Aa
recurrent HSV1
Two years ago, I had oral and genital sex with other than my regular partner followed - 24-48 hours later by a sore ulcerated area both sides of my vaginal walls and a copious green/yellow sticky discharge plus flu symptoms. Worried about herpes I started myself on acyclovir. Ulcerated areas disappeared 2-3 days later. Of two sets of tests [all neg for other STDs] one swab showed herpes. It was not typed. I continued to take acyclovir prophylactically. My first IGGs were neg for HSV1 and HSV2. Eventually after 12 months I had a weaky positive IGG for HSV1. I have never had a positive HSV2. On a few occasions when I had sex with the same guy I got symptoms [within 24 hours] with the same discharge and soreness. I am unsure whether I have passed HSV to my regular partner. At around the 14 month mark he told me he had a sore rash on his penis that had already lasted several weeks that cleared up eventually and has not returned. Looking at it, it might have been thrush but I might be clutching at straws. I am still having sex with the other man - about once a month. I take prophylactic acyclovir for about a week before but still get symptoms every time within 12-24 hours with the same ulcerated area on my inner vagina - somtimes bilateral sometimes one side with the same copious discharge. The sores go within 2-3 days the discharge within a week after which I stop the acyclovir.
Finally my question. If this is HSV1 then I seem to be getting 12 recurrences a year - more than I was expecting. Is it because trauma is a trigger? I am perimenopausal and the sex is quite rough. I have never had symptoms following sex with my regular partner however - although sex with him is much briefer. There was a lot of doubt expressed over the past two years about the diagnosis. Is it possible that these symptoms are not HSV? If it is and it is triggered by trauma will I eventually build any resistance?
Many thanks for your help.
Finally my question. If this is HSV1 then I seem to be getting 12 recurrences a year - more than I was expecting. Is it because trauma is a trigger? I am perimenopausal and the sex is quite rough. I have never had symptoms following sex with my regular partner however - although sex with him is much briefer. There was a lot of doubt expressed over the past two years about the diagnosis. Is it possible that these symptoms are not HSV? If it is and it is triggered by trauma will I eventually build any resistance?
Many thanks for your help.
MEDICAL PROFESSIONAL
Yes, atrophic vaginitis might be possible, but that's outside my area of expertise.
With "several" negative HSV tests from the lesions, that's further strong evidence against HSV, if the ulcers were still open and painful when the specimens were taken. Any single test can be negative, but with "several", you would expect at least one to be positive if you had herpes. In any case, a herpes-knowledgeable provider will know the importance of seeing you immediately (within 24 hours) of the next genital ulcer episode. If such a test is negative, as I think it will be, you can just disregard herpes as a potential cause.
With "several" negative HSV tests from the lesions, that's further strong evidence against HSV, if the ulcers were still open and painful when the specimens were taken. Any single test can be negative, but with "several", you would expect at least one to be positive if you had herpes. In any case, a herpes-knowledgeable provider will know the importance of seeing you immediately (within 24 hours) of the next genital ulcer episode. If such a test is negative, as I think it will be, you can just disregard herpes as a potential cause.
I am not sure if i am entitled to another thread but thank you for you response. I have been also tested for herpes several times always with negative result but never quick enough to catch the sore areas... only the discharge. I am perimenopausal so presume age related atrophic vaginitis is possible?? Again thank you for your help - the problem has been a big blight on my life for two years.
MEDICAL PROFESSIONAL
I missed that your initial HSV-1 result was negative. Apologies. That it was later positive supports the apparent acquisition of that virus between those tests. However, I don't know how to interpret the "weakly positive" outcome. If your genital symptoms were due to HSV-1, I would expect a strongly positive result.
If sex is consistently triggering ulcers and discharge, I would wonder about an underlying health problem that is making your genital tissues fragile. There are certain immunologic and genetic diseases that might do that. For example, there is condition called Behcet's disease which causes genital ulceration, occurring mostly in people of Mediterranean origin (Armenian, Turkish, certain Jewish ethnic groups). Or Stevens Johnson syndrome, a dermatologic condition that usually also causes a generalized skin rash but probably can be limited to genital ulceration alone. You might raise these issues with your gynecologist and consider referral to a dermatologist, who would likely be more familiar. Or something as simple as a chronic yeast infection. Or even an allergic reaction to semen (which has been reported to occur, although it is exceedingly rare). All such conditions are well beyond my expertise.
It seems peculiar that you have been tested "many times" for the STDs you mention, which don't cause ulceration, but apparently not for HSV. As I suggested above, that's an obvious next step.
HHH, MD
If sex is consistently triggering ulcers and discharge, I would wonder about an underlying health problem that is making your genital tissues fragile. There are certain immunologic and genetic diseases that might do that. For example, there is condition called Behcet's disease which causes genital ulceration, occurring mostly in people of Mediterranean origin (Armenian, Turkish, certain Jewish ethnic groups). Or Stevens Johnson syndrome, a dermatologic condition that usually also causes a generalized skin rash but probably can be limited to genital ulceration alone. You might raise these issues with your gynecologist and consider referral to a dermatologist, who would likely be more familiar. Or something as simple as a chronic yeast infection. Or even an allergic reaction to semen (which has been reported to occur, although it is exceedingly rare). All such conditions are well beyond my expertise.
It seems peculiar that you have been tested "many times" for the STDs you mention, which don't cause ulceration, but apparently not for HSV. As I suggested above, that's an obvious next step.
HHH, MD
Thank you so much for your help. My IGG for HSV1 was negative at the initial outbreak so I assumed the weak positive was a seroconversion which took an unusally long time - a year. Would the rough sex give me these sores and the discharge. It has been swabbed many times for chlamydia, gonorrhoea, trich etc and always been negative.
MEDICAL PROFESSIONAL
Most likely you do not have genital herpes at all. The only typical experience you describe is the initial symptoms: the combinaton of genital ulcer, vaginal discharge, and fever or other flu-like symptoms is classical for initial genital herpes. However, everything else is against it.
1) Even with HSV-2, symptomatic outbreaks as often as once a month is uncommon, and I have never heard of genital HSV-1 causing such frequent outbreaks.
2) However, your blood test shows for sure you don't have HSV-2; and the postive HSV-1 result is most likely to reflect a distant (childhood?) infection, as for 50% of the population.
3) Acyclovir resistance is rare in HSV. The continuing symptoms while taking acyclovir is strong evidence against herpes.
4) Herpes outbreaks are not triggered by sex.
5) Recurrent genital herpes is virtually always unilateral, not bilateral; i.e. always on the same side, generally within an inch or so of every other outbreak. At the earliest stage, you should see red bumps or blisters, before open sores develop. Since you don't describe these things, and have had bilateral lesions, this also argues against herpes as the cause of your symptoms.
My advice: Find a health care provider who is knowledgeable about herpes. That might be your own ObG, or a Planned Parenthood or health department family planning clinic. Ask around. Second, stop taking acylovir entirely. Third, see the herpes-knowledgeable provider immediately (within 1-2 days) the next time you have genital sores, for professional examination and a culture or PCR for the virus. (Any provider who understands herpes will appreciate the need to grease the skids for an immediate appointment if and when symptoms reappear.)
Could it be herpes? I cannot rule it out entirely. But my bet is strongly against it.
I hope this helps. Best wishes-- HHH, MD
1) Even with HSV-2, symptomatic outbreaks as often as once a month is uncommon, and I have never heard of genital HSV-1 causing such frequent outbreaks.
2) However, your blood test shows for sure you don't have HSV-2; and the postive HSV-1 result is most likely to reflect a distant (childhood?) infection, as for 50% of the population.
3) Acyclovir resistance is rare in HSV. The continuing symptoms while taking acyclovir is strong evidence against herpes.
4) Herpes outbreaks are not triggered by sex.
5) Recurrent genital herpes is virtually always unilateral, not bilateral; i.e. always on the same side, generally within an inch or so of every other outbreak. At the earliest stage, you should see red bumps or blisters, before open sores develop. Since you don't describe these things, and have had bilateral lesions, this also argues against herpes as the cause of your symptoms.
My advice: Find a health care provider who is knowledgeable about herpes. That might be your own ObG, or a Planned Parenthood or health department family planning clinic. Ask around. Second, stop taking acylovir entirely. Third, see the herpes-knowledgeable provider immediately (within 1-2 days) the next time you have genital sores, for professional examination and a culture or PCR for the virus. (Any provider who understands herpes will appreciate the need to grease the skids for an immediate appointment if and when symptoms reappear.)
Could it be herpes? I cannot rule it out entirely. But my bet is strongly against it.
I hope this helps. Best wishes-- HHH, MD
You are reading content posted in the STDs Forum
Herpes spreads by oral, vaginal and anal sex.
Herpes sores blister, then burst, scab and heal.
STIs are the most common cause of genital sores.
Millions of people are diagnosed with STDs in the U.S. each year.
STDs can't be transmitted by casual contact, like hugging or touching.
Syphilis is an STD that is transmitted by oral, genital and anal sex.
