Next Steps

[needshelp]

Hi Terri,

Not long after our wedding, my husband had his first herpes outbreak. Talk about a bummer honeymoon. We did not sleep together before we were married, so I know I was exposed about 10 weeks ago. Two weeks after our wedding, I started having symptoms. It initially felt like a yeast infection, but I was on high alert for herpes, so when over-the-counter treatment failed, I went to get tested. My course has run like this:

2/24 – 1st exposure
3/9 – Symptoms begin. Generalized vulvar redness. Itchy.
3/16 – Generalized vulvar redness and itchiness. Herpes culture, BV swab, yeast, all other STDs negative. Urgent care MD assured me she’d seen a lot of herpes but never anything like this. Treated with Diflucan, Terconazole, and 1 week of Acyclovir with no improvement.
3/30 – One to two dozen lesions started appearing on labia majora. Flesh-colored, do not appear to be vesicular. Generalized itchiness.
4/10 – Lesions persist but have not changed. PCR swab negative. A different Urgent Care MD again assured me that she has never seen herpes like this. She tried unroofing one of the lesions to see if she could get fluid but it just started bleeding. She prescribed 1 week of Valacyclovir with no improvement.
5/2 – Finally able to get in to see my own PCP. Lesions persist but still haven’t changed. He is confident that while testing done so far could be falsely negative, if antivirals haven’t helped at all and the lesions haven’t ulcerated or crusted, herpes is unlikely. IgG is negative. He prescribed triamcinolone, which only made my symptoms worse.

My question for you is what steps should I take next? Is there anything else my PCP should test for or try? He is just shrugging his shoulders. From what I’ve read, 8 weeks is an unusually long primary outbreak, but there isn’t a lot online about atypical presentations. (And maybe this isn’t atypical and people just don’t know what they’re talking about.) Am I just going to have to wait this out?

Thank you!

[Terri Warren]

An outbreak lasting 8 weeks does not sound like herpes to me.
Have you had other sex partners prior to this or was he your first partner ever? Had he had previous sex partners? Do either of you get coldsores? How was he diagnosed with herpes and do you know it if is HSV 1 or 2?
My suggestion would be to have a biopsy done of one of the lesions and have it sent to pathology to see what it is. It’s hard for me to believe that that has not yet been done.

Terri

[needshelp]

Thank you so much for your advice!
My husband was my first partner. He was married briefly before and widowed; his first wife was his only other partner. In the 6 years since his first marriage and our honeymoon, he had no signs of outbreak.
Neither of us get cold sores, and he was diagnosed with HSV2 by a culture swab.

I will advocate for a biopsy. The physicians I have seen so far also think herpes is unlikely. My husband’s HSV2 diagnosis has obviously rocked our world, and I’m probably suffering from confirmation bias as I was waiting for my own symptoms to start. Unfortunately, no one has been able to offer any other things to test for or try. It’s as if my doctor is just hoping it will go away.

Regardless of the length of the outbreak, have you seen herpes lesions that never open or ulcerate? Is there any precedent here or are my symptoms way off in left field?

Thank you!

[Terri Warren]

I have seen herpes outbreaks that get started and then don’t go all the way to blister or ulcer but they usually then go away within a few days. I am assuming that you have already had an antibody test? If not, you should get one. So he is the first sex partner you’ve had in your lifetime?

Terri

[needshelp]

Hmm…I wonder if I could be having outbreak after outbreak then. They don’t seem to be changing or going away at all, but there are so many that it’s hard to tell. Perhaps when some heal, new ones are coming in.

Yes, I had an antibody test drawn about 8.5 weeks after exposure. During that 8.5 weeks, I was prescribed two full weeks of antivirals. Negative so far, and I’ll have another one drawn in a couple of months. And yes, he was my first partner. Uncommon to wait for marriage but it happens. 🙂

Thank you so much for sharing your wisdom. Hopefully a biopsy will give me the answers I’m looking for – and some relief!

[Terri Warren]

I’m glad you are pursuing additional testing – this is a confusing situation for sure.
I’m wondering if it could be staph or strep?

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Terri

• This reply was modified 5 years, 4 months ago by Terri Warren.

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