Concerned and frustrated with unhelpful doctors…

[ConcernedIndividual]

Hi Terri, Im a 30 year old male in a 5yr relationship w/ a 40 year old woman. My gf in the past said that she gets “cold sores”, and twice in 5 years she has had 1 single small and shallow discoloration on her lip. After doing a bit of research and looking at her lip, we avoided contact to be safe, but decided on both occasions that they didnt look very much like cold sores (they werent blisters, fluid filled, painful, crusting, scabbing nor were preceded by any prodromal symptoms).

However recently my very sunburned GF has returned from a 10 day sun filled trip to Mexico with her mother and 8 days later has 2 small blisters on her lower lip. She says that she noticed a tingling sensation the day before. Also her mother who traveled with her gets cold sores when travelling, and had one during their trip.

Last Thursday we noticed the blisters, and I suggested she go to the telemedicine clinic, where she was told it could be a cold sore but also could be a reaction to the sun/sunburn and advised a lip swab. The doctor also noticed a sore red cut on her finger and said it could be related to a coldsore (whitlow?). She then went to the walk-in clinic Sunday and was told they were out of swabs and sent home with a requisiton for a blood test and Valcyclovir (4 pills, twice 12 hrs apart after blood test). The lab said the blood test would not specify the type of HSV and a more accurate test would need to req’d again.

Im concerned after reading about viral shedding, that if she has recently contracted HSV-1 (from her mother) that it may now pass to me during receptive oral sex. However if she HAS had it for 5 years then as someone who hasnt had an outbreak after years of kisses and oral sex I assume id either be a carrier or very lucky.

Im wondering:

1 Can an swab still be done after 2 doses of valacyclovir? Is this adviseable?

2 I assume I should get tested as well?

3 Is a more accurate type specific test recommended for her and I?

Anything else youd recommend?

[Terri Warren]

1 Can an swab still be done after 2 doses of valacyclovir? Is this adviseable?

No

2 I assume I should get tested as well?

Yes, it would be helpful though the traditional IgG test misses 30% of HSV 1 infections compared to herpes Western blot so if you are negative, it could be incorrect

3 Is a more accurate type specific test recommended for her and I?

Yes, herpes western blot

Anything else youd recommend?

It sounds to me like she has had oral herpes all along. The sun is a huge trigger for herpes outbreaks and the only one that we know for sure. Herpes in the finger looks like a group of water blisters on a very red base and is quite tender. The cut does not sound like that to me and the other thing is if she has had oral herpes four years, it would be extremely unlikely for her to get herpes on her finger

Terri.

[ConcernedIndividual]

Hi Terry, ty for your response. Since I last posted my GF visited the walk-in again and saw another doc. He swabbed the deflated blister on her lip (which was healing at about the 5 or 6 day) and sent it for a test which he claimed was extremely sensitive and accurate and said it “would likely show results even though it was healing”. He said the previous bloodtest type she was given was “not great” but said he’d hold off on the WB test until the results came back on the swab (and other bloodtest).

Was i correct to understand you that even after just 2 single doses of valacyclovir this (I assume PCR) test would not detect a positive correctly on 5-6 day old healing cold sore? It was covered by a cold sore patch the entire time.

My main concern is that if I am thus far uninfected, that contracting HSV-1 orally or genitally (especially genitally) is very worrying to me. Especially after reading about asymptomatic viral shedding. As I said earlier, Im mainly concerned that this is a new infection (thus a new risk) as we have been together and sexually active for over 5 years without me showing any symptoms (meaning If shes had it all along, transmission risk to me is low, or has already occured).

Is this faulty logic? Can you offer your thoughts/perspective on this?

In a permanent relationship Id consider this a minor risk of oral and sexual contact. However our relationship has been very uncertain this past year, and id very much hate to separate and have contracted this when I had the foresight to avoid it.

That being said, i think the best route is to:

a) verify by WB that she has it,
b) see if I already do too (meaning im asymptomatic and worrying for nothing)

My plan is to currently go and get a WB test done myself.. And if her swab comes back negative to send her back to insist on receiving the same.

Is this a good plan of attack?

Also is there anyway to determine whether this is a recent infection, (in case hers is positive and mine negative)?

[Terri Warren]

I think that is a very reasonable plan of attack yes,and if one of you is positive on the blot, there is no way to know when you or she was infected. I think you are approaching this in just the right way.

Terri

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