Scared about my baby

[WorriedMama]

Hi Terri,

I would firstly like to thank you so much for the work that you do. You have helped me so much already simply by education through this forum. You have also very kindly taken the time to talk to me previously (I live in Australia) as I am unable to access the video conferencing app.

You might not recall my story but I have suffered from OCD all my life. It went largely undiagnosed for years and I have been able to manage it for the most part. I am a first time mother and for some reason postpartum my OCD flared up so servely that I have been hospitalised and currently take medication and work with a psychiatrist and cognitive behavioural psychologist.

I am aware that my thoughts and fears are completely irrational with respect to HSV and I hope they do not come across offensively. My fear is that my son will somehow get an illness or sickness. I am just seeking some clarity with respect to HSV.

I have never had reason to believe I have HSV. My previous partner (6 years ago) had a significant number of partners before and during our relationship(which was on and off) however I understand for the most part he practised safe sex. If he was knowingly infected I have no doubt he would have informed me. I still have some contact with him but asking for his status now would be futile as he has slept with a number of women since me. For the 6 years since our relationship ended I never even thought about HSV.

5 years ago I met my current partner and the father of my child. He and his father and sister have recurrent oral cold sores. My partners become very frequent with stress – recently 6 in 6 months.

It has never ever bothered me that he has cold sores. I have never had one nor has anyone in my family so i simply didn’t kiss him when he had one. He is an amazing partner and father and it’s certainly not something I care about at all. However, unfortunately my OCD obsession revolves around any kind of sickness or illness with respect to my son and I fear I will somehow give my son HSV. Although he is now close to two and I know if he were infected he would be unlikely to have any lasting medical problems it is an irrational OCD fear which has had a hold of me for almost two years. It is very painful.

It started off when at 6 weeks postpartum I developed a rash on my cheek (face). I didn’t think anything of it at first as I had been going through a lot of old paperwork and figured I scratched myself. However someone mentioned it looked like stress or HSV. I went into complete panic as my baby was only 6 weeks old. I had a home doctor come out and look at it at night with the light from his phone he thought it looked like HSV. Wasn’t sure. He saw my distress and then said it could be contact dermatitis so I went and got a very strong steroid cream by prescription. It didn’t change at all overnight. The next morning I had it PCR swabbed which was within 24 to 48 hours from first appearance. I likely did not wash my face from the steroid cream and may have applied some that morning. The second doctor did not think it looked like HSV. The PCR swab came back negative. It resolved in about 4 or 5 days.

In the two weeks that followed I checked my cheek daily. I was constantly thinking it would come back and about 2 weeks after it first appeared I thought I saw a red bump so I immediately put Zovirax on it. I have never used this cream before. A rash appeared in the same spot. This time the rash did have vesicles and yellow fluid leaked out. They were very very small vesicles. I saw two doctors the day after it appeared (it appeared at night) and neither were sure. I had a HSV swab and bacterial swab done but the doctor failed to complete paperwork for the HSV swab and it was destroyed. The bacterial swab came back negative.

My fear was not that I had HSV it was that I may have autoinnoculated my hands as I was unaware HSV could come out in your hands and after the first episode I washed my hands so much they were split and rashy and raw. I became terrified of having HSV in my fingers and passing onto my baby particularly during bathing or nappy changes.

I also became concerned I had HSV2 from my previous partner simply on the basis that he had a number of sexual partners. For no reason other than that.

It has taken me almost two years to get up the courage to do an IGG test. Doctors kept talking me out of it. I finally did one and was negative for both HSV1 and HSV2. My partner also took one and was positive for HSV1 and negative for HSV2. We tested at different places. I have really struggled with accepting the results given the inaccuracy of the IGG particularly with regard to HSV1 but also even HSV2. For some reason they dont give numbers in Australia.

I have the following questions:

1. Western Blot
This is quite a difficult test to obtain in Australia and certainly not available where I live. I am wondering if both my husband and I are negative for HSV2 do you think we can confidently trust that? Should I cross that off my worry list?

2. Transmission and Herpatic Whitlow Risks
As above, I am not concerned about my partner having HSV1 – it is a fear that I will get it in my hands. I understand from our previous chat that as nothing appeared close to the rash on my face autoinnoculation is unlikely – I did have a chunk of skin missing on my finger the second time the rash appeared but I think I had just somehow cut my finger. Never a blister etc and I swabbed it just in case and was negative. So I guess my question is what is the chance is of getting herpatic whitlow from indirect transmission. As my partner gets recurring cold sores and unfortunately although they are much improved my hands are still sometimes raw and can get rashy and cracked (I am working so hard on this) what is the chance of catching it from surfaces ie if he touches his mouth and then something which I immediately touch with broken skin on my hands? I always wear gloves in kitchen with dishes.

3. Suppressive Medication
My partner and I have discussed him going on suppreasive medication for his cold sores given the stress it places me under with respect to our baby. I understand there are no health risks for long time use? Does the body become dependent on them? As in if he had to stop taking them would his frequency be worse than before usage? Or if he forgets one day will he get a recurrence?

3. Atypical Oral Herpes
I understand genital herpes can be quite atypical. However I am unsure if oral herpes are often atypical? I understand some people show no symptoms at all and my partners are very obvious cold sores but for instance our weather here is incredibly dry at the moment and at times very cold. During this season and right now in fact I have windburn across the entire top of my lip. It is just very rough dry flaky skin. I also had a sore corner of my mouth yesterday which I kept looking at, opening my mouth, licking etc and now it is larger and sore. Looks absolutely nothing like a cold sore however, due to my OCD I wonder if it could be atypical – no blisters etc but unfortunately I often think I imagine prodome tingling due to my irrational fear and as such I had an achy feeling in my lip but in a totally different spot a few days ago. Do oral herpes present in this way? If you feel a tingle in your lip would the sore appear in that spot? I should mention any mark on my
Body and I jump to a HSV conclusion.

I apologise if I sound ignorant or offensive! I truly have never cared at all about HSV until my son was born and it is only due to OCD and a fear of something happening to him that I now worry. Im incredibly ashamed of my fear and it is not something that would ever make me second guess my relationship with my amazing partner! It is certainly not something I would ever normally worry about.

Also if I have asked too many questions please let me know and I will pay for more posts. I think this service is so important and I would never ever mean to take advantage of it!

With warm regards.

[Terri Warren]

Of course I remember you and I’m sorry you are continuing to have worries about herpes.
1. Western Blot
This is quite a difficult test to obtain in Australia and certainly not available where I live. I am wondering if both my husband and I are negative for HSV2 do you think we can confidently trust that? Should I cross that off my worry list?

I do think you can cross that off your worry list., yes

2. Transmission and Herpatic Whitlow Risks
As above, I am not concerned about my partner having HSV1 – it is a fear that I will get it in my hands. I understand from our previous chat that as nothing appeared close to the rash on my face autoinnoculation is unlikely – I did have a chunk of skin missing on my finger the second time the rash appeared but I think I had just somehow cut my finger. Never a blister etc and I swabbed it just in case and was negative. So I guess my question is what is the chance is of getting herpatic whitlow from indirect transmission. As my partner gets recurring cold sores and unfortunately although they are much improved my hands are still sometimes raw and can get rashy and cracked (I am working so hard on this) what is the chance of catching it from surfaces ie if he touches his mouth and then something which I immediately touch with broken skin on my hands? I always wear gloves in kitchen with dishes.

I have no concerns about your getting whitlow on your hands from your partner’s cold sores at all.

3. Suppressive Medication
My partner and I have discussed him going on suppreasive medication for his cold sores given the stress it places me under with respect to our baby. I understand there are no health risks for long time use? Does the body become dependent on them? As in if he had to stop taking them would his frequency be worse than before usage? Or if he forgets one day will he get a recurrence?

There are no long term risks or problems, no. The body does not become dependent on them – it just keeps viral replication down while taking it and if he stops them, the recurrence rate will return to normal. Missing one day usually does not result in an outbreak

3. Atypical Oral Herpes
I understand genital herpes can be quite atypical. However I am unsure if oral herpes are often atypical? I understand some people show no symptoms at all and my partners are very obvious cold sores but for instance our weather here is incredibly dry at the moment and at times very cold. During this season and right now in fact I have windburn across the entire top of my lip. It is just very rough dry flaky skin. I also had a sore corner of my mouth yesterday which I kept looking at, opening my mouth, licking etc and now it is larger and sore. Looks absolutely nothing like a cold sore however, due to my OCD I wonder if it could be atypical – no blisters etc but unfortunately I often think I imagine prodome tingling due to my irrational fear and as such I had an achy feeling in my lip but in a totally different spot a few days ago. Do oral herpes present in this way? If you feel a tingle in your lip would the sore appear in that spot? I should mention any mark on my
Body and I jump to a HSV conclusion.

Oral herpes does not occur as you describe here, no.

Terri

[WorriedMama]

Thank you so much for your reply Terri! I purchased another round of questions – not quite sure if I was supposed to or if I had more left or if I asked too many questions last time so if I need to fix anything up, please let me know. This is such a valuable service and I would never take advantage of it.

I just wanted to make sure I understood your advice above (I didn’t word my question well, I apologise) I was just wondering with respect to the Western Blot vs IGG how much better is the Western Blot than the IGG for HSV2?

would you recommend obtaining it in my circumstances when both my husband and I have received negative IGGs for HSV2. We have not done the Western Blot.

The reason I ask is (I apologise for the information) many months ago after my son was born I had an itchy anus. It was very hot one night and I had tight thick pants on and likely was sweating but half asleep I got out of bed and rubbed very hard with toilet paper. A number of welts appeared (spread out not like blisters) and I immediately went to doctor for PCR swab that same day – he said it looked nothing like herpes and said it looked like an allergic reaction (I suspect because I had itched the life out of myself) and there was a little water on surface of welts but he said just normal water in skin. PCR was negative. I do however have an anal fissure which hurts when I use the bathroom. I have been to a gastroenterologist and have medication to begin but I feel very very regularly itchy and irritated down there. Never seen any blisters etc (my husband checks for me) but it irritates me so often I am wondering if it could be consistent with HSV2? I have never really received oral sex in my life (maybe twice tops
From an ex with no history of cold sores) so not thinking it is that. I am hyper sensitive to any sensation on my body due to OCD so not sure if the itchyness is common?

Also what you would recommend for my husband re dosage for suppression meds?

thanks so much Terri!

[Terri Warren]

You could do the blot to confirm or deny your status and it might help you move on from your worries.
The incident that you describe with the itchy anus sounds nothing at all like herpes to me.
Suppresive medicine would be 500 mg Valtrex once a day or 400 mg acyclovir twice a day

Terri

[WorriedMama]

Thank you so much for your reply Terri!

With respect to HSV1 – is there a percentage on accuracy of the Western Blot? I understand IGG for HSV1 is only 70% accurate.

With respect to the rash on my cheek do the symptoms sound indicative of a primary HSV1 outbreak? It was almost 2 years ago. Nothing at all since and I am an extremely extremely high stress person and have also been sick a number of times since (therefore weakened immune system). The first time it appeared I did not notice any fluid. After it was completely healed 2 weeks later the rash appears in the exact spot (after I put Zovirax cream on the spot) but this time leaks yellow fluid. First time cleared in about 4 days. Second time maybe 5 days. Bacterial swab was negative, HSV swab destroyed due to doctor error. Have never had a cold sore on lip or mouth. My husband did not have a coldsore anytime around the timing of this. Can weird unexplained things just happen postpartum due to hormones or something?

I’m so sorry to bother you with these questions – I guess for me there are pros and cons to doing further testing and I don’t have a lot of support at home to test further so trying very hard to make the right decision.

As always, your advice is very much appreciated and valued. Thank you

[Terri Warren]

The symptoms on your cheek do not sound like herpes to me. The University of Washington says that the Western blot are ages be one is about 95% sensitive. The IgG is 70% sensitive.
If you are unable to obtain the Western blot and you don’t have any more lesions to swab, you are going to have to rely upon the IgG test and simply wait for more lesions to show up. I would think if this was HSV one on your cheek you would have had another outbreak by now.
If you want to obtain the Western blot, we can work on that together.

Terri

[WorriedMama]

Thank you so much for your reply and your support – it’s very much appreciated when I really do not have any support at home to find definitive answers.

I have paid for more questions if that’s ok.

I have attempted to find out where to do the Western Blot in Australia. I see that a previous poster mentioned Westmead In Sydney – I assumed they meant Westmead Hospital but when I called there the doctor had no idea about this test. I have also noted your mention of Anthony Cunningham as an expert in Australia – I see he works at a university in Sydney – would you happen to know if perhaps the testing is done at the University? Or perhaps do you know of anywhere else in Australia? I will keep searching as I think it is best for me to move forward with the western blot test.

You may recall my concern is not actually having HSV1 but rather that if I had it in my cheek 2 years ago that I autoinnoculated myself in my hands and this presents fears with respect to transmission to my baby during nappy changes etc. The conundrum I am in is that if I have HSV1 I will be terriefied that perhaps this is laying dormant in the nerves to my hands or fingers and will eventually appear.

You previously very kindly advised of the daily suppression medication one can take for cold sores – my husband gets them often and it causes me severe anxiety. I sent him to the doctor armed with your advice but he was told they don’t prescribe that medication in Australia for cold sores in the form of daily suppressive medication and at most someone who gets ten a year or has genital herpes can take it for 90 days at most. He was given ezovir and told to take 3 tablets (1500mg) in one go at first sign of an outbreak. Today he noticed the red lump and took the medication. He doesn’t get any prodome symptoms so it’s always a little late. He had a very bad reaction to the medication. An ambulance was called etc. Are the doctors here out of touch regarding daily suppression medication?

Many thanks

[Terri Warren]

I do understand your concern, yes. I don’t know what ezovir is.
If you can arrange to get your blood drawn and spun in australia, we can get you the blot in the US.
If you had whitlow on your hands it would be infectious when you had symptoms, but hands do not shed. Perhaps I am not fully understanding this concern?

Terri

[WorriedMama]

Hi Terri,

I have now spoken to the pathology department at Westmead Hospital in Sydney, Australia and they do in fact do the Western Blot – I understand if you can get a pathologist in Australia to send them the blood as they direct they will do the test. I assume this means for your Australian writers that they can likely obtain the Blot with a little persistence from most places in Australia! If anything goes awry I will book a consult with you to obtain in America.

You have my concern correct! I am afraid that I have whitlow although I have never displayed symptoms that I know of. When I had the “rash” a second time on my cheek there was a chunk of skin missing from my finger but it was as if I knocked my finger and ripped skin off without noticing – nothing like a blister etc so I put it down to an annoying coincidence. I guess my question is whether it is possible to autoinnoculate from oral to finger without displaying any symptoms in your finger at the time of autoinnoculation and for it then to break out in finger years later. It haunts me that I could transmit to my son.

I will keep you posted on Western Blot.

Many thanks and Kind Regards

[WorriedMama]

Sorry Terri,

Not to lead anyone astray, I am now being told that at the Hospital the Western Blot has been replaced with the ELISA IGG and they don’t do the Blot anymore.

[Terri Warren]

Well, that’s too bad. WE can arrange it when you come to the US

Terri

[WorriedMama]

Hi Terri,

Thank you for your last reply. Unfortunately I don’t think I can get to the US anytime soon so it looks like I won’t be able to get the Blot 🙁

I have been doing rather well with OCD and treatment, however I have lately crashed again.

I previously had negative IGG for both HSV 1 and 2 but I am having a difficult time accepting the results.

As advised previously, my husband gets recurrent cold sores (hsv 1) used to be 1 or 2 a year but after our baby can be 6 or more a year.

I’m Australia they will not prescribe ongoing suppression medication.

I am not sure if the Blot would even help me at this point because I have been with my husband for 6 years – we used to passionately kiss (when we were younger) all the time. Is it even possible I have avoided infection? Would it be very rare to avoid infection in such circumstances?

Further I was diagnosed with an anal fissure which seemingly flares up quite often. I always have a little blood after bowel movements and am considering surgery as it has been years long. However yesterday it was quite hot and I was sweating down there (which may be exacerbated by anxiety) and my chemist gave me hydrozol cream to apply – this is a steroid cream and it made me feel very wet down there and itchy and I think the pain was worse (but was in and out of sleep so can’t be sure). I wiped off and the symptoms eased significantly. I am worried this could be an idicator that I do infact have herpes in my anus
As I have heard steroid cream is counterproductive to herpes treatment? There are no visible blisters or lesions at all. Could I be jumping conclusions? It is possible I just irritated my fissure further? I’m so confused on what to do next. Would the issue only be if I had visible sores? I’m so confused and this fear impacts so significantly on my life.

I should mention my husband tested negative for hsv 2 and positive for hsv 1.

Thank you for your advice always.

[WorriedMama]

I should also mention today, I feel nothing really at all on a much cooler day – would it be that it would be worse today from the cream if it were herpatic?

[Terri Warren]

Steroids creams can make herpes worse, that’s correct, but that doesn’t mean you have herpes for certain.

You don’t need to come to the US to get the blot – you can simply have it drawn and spun in Australia and shipped to the US. Could you arrange that if you had a lab requisition requesting it?

It is totally possible that you have escaped infection, yes!

Terri

[WorriedMama]

Thankyou Terri for your reply. I think I have 2 follow up questions remaining. Given I have OCD, I am wondering how to manage when rashes or bumps etc appear without running to the doctor weekly for swabs :/

For example, I am very very fair skinned and often break out in red bumps etc after showers or beach. Can happen anywhere on my body and goes down within hours.

I have also had on 2 occoasions (in different locations) a bump on my lip with a grey centre – looks like a clogged pore or blackhead (never blisters or scabs) and only lasts a few days – looks nothing like my partners cold sores. They can itch or feel a bit tingly but fleetingly.

I guess with regards to the above, my question is with atypical herpes does this only happen on vaginal or anal skin? For the lips and normal areas of skin like thighs stomach etc on body would an hsv infection be obviously that? Blisters etc?

Thankyou so much!

[Terri Warren]

I would say that anytime you have a bum that goes away in a few hours, you should be reassured that this is not herpes. Genital herpes infections can appear anywhere in the boxer shorts area. Your lip is not included in that area. Think about buttocks,thigh, anus, lower belly. And remember that you are looking for a group of water blisters on the red base

This is your final post on this subscription. If you have more questions, feel free to renew

Terri

• This reply was modified 4 years, 1 month ago by Terri Warren.

[WorriedMama]

Thankyou Terri,

I have reviewed my subscription.

I have another question currently of concern. My 2 year old son started getting fevers from Saturday night until Tuesday night. We managed these with Panadol and neurofen.

On Monday I took him to my doctor and he had a very very quick look in his mouth and said he saw a couple of specks of pus on his throat (both my husband and I noticed he had bad breath for the first time ever In his life).

My doctor assured me nothing to do with HSV and likely a bacterial throat infection. We were given antibiotics. My doctor did not look at his gums or cheeks etc. My husband and I looked in his mouth, at gums, inside cheeks etc and can see no sores or lesions.

However I have read quite a lot online about herpatic gingivostomatitis. The symptoms of this seem similar to a throat infection (fever and bad breath), however my son has no visible sores on lips or inside mouth. I read that with herpatic gingivostomatitis it can often go unnoticed and is the most common way herpes presents in small children.

My son did also get a rash on arm (nothing like herpes) and possible no link to his illness. Could be a reaction to soap or sunscreen because he has very sensitive skin.

1. What do you think are the chances of my son having herpatic gingivostomatitis and not having a throat infection as my doctor suggests?

2. Is herpatic gingivivostomatitis obvious if you look in a child’s mouth and would obvious sores usually accompany it either on lip or inside of mouth? His lips looked a little red but I may have imagined.

3. If it were herpatic gingivivostomatitis is there a chance I could get whitlow from my son drooling, kissing my hands? They don’t have obvious open cuts but my skin is dry and flaky (maybe small cuts)due to previous handwashing issues.

4. If you get whitlow (and never any previous herpes exposure) does it show up in the 2 – 10 days or can it be an asymptomatic infection and show up years later?

Thank you so much

[WorriedMama]

Hi Terri,

Please note I took my baby back to the doctor for a thorough check and he said absolutely no sign of HSV infection so no need for you to answer the above. Sorry to have bothered you! Kind Regards

[WorriedMama]

Hi Terri,

I am back again. I hope I am not bothering you with my worries.

I think I am overestimating the risks involved to my baby and I with respect to HSV. Just in short my concern is that I will get HSV in my hands and then pass to my baby accidentally ie during happy change / bath.

I had a few questions that may help me understand more:

1. If a child had hsv in the back of his throat (no known or recognised symptoms since) and he was very drooly and sucked on my child’s plastic toy and then my child put it immediately in his mouth is there a risk of transmission? There was a significant amount of drool. I wouldn’t know if he had sores in his throat again.

2. In the same scenario what if I picked up the toy instead of my son sucking it – am I at risk for whitlow if my hands are a bit cracked and dry? What sort of cut and what sort of contact would need to be in the hand for whitlow transmission?

3. Would a herpatic whitlow first infection ever be asymptomatic like an oral infection can be? Can someone be infected with whitlow and it not present until years later?

Thank you for your ongoing help.

[Terri Warren]

1. If a child had hsv in the back of his throat (no known or recognised symptoms since) and he was very drooly and sucked on my child’s plastic toy and then my child put it immediately in his mouth is there a risk of transmission? There was a significant amount of drool. I wouldn’t know if he had sores in his throat again.

This situation may present a very small risk of transmission. Very very small.

2. In the same scenario what if I picked up the toy instead of my son sucking it – am I at risk for whitlow if my hands are a bit cracked and dry? What sort of cut and what sort of contact would need to be in the hand for whitlow transmission?

Not really, no. I don’t think so. Generally, you need a significant break in the skin of the hand and more contact with virus (like fingers in vagina or fingers with breaks rubbing a lesions) for infection to occur

3. Would a herpatic whitlow first infection ever be asymptomatic like an oral infection can be? Can someone be infected with whitlow and it not present until years later?

No.

You are really reaching here for possible causes of infection. I would say that the questions you ask are maybe one in a 100,000 risk and you need to keep working on your obsession with this virus. I’m not upset with you or anything, I’m just worried about your continuing focus on this issue.

This is your final post on this subscription. If you have more questions, feel free to renew

Terri

• This reply was modified 4 years, 1 month ago by Terri Warren.

[WorriedMama]

Hi Terri,
I hope this post finds you well. I have been working very hard on my ocd and overall have put a lot of my fear and anxiety behind me however, unfortunately I do get triggered from time to time and I was hoping you could give me some advice on something which happened recently. As a reminder I have tested negative IGG for both 1 and 2. My husband is positive for 1 and negative for 2. I am not the recipient of oral sex from my husband.

About 6 weeks ago I was at home and it was very humid and hot. I noticed a red blotchy patch of skin appear on my lower belly. It was quite red however it was not on the surface of my skin but rather underneath. I mean there was no sore or blister or anything. I was very concerned and took photos and planned to go to the doctor in the morning. I went to sleep and by morning it had vanished.

Last week I had a similar patch of red skin appear in the same location but less obvious. Again no sore no blister nothing. This time it was completely gone in about 2 1/2 hours.

I took photos to my dr who said urticaria (hives) but there were no lumps or welts or itch. He said given it came and went so quickly there is no way it could be hsv. Do you have the same view?

It really was both times a red patch. No sores or lumps or blisters or pain or itch and it went within hours to completely normal skin. It turned to normal skin when I pressed on it I think it’s called blanching.

I am so worried because i was rubbing it so much and I changed my sons nappy immediately after touching it….I didn’t think hsv initially because there was no sores or anything but my ocd has played up and now I’m second guessing.

Any insight you could give would be much appreciated. Is a hsv rash on stomach remarkable? Would it be painful and last more than a few hours? Would it blister? Do these red patches sound anything like hsv. Bright red patch with nothing at all on the surface.

I’m just terrified I could have passed something to my son

Thanksyou

[Terri Warren]

this sounds exactly like hives to me. And nothing like herpes whatsoever. Honestly

Terri

[WorriedMama]

Hi Terri,
I hope this post finds you well. I am pleased to report that I am still seeing a psychologist and psychiatrist about my OCC and the improvement for me has been noticeable. Unfortunately I have had a recent setback and wanted your expert advice.

I am wondering about the presentation of hsv in the anus? I have very very frequent feelings of itchiness and irritation in my anus. Sometimes I feel like it coincides with my period but given the regularity of discomfort I feel I could be mistaken. My anxiety increases significantly during my period so it could simply be a psychological connection.

I have seen a number of doctors, all of whom who have said I have an anal fissure. I never thought to check if it were in the same location each time but it is in my anal hole. It has been around for years. I have noticed it is worse when I pass hard stool which is very very frequent for me.

I recently had the fissure examined (not swabbed) and the Doctor was very unconcerned. He said it is a fissure but looks nothing like herpes related as was not red or inflamed etc. another doctor told me herpes in the anus would be more on the sides of inside the butt crack and not in the anal hole itself…

I also have a pile where the fissure is – been there unchanged for years.

I have a negative IGG for 1 and 2 but I am now reconsidering the Blot. As I live in Australia I would hope I could arrange for you to be the ordering clinician for me. Given the difficulty I will face in getting the Blot and the opposition from my family to do so, could you advise me as follows:

1. Do outbreaks in the anus occur with menstrual cycles?

2. Is there a presentation that is usual? Is a fissure in the anus hole only common?

3. With a negative hsv 2 test for my husband of 6 years and I (we are monotonous) am I likely worrying for nothing?

4. Is there a usual prodome and what would it entail?

Thanks so much

I have seen a number of doctors, three have which have diagnosed me as having

[WorriedMama]

Sorry Terri,
I should mention the most obvious symptom I experience anally is itchiness and a feeling of wetness (very embarrassing) and often but when doctors look nothing out of the ordinary except a fissure…(not sure if same one each time) I do have difficult bowel movements so not sure at all anymore what to think. My doctor thinks I should trust my negative IGG and my husbands negative IGG for hsv2….as to Hsv1 I am negative but I know the unreliability of the test. I will say I have maybe received oral once or twice in my life and many many years ago from a different partner and very short…no history of cold sores for that partner

[Terri Warren]

1. Do outbreaks in the anus occur with menstrual cycles?

Some do, some don’t. I would advise that you keep track on a calendar. Are you saying that the fissures don’t bother you except around your period?

2. Is there a presentation that is usual? Is a fissure in the anus hole only common?

Ulcerations that are painful and resolve in a week or so. Anal fissures are certainly common and most any clinician could tell the difference between an anal fissure and herpes

3. With a negative hsv 2 test for my husband of 6 years and I (we are monotonous) am I likely worrying for nothing?

Probably, yes

4. Is there a usual prodome and what would it entail?

Prodrom is a nerve sensation that happens a few days before an outbreak and feels like tingling or crawling under the skin

Terri

[WorriedMama]

Thanks Terri,
No I don’t think it is just around my period I think it is so frequent but my anxiety is much worse around my period and so I worry more and perhaps notice it more…I unfortunately am just so confused by it all…. I have seen so many doctors and a colectoral surgeon about it and they all say fissure not herpes…i have looked myself a number of times and I can’t even see anything, it’s only when I am examined that a doctor can see it. Apparently something like 2mm long and not red or inflamed but for me because I am so sensitive perhaps I just notice it so much. I just wish it were simple to get the Blot in Australia so I could know for sure and move on with my life.

[Terri Warren]

I wish you could find someone to draw and spin on serum separator tube – you can’t? Then you can get the lab req from me and ship it to UW>

terri

[WorriedMama]

Hi Terri,
I have renewed my subscription. I am so sorry to bother you but I have decided to pursue the Blot and I have a few questions.

Both my husband and I (we are monogamous) have had IGG testing done here in Australia. I was negative for HSV 1 and 2. He was negative for HSV 2. He has recurrent cold sores so we knew he would test positive for HSV 1.

1. Anal symptoms
I get very frequent anal symptoms. I have had fissures over the years. I just figured it was as a result of diet issues with a prior eating disorder. I have had one for a long time which I thought I had healed but has recently started giving me problems again. I saw a number of doctors and a colon specialist – all said not herpes, just a fissure. It has been there (I am assuming the same one) on every occasion I’ve seen a doctor. I also had it PCR swabbed at least three different times. Twice came back negative and once came back inconclusive (apparently some fecal natter was on the swab and it made the test fail). I have seen my doctor so many times when I feel symptoms. He visually checks me. Other doctors have also visually checked me. They all say it’s just a fissure. The symptoms I experience are irritation with using the bathroom – sometimes it feels like I’m passing a piece of glass and itchiness in the anal area. Despite numerous checks by my doctor and myself and my husband also monitoring nothing has ever been visually seen (aside from the aforementioned fissure). I also have quite large skin tags in the area. I have been told by my doctor that I need to change my diet to resolve the problems and that I can put the herpes fear aside. Is there any comments you have in relation to my description? I am only concerned about HSV 2 because it is so frequent and I expect far too frequent for GHSV1. Also I don’t receive oral sex from my husband. Is there something that could help me make a reasonable conclusion? Can anal herpes be inside only? Does this sound like herpes?

[WorriedMama]

Just following on…

2. Whitlow Fears
The only reason I fear a HSV1 diagnosis is due to a rash which appeared on my cheek over 2 years ago. It came up once, went away then flared up 2 weeks later in the exact same spot. Some doctors said HSV1 and some said not. There was a PCR test done but it was negative and likely done too late. During this time I had no idea you could get HSV in hands and I had very cut hands from overwashing. I sleep with my head in hands a lot and was terrified that I may have auto inoculated. I know we have spoken about this before but can you get whitlow say during your first outbreak of HSV if not an established infection that (like oral and genital) is dormant or asymptomatic? I fear that if the rash on my cheek was HSV that I may have auto inoculated and it may show up in the future. One of the reasons I have been hesitant to do the Blot is opening up old fears.

3. Suppression
Thank you for all of your information on this. We have now been able to talk to a doctor who will prescribe suppression for him. Do you have a view on which is the best?

4. Blot
I will investigate how to get this done in Australia and if not possible perhaps I can find a lab to spin my blood and order through your service? Would this be ok?

Thank you so much

[WorriedMama]

Sorry Terri,

I forgot to mention I notice symptoms quite often before my period. This terrifies me as I have read this is common for HSV sufferers…the only other explanation I have is that I notice it more because of my ocd and anxiety are so much worse during this time.

I think I need to absolutely get the Blot. For HSV2 what is the sensitivity of the test – I’m scared that I won’t believe the result as I experience these weird symptoms.

Thank you so much

[WorriedMama]

Sorry Terri,

I keep thinking of things to tell you. I had a conversation with my husband because my most distressing symptom is a tingle I feel in my anus – it is brief, feels like something is tickling me or like sweat dripping (I am not sweaty). It can happen a few times and the last two times I have noticed it was right before my period. My husband told me this is what his prodome for his lip feels like. I am quite terrified now and feel like I should certainly get the Blot to move forward one way or the other. This fear of HSV2 genitally has impacted upon my quality of life so significantly.

I think I would prefer to order through you and send to UW. I’m not sure I could trust a result from elsewhere. I am a little concerned about the sample being compromised in the time it would take to get from Australia to the US. Can you please advise? Also would you mind advising on my other questions. I am going to pay for another set of questions now as I have asked more and posted more.

Thank you

[Terri Warren]

The sensitivity for the blot for HSV 2 is 99.9%.
I think you can safely ship the sample from Australia – I have certainly had others do it.
Your anal symptoms sound nothing like herpes to me and because you have been examined so often, I do think someone would have done a swab test if they had any concerns that your symptoms might be due to herpes.
Given your description, I seriously doubt that you have whitlow. Whitlow is remarkable, not subtle.
If your blot is negative for both HSV 1 and 2, suppression would be fine for your husband – valacyclovir 500 mg once a day is good.

Terri

[WorriedMama]

Thank you so much Terri. I really appreciate your advice. I think the help you give to so many people who are struggling with understanding this virus is so incredible.

I have had now 4 swabs of my fissure at different times. All PCR swabs. These were only taken at my request – all doctors have said looks nothing like herpes. Due to the location it is difficult for me to assess whether I have it swabbed in time. The day of my most recent swab about a week ago my doctor did swab the actual fissure and I was experiencing pain at the site at the time – I am uncertain as to how much faith I should put on the negative PCR swab results given the information online about false negatives – do you have a view on this? The fissure has now calmed down – no pain and as a result I have no idea if it’s there or not. It’s not something I myself have ever been able to see.

My doctor is currently investigating my ability to have blood drawn etc and I am hoping he will find a lab to do this so I can then takes steps to do the Blot through your service at Westover Heights.

Am I correct in saying that whitlow does not present asymptomatically on primary infection? I want to be certain that if I test for the Blot and it is positive for say HSV1 that I don’t go down the rabbit hole of do I have whitlow and it has not presented yet (2 years after the fact).

Thank you for your advice, hopefully next time I write it will be me taking the steps to obtain the Blot.

[Terri Warren]

Whitlow is not asymptomatic. It is dramatic.
Let me know about the blot, good to know that your swabs are negative – very important indeed.

Terri

[WorriedMama]

Hi Terri, I have suffered with OCD my whole life. I am in treatment. Following the birth of my son three years ago (and 6 weeks after giving birth) I had a rash appear on my cheek. A family member said the word “herpes” and my downward spiral began. One doctor agreed and another didn’t think so. The rash lasted maybe 4 days to a week. I didn’t see blisters. I had a PCR swab within 48 hours which came back negative. It healed and within 2 weeks was back in the same location. This time the rash had pinprick size vesicles with a yellow fluid. Swabbed again and the bacterial swab came back negative and the HSV swab was destroyed due to hospital not completing the paperwork. About 1.5 years later had negative Igg for 1 and 2. After 3 years of extreme stress and imagining infection with HSV the rash never came back until now. I also have frequent lip injections and nothing ever on my lips. The rash on my cheek Has now come up again. It is a red line with spaced apart vesicles (maybe 6) they are so tiny tiny tiny. I had PCR swabbed within 24 hours and am waiting on results. Everyone looks at it and says oh it’s nothing. My doctor said it does not look like herpes and if he had to commit to a diagnosis it would be a patch of eczema.

Question 1: does his diagnosis sound reasonable? I have read eczema and HSV look nothing alike.

Question 2: Would HSV behave this way – as in Only appear on 1 cheek and have a gap of three years – wouldn’t something like lip injections be likely to trigger an outbreak on my lips?

I am not overly concerned about getting HSV1 as my husband has it (recurrent cold sores). I guess my biggest concern and main question is relating to a long standing fear of mine that somehow my baby will get this from me via indirect transmission genitally – specifically, on the day the rash appeared (before I noticed it) I was outside eating with my family (no cutlery, just fingers) and my baby wanted to see. I immediately stopped eating….

[WorriedMama]

Continued: and pulled off his wet swimmers and held them
By the crutch while he weed and out them back on him. As they were wet I had to really hold the swimmers tightly and pull them on tightly to get him back in them. I know the rash was on my cheek but I anticipate I could have been shedding from the mouth and therefore by virtue of my eating and not washing my hands before helping him I am beside myself with fear that I have passed this on to him genitally. I know you say hand to genital transmission does not happen and very unlikely to pass via actions like nappy changes but, for

Question 3: could you help me understand this? I probably had quite a bit of saliva on my fingers as was eating without cutlery.

Question 4: with genital HSV is there ever an asymptote tic infection? It seems people have an obvious primary and then some luck people never get again?

I’m sorry if I sound crazy – I will also let you know when the swab results come in.

Finally I am now going to proceed with the western blot – my Doctor is finding someone to draw and spin blood for me and I would like to order from you if I can? I can’t organise a phone consult as an in Australia and we don’t have access to the app – can you advise me of next steps? I am having difficulty ordering the test from UW by phone due to my location – are you aware of a way for me to order online?

Thank you for your Continued support.

[WorriedMama]

Sorry Terry on re reading post 1 there was a typo – my baby wanted to wee while we were eating, he was in wet swimmers as he had been in the pool earlier and so I helped him out of his swimmers, was holding the swimmers by the crutch while he weed in the backyard and then helped him back into the swimmers.

[WorriedMama]

Hi Terry
Sorry to keep posting but my PCR swab test came back negative. Also, despite my ocd I must admit this recurring rash doesn’t look like what I know cold sores to look like. Being on the cheek and thicker skin I would have thought it would be really obvious to doctors if this was in fact herpes. On day 2 it’s kinda raised hard skin – by the night of day two it’s gone down so much… Looking forward to your thoughts on all of this.
Thank you

[Terri Warren]

Question 1: does his diagnosis sound reasonable? I have read eczema and HSV look nothing alike.

But your description of the rash sounds nothing at all like herpes and it does sound like eczema.

Question 2: Would HSV behave this way – as in Only appear on 1 cheek and have a gap of three years – wouldn’t something like lip injections be likely to trigger an outbreak on my lips?

No, I don’t believe that this is herpes due to the presentation and the timing. Trauma of lip injections would be very likely to trigger an oral outbreak – that’s why plastic surgeons suggest suppressive therapy prior to facial procedures.

I can help you with the blot. Go to westoverheights.com and go to the box that says video consults. Use ANY American address you can come up with = it doesn’t matter what you use. I’m sure you can sign on to the computer, right?

Terri

[WorriedMama]

Hi Terri,
I hope this finds you well. I have purchased another round of questions. I have been trying to book the evisit with you as I would like to obtain the Blot. I used an American address as you suggested (I am in Australia) and I get through the first hurdle but I cannot download the app due to my location. I have tried everything. I have a lab who can spin my blood etc so I am ready to go. Are there any other options for our evisit?
Thank you

[WorriedMama]

Hi Terri,
Please ignore the above.
We have spoken on evisit.
Thank you for your kindness and your time.

[WorriedMama]

Hi Terri

Thank you again for your time on evisit earlier.

Sorry to bother you, I was very nervous when we spoke and probably did not quite take in as much information as I would normally.

To clarify, the situation with my son ie him hitting the rash on my face then grabbing his genitals – was that a zero risk situation? He hit my face then immediately grabbed himself without any time in between. The other factors worth mentioning are the rash was swab tested on day 2 – negative. The brief hit by my son was the evening of day 5 or 6. At that time the rash had really reduced to a red blemish on my face. Am I correct that the level of virus at day 5 or 6 would be significantly less than day 2 (where there was not even enough to be positive by PCR). I know you said not to give it a second thought but I do keep wondering if you would classify it as zero risk to my son. I’m sorry again I am in probably the worst place I have ever been in my life over this situation and struggling to move forward.

Thank you again.

[Terri Warren]

Yes, that is a zero risk experience. And yes, if this was herpes, there would be far less virus present at day 5 or 6, correct. But I don’t think for a moment that it was herpes, really.

My daughter is bringing me the kit tomorrow and we’ll get it shipped out to you right away. While you wait, you need to know I have absolutely no concern about this contact, OK? Just none.

Terri

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