Next Steps and Likelihood of Acquisition

[AC333]

Hello Terri,

I had a new sexual partner from early April to late August. We did not use protection, as I didn’t know HSV wasn’t included on a full panel STD test and he was clear on everything else.

In early August, I began noticing a tenderness on my upper outer labia. A few days later, that area developed a bump that was sensitive to the touch. There was another similar bump on my pubic bone that I thought was a pimple, so I tried popping it but it felt differently from a pimple so I left the labial bump alone. With time, it grew in size and reduced in sensitivity. Eventually, it ruptured and whitish-yellow pus came out along with blood. The area was itchy for the days that followed, and the lesion scabbed over like a normal pimple would.

About two weeks after the lesion healed, I got very bad itching in between my inner and outer labia. I foolishly scratched it, which led to a lot of tears. I’m not sure if these tears were just injuries from scratching or if they were an outbreak. It was around this time that I was diagnosed with bacterial vaginitis, and my recent partner was diagnosed with HSV1, with an IgG of 23.30. In the days that followed, I got nerve tingling in my right foot when I sat in the car or lied down in bed. Today, I sometimes feel sensitivity, tingling, or pain in the area where my lesion was.

I tested negative via IgG on 9/9 (IgG 0.79) and again on 10/11 (IgG 0.6.4) My most recent unprotected exposure was 8/3, and my symptoms began soon after this instance as well.

What are the next steps? How likely is it that I have HSV1? (I have many images of my symptoms if there is any way to send them to you). I plan to retest in late November for ideal accuracy, but if that test is also negative- then what? It seems to me like I have every symptom needed to suspect HSV especially given my recent partner’s result, but I’ve had two negative tests thus far and am feeling confused and scared.

Thank you!

[Terri Warren]

Genital HSV 1 is almost always acquired through someone with oral HSV 1 giving oral sex to someone who does not have HSV 1 anywhere. It is very rarely acquired through intercourse. I don’t know what kind of sexual practices you two are engaging in but if oral sex is involved, HSV 1 is possible.

The IgG test for HSV 1 misses 30% of infections compared to the gold standard western blot, so even a negative isn’t a perfect answer.

I would say you could consider redoing the IgG in 12 weeks or the western blot. In the mean time, if you get anything else that looks like a cut or ulcer, get it swab tested right away. The thing you described with pus sounds nothing like herpes to me.

Terri

[AC333]

Thank you for the response. We did engage in oral sex a few times many months ago.

The itching may have been caused by my BV, and the bumps have been said by everyone (including my gynecologist and dermatologist) to not resemble herpes. It is the tingling that is really making me think I have acquired herpes from this person. Is the tinging essentially a telltale sign? I can’t think of anything else it could be caused by. It was mainly in my right foot while driving or lying down, and very mild tingling occasionally in the groin.

I do plan on retesting several weeks from now. If that test is negative again, I will spring for a western blot. Though my negatives aren’t a definite answer, does the fact that I’ve tested negative twice now mean anything, or is it largely insignificant because it hasn’t been 3 months yet?

Does this sound like a classic case to you? Is there any reason I should think it isn’t? Currently I do feel rather convinced that I have it and am frustrated that it isn’t showing up on tests. I’m holding off on the WB due to cost.

[Terri Warren]

Tingling is so non-specific. I would never count on tingling as necessarily a sign of herpes. sounds more to be like possibly some nerve compression since you get it while driving in particular

The fact that you’ve tested negative so far is very useful and important. This sound nothing like a classic case of herpes to me since the only real symptom you have is tingling.
Terri

[AC333]

How would you interpret a third negative if it comes at the three month mark? I’m having a very hard time accepting or believing that I haven’t acquired herpes from this person.

Yesterday the tingling/numbness in my foot felt more constant after having been gone for a while. My bump in August was accompanied by another at around the same time on my pubic bone that released clear liquid when I tried popping it (i thought it was a pimple), the skin where the big bump later formed was sensitive to the touch for days before it appeared, and the itching between my labia didn’t feel typical of BV because it was all external and quite intense. Most importantly, my recent partner tested positive with an IgG of 23.30 and we had unprotected sex and he did perform oral on me, but to my memory it was only a few times months ago. But of course if he had it orally something as small as a kiss could have done it, which we also obviously did a lot.

I feel like these symptoms do not line up with anything else and given his positive result are quite clear, but my negative tests are throwing me off. Right now I guess it is just a matter of waiting until the appropriate amount of time has passed to test again, but any wisdom or insight from you would be much appreciated.

[Terri Warren]

A negative IgG at 12 weeks out suggests with 92% certainty (as compared to western blot) that you are not infected with HSV 2 and 70% that you don’t have HSV 1. If you want to know if you have HSV 1, you should do the western blot. And if you do the blot and it is positive for HSV 1, you cannot know if your infection is oral or genital. I think it is important that your doctors do not think the presentation you describe is herpes.

The other thing is, if you test positive by western blot and continue to test negative by IgG, you cannot know if your infection has been present for 3 months or 3 years.

Terri

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