Should I Test Again?

[worried234]

I am a 34-year-old female. I have been tested for herpes a few times because I have had recurring non-specific skin irritations, bumps, etc. in my genital area and wanted to rule out herpes, and I had new partners after the first test. I have never experienced a “classic presentation” of herpes. I’ve never had cold sores.

All tests HerpeSelect (I don’t have the specific values of the results)
Sometime in 2011: Negative for HSV 1 and HSV 2
September 2013: Positive for HSV 1, Negative for HSV 2
August 2014: Negative for HSV 1 and HSV 2

I was concerned about testing positive-then-negative for HSV 1, but my doctor said that false positives are possible. My last sexual contact was in Aug. 2013, so as my latest test was nearly one full year after potential exposure, my doctor told me that she was confident in my negative results. I have still not had any contact since Aug. 2013 so no chance of anything new.

I felt confident about my results until about a month ago. One night I suddenly noticed a large, extremely itchy bump to the right of my clitoris (on the skin where hair doesn’t grow, but near to the hairline). The area around the bump was pink and swollen to larger than the size of a quarter. I honestly thought I had been bitten by a mosquito, because it was so sudden, itchy and large, and I live in an area with a lot of mosquitos and immediately develop itchy welts when bitten. I have a photo but don’t know how to attach it and not sure if it would help. The next morning, the area swelling had gone down, and only the bump itself was pink, resembling a bite or a pimple without a head. I kept an eye on it over the next several days. Mostly it didn’t bother me, but sometimes it would get very itchy, and it was tender if pressed. I also experienced urinary discomfort off and on. At one point it started getting smaller. But finally after seven days it was getting bigger again and more tender. It was at least 1 cm in diameter and still pink. It didn’t have a head like a pimple nor did it resemble a blister. I tried applying some pressure and opaque yellow pus came out. Then I really squeezed it hard and some pus shot out, like with a pimple. I got a bit overzealous with squeezing and trying to get the pus out and the area looked a little traumatized afterward. But the bump looked a lot smaller and I felt satisfied that it was probably a pimple or similar, and I figured the urinary discomfort was just due to swelling in the area.

I didn’t worry until the next morning when I saw that it wasn’t healing and a little bit of clear liquid was on the surface. I don’t know if it would medically qualify as an ulcer or lesion, but it was definitely a small open area on the skin. It was very tender to the touch and continued to itch at times. It remained open for three days and the urinary discomfort continued to come and go. Unfortunately I was out of town and it was on a weekend so I was unable to get it looked at and swabbed. When I would check on it, it would have either a little bit of clear liquid or a thin layer of white on the surface and it was gooey. On the morning of the fourth day, the place where the open spot had been now looked closed up but did not scab. The urinary discomfort was gone. The spot healed further over the next several days. Although even now, a couple of weeks later, that spot is still a little pink and very slightly raised, though it is now very small.

The bump itself doesn’t seem like herpes to me, but the itchiness, urinary symptoms, and days of open skin worry me. Could a sebaceous cyst behave like that? The thought of herpes caused me a lot of anxiety in the past and I thought I could finally rest easy after my most recent negative results. But now I’m worried. Do you think I need to retest? That one positive HSV 1 result has always been in the back of my mind. Can I at least feel confident in my negative results for HSV 2? Thanks in advance for your help.

[Terri Warren]

So you’ve not had sex in two years and this bump is recent, correct?
What you describe sounds nothing like herpes to me but rather a cyst or deep pimple of some kind. Herpes lesions definitely don’t pop like pimples. I think you can believe your HSV 2 result. The HSV 1 screening test misses 25% of infections, so I can’t be as reassuring about your HSV 1 result.

Terri

[worried234]

Hi Terri,

Thanks for your reply. That’s correct, I haven’t had any sexual contact in two years (last contact was oral sex and frottage) and this is the first time I’ve had any bump that acted like this one did. The bump appeared about a month ago.

I know from reading this forum that false negatives for HSV 1 and false positives for HSV 2 are not uncommon with the IGG antibody testing. But I don’t remember reading about false positives for HSV 1. I guess I’m wondering which is more likely to be the false result: my positive HSV 1 result in 2013, or my negative HSV 1 result in 2014. Do you have any thoughts on that?

For now, would you say that the best course of action is to wait and see if I ever get another bump that opens like that and if so, get it checked out ASAP? I appreciate your guidance.

[Terri Warren]

the forceful popping of the lesion is not suggestive of the normal course of herpes. The urinary discomfort however can sometimes come from lesions in the urethra.
You could certainly get a western blot for clarification of your HSV 1 status – and I don’t have a clue about your situation in particular about false positives or negatives – but even if it is positive it would not tell you if this particular thing was herpes or not. You could certainly have this looked at, yes, and if any swabbing was done, it should be PCR.

Terri

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