Feeling uncertain

[uncertainjan]

Hi Terri,
I had a new relationship between Nov 27 2022 and Dec 13 2022 having unprotected sex with a partner who told me he was negative for the usual STI’s. I assume this didn’t include type specific HSV. Only unprotected oral was on Nov 27th for context. I since tried contacting this person with no luck.
On Jan 4th 2023, 22 days post exposure, I noticed a strange lesion on my labia minora. I saw a spot of blood on my toilet paper, so I investigated.
It looked like a small round bump of puffy, inflamed skin (honestly was not sure if it was inflammation or a blister. But it didn’t seem transparent or like it had a skin bubble holding in fluid from what I could tell) with a jagged ulceration that looked like five tiny connected shallow circular/oval cuts. Right beside this lesion was a very white, solid white head that had thick, pasty, puss. The appearance and consistency was similar to a blackhead, just lacking the oxidization. Because the two were so close together, to the point where the inflammation was touching the whitehead, I wondered if they were related.
16 minutes after, the lesion was flat, no longer inflamed. I have no memory of it leaking fluid or being wet. The next day I woke up to a white pussy dome overtop of it, like a protective barrier. I assume because it’s mucosa. It wiped away really easily, and looked more like a single cut or ulceration. It never got white in the center, just looked like an open wound, pink, a little blood. Like when you pick a scab off of a pimple. And hurt when I peed only once, right after I removed the puss dome to expose the fresh wound. The lesion was basically gone within 36 to 48 hours of me discovering it, and no longer swabbable. During that time I don’t really remember there being other symptoms aside from maybe mild itchiness. But I’m honestly not even sure.
Over 4 days, I went to 4 doctors and an emergency room trying to get it swabbed. And when I finally found someone willing to (on the 4th day)

[uncertainjan]

Continued: you couldn’t even tell where it had been.

The first doctor I went to did not swab it, but gave me an igg (diasorin liaison) at 22 days post sexual encounter. Results:
Week 3: HSV 1 and 2 negative – no values given.

over the course of the next 9 weeks I kept a close eye on my genitals to see if anything swabbable would pop up. Unfortunately nothing did. I went in and was told I had a pimple at one point, because I had a tiny bump with a pretty white, whitehead, that was all.

At week 12 I took another igg test. The diasorin liaison again, and then I noticed some opened skin by my anus. So I went in and got that swabbed, incase it was related in any way, about 12 hours after finding it.
IGG came back:
Week 12: HSV 1 and 2 negative – no values given.
Swab came back:
HSV 1 and 2 negative

After this experience I feel very upset that I was unable to find someone to swab it in time, and still feel uneasy about the whole thing. Also, I’m in Canada and not sure why public health doesn’t give values.

My questions to you are:

– Do you think my symptoms and the short window in which it healed (within 48 hrs) sound herpetic?

– Do you think that my igg tests at 3 weeks and 12 weeks and the anal swab are enough for me to try to put this behind me? I’m having a really hard time feeling comfortable with my results due to not having the original lesion swabbed, and plan to swab anything that pops up in the future.

– Seeing as I have no tests indicating I have an hsv infection, but there is still a chance it was missed, do you have any advice on how I should go about discussing this with future partners? As I don’t want to unknowingly put anyone at risk.

Thank you so much in advance.

[uncertainjan]

Sorry for the long string of text here… I felt I may not have described the lesion very well and wanted to clarify.

There were two things I saw: one was a very typical open comedone that was very opaque white. Not worried about that. And the other was a small bump of what looked like inflamed labial skin – skin color or slightly pinker than surrounding skin. With a crescent shaped, jagged laceration with about 5 distinct divots. Inflammation went down very quickly, and the cut looked like it got smaller and closed up. Over the course of 12 hrs, a yellowish/whitish discoloration occured that looked like it was coming from under/within the skin. Eventually forming the opaque white dome of what looked like puss or debris.
After wiping it away, and exposing the fresh wound, the cut looked rounder and had a deeper hole in the center, like it was the deepest part of the original laceration, and seemed to heal pretty much entirely within the next 24hrs. The same kind of whitish dome effect, but significantly smaller, occurred a couple more times throughout the healing process and I mostly left it alone.

I had used a new toy the night prior that had a jagged irregularity in the silicone I noticed later. I wonder if it could have caused trauma. It irritated my thumb skin a little when I rubbed the silicone there. I also am unsure if I just had another open comedone that I might have ripped out while wiping, since the two were so close together.

I also tested for all common STI’s in feb and march, including syphilis – all negative.

Thanks so much again. Sorry for long post. Just want to give clearest picture.

[Terri Warren]

I think with 92% certainty, you do not have HSV-2 infection. The IgG test misses 8% of HSV two infections compared to the herpes western blot. It is possible that you had trauma from the sex toy. With the negative swab test that you have obtained and the negative IgG test at 12 weeks, I think that HSV-2 infection is highly unlikely for you.
As you may know, the HSV one antibody test misses 30% of infections so I am uncertain about that result. If you feel that you need greater certainty, you can obtain the herpes Western blot and that can be done both through me or through your own provider in combination with the University of Washington. You can obtain that kit at 206-685-6066.

Terri

[uncertainjan]

Thank you so much for your response Terri. As a follow up I’d like to ask:

– If I do find a way of contacting the person this occurred after, and they get a negative test back for hsv 1 and 2, do you think that would be enough clarity to assume I didn’t contract a missed hsv 1 infection? Or would it be the same? Would you still recommend a blot in that circumstance?

– Since the lesion occurred 38 days, or 5 and a half-ish weeks after I received unprotected oral, does this decrease the likelihood of hsv 1 being the culprit? I know it’s possible for first outbreaks to occur outside of the typical 2-20 day window, but how rare/likely is it?

– Is it possible/likely that a first herpes outbreak could last 36 – 48 hours only? (assuming I didn’t have antibodies based off the week 3 IGG)

– Do you have any insight into the process of doing a western blot from within Canada? How it works through you if I decide to go that route?

Thank you again.

[Terri Warren]

– If I do find a way of contacting the person this occurred after, and they get a negative test back for hsv 1 and 2, do you think that would be enough clarity to assume I didn’t contract a missed hsv 1 infection? Or would it be the same? Would you still recommend a blot in that circumstance?
Well, it sounds like he doesn’t want to talk to you. However, if he was able to test and agreed to do it and was negative for type one, would that really settle things down? Knowing that the test misses 30% of infections?

– Since the lesion occurred 38 days, or 5 and a half-ish weeks after I received unprotected oral, does this decrease the likelihood of hsv 1 being the culprit? I know it’s possible for first outbreaks to occur outside of the typical 2-20 day window, but how rare/likely is it?
I think it definitely decreases the likelihood that it is an HSV one infection from this contact, yes

– Is it possible/likely that a first herpes outbreak could last 36 – 48 hours only? (assuming I didn’t have antibodies based off the week 3 IGG)
No I don’t believe so

– Do you have any insight into the process of doing a western blot from within Canada? How it works through you if I decide to go that route?
Yes, that can be done. You would need to purchase a shipping label for the University of Washington to send you the western blood kit. You would then need to get that label or a copy of that label to them so they could do the shipping and then you would need to identify a person in Canada to draw your blood and then you would need to ship it back to the University of Washington. We do it actually all the time

Terri

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