Is my pain related to herpes?

[JaneCl]

Hello there,

For around six years now, I've experienced fleeting 'flashes' of pain or sensation in my vulva.  These are not particularly agonising, but I can feel it nonetheless.  It tends to happen once or twice a day, and go on for a period of maybe two months or so.  Is this possibly the result of a herpes infection?  I have never had active symptoms that I know of, but I think that I may have received oral sex from a partner with a cold sore in the past, and this is around the time these kind of symptoms first appeared.  I've heard that herpes can damage your pudendal nerve, similar to herpes zoster.  Is this what is happening?

I am currently sufffering from vulvar vestibulitis caused by a chronic thrush infection.  This kind of pain is provoked and doesn't tend to bother me except during sex etc.

Thanks!

[H. Hunter Handsfield, M.D.]

Herpes is not a likely cause of your symptoms.  Although HSV indeed can cause tingling or pain that originates in nerves, usually it does so only in conjunction with recurrent herpes outbreaks.  Typically the nerve discomfort would start 1-2 days before an outbreak then go away as the skin lesions heal.  Such outbreaks (or neurological symptoms, if they ever occured without visible skin lesions) would never occur more often than once a month, more often every 6-12 weeks; between outbreaks there are no symptoms of any kind.  Without recurrent vulvar blisters or sores, and with more or less continous symptoms like you describe, herpes isn't likely.

As you have learned, vestibulitis is a troublesome and enigmatic condition.  Most cases are not caused by yeasts or other fungal infections, which is what "thrush" means.  In any case, the flashes of discomfort you feel are more likely related to that conditition than to something entirely separate, like herpes.

You could have a blood test to see if you are infected with HSV-2.  If so, a trial of anti-herpes therapy could be tried to see if it has any effect on your symptoms. Talk to your provider about it -- but don't get your hopes up.  I don't expect it to make any difference.

Good luck-- HHH, MD

[JaneCl]

Thanks for your response!

This has been a mystery that has gone on for so long.  The only reason I think it is connected to this oral sex episode is that it began to occur not long afterwards.  I have only had vestibulitis for around one year, so I'm not sure how related these pains are.

In any case, I seem to have caught HSV1 orally during this episode also - what are the chances of getting cold sores on my mouth but not suffering from the virus 'downstairs' also?

Thanks!

[JaneCl]

Oh and one more thing - so can just having the virus damage your pudendal nerve as some people seem to suggest?  Perhaps worth noting, as an aside, is that very rarely when I scratch the small of my back, the sensation is triggered.

Sorry to hassle you - just so confused!

Thanks again

[H. Hunter Handsfield, M.D.]

There is no evidence that HSV causes nerve damage that then goes on to cause persistent symptoms.  You'll see such theories on the web but there's no science behind it.

I doubt your symptoms have anything to do with the oral sex episode you describe.  Certainly it is possible to catch HSV orally and not genitally, even if both sites are exposed.  Whether or not you caught oral herpes at that time (I'm skeptical about that as well), there is no reason to blame your vestibulitis symptoms on it.  But feel free to follow the advice in the last paragraph of my reply.

[JaneCl]

Thanks so much for such a detailed response - you've certainly set my mind at ease.

Sorry to bother you further but can you just clarify what you meant in your second last sentence - did you mean that you were skeptical that I caught herpes on my mouth at the time or that I acquired HSV1 genitally?  

Thanks again!

[H. Hunter Handsfield, M.D.]

I'm skeptical you caught it on your mouth -- but I could be persuaded otherwise depending on the severity and symptoms of the first episode of oral herpes.  I'm even more skeptical you caught it genitally, if there were no symptoms of genital herpes around the same time as the oral symptoms.

[JaneCl]

Thanks!

[JaneCl]

Hello again Doc!

I've just been reading some other posts, with people describing similar symptoms to mine and being able to connect these at least indirectly to an episode in which they may have contracted herpes.  It seems there is at least some suggestion that nerve damage is possible.  How can these all be coincidences?

[H. Hunter Handsfield, M.D.]

How can they be coincidences?  First, because when millions of people have a particular problem, and millions of people have certain sexual exposures (or other risk factors), it stands to reason that some people have both, just by random chance.  Second, people with unexplained symptoms participate in forums like this and other websites more often than persons with typical herpes, chlamydia, HIV, or whatever.  Thus, atypical symptoms tend to dominate the discussions.

Nobody can say permanent nerve damage, causing continuing symptoms, doesn't happen with herpes.  Many people believe it happens.  But belief and science aren't the same thing, and there is no science behind the claim.

That will have to end this thread.  Please try to accept the reassurance about the good news that you don't have herpes.