appeared, cleared in four days

9. Four days later, a sore appeared and is still present 8 days later but this one has felt like it healed with no soreness while wiping and sensitivity to water one day to have it return the next.

Throughout this whole time (since October), there have been a handful of instances of sensitivity and discomfort, but no lesions appear.

you are correct that HSV 1 in the genital area just doesn't behave in this way normally.  And they don't appear to respond well to antiviral treatment, correct?

If you were my patient, I would sen you home with PCR swabs so that you could obtain one right when it shows up and not make you wait for an appointment. 

Have you ever in your life had a cold sore in your nose or on your lip?  If yes, that would account for your HSV 1 positivity.  What was the number associated with your positive result? 

Had you had a sex partner give you oral sex recently, just prior to all of these symptoms/

Terri