Do I have herpes or what?
March 1, 2009 5:09 PM   Subscribe

I know you are not my doctor, but... I have had three outbreaks of something in the last four years, which could be herpes, but so far all the tests say it's not. Any other ideas what I might have? Much much

Four years ago, I noticed some discomfort in my vaginal area. It felt dry and a little painful. I thought maybe my boyfriend had cut me with a rough fingernail or something, and didn't really think much of it. A couple days later, I realized I'd developed some small white sores on my labia. They looked like ulcers you might get in your mouth. On each side, there seemed to be one main one and then a scattering of smaller ones around it. At this point I realized it was more than just a cut, and went to the gyno right away, taking an appointment with a guy who was not my regular doctor. The doctor took one look and said it was definitely herpes, sent a swab test off to the lab, and gave me prescriptions for Valtrex and some ointment.

I broke the news to my boyfriend who was so good and supportive about it. He was the only person I'd been with in the last three years, though I'd had three partners before him. He went to his own doctor for a blood test, even though he'd never had any symptoms of herpes. A couple days later I called in for the results of the culture they'd taken, and... it was negative for herpes?! My boyfriend's results were also negative.

A year or so later, I got the same discomfort and sores again. Once again I went to the gyno, seeing my regular doctor this time. She took a look and said it didn't look like herpes at all, and she didn't know why the first doctor had said that. She took another swab culture, which again came back negative.

Just to make double-sure, I got a blood test a few months later after my regular check-up, which also was negative for herpes. So nobody could tell me what I have, but it's not herpes, and I went on with my life.

Last week my husband (same guy - we've since gotten married) and I both came down with the flu. About two days into being sick, I noticed that same feeling I had with previous outbreaks of whatever I have. This time there is one main sore on the right side of my labia, and a smaller one directly opposite it on the left side. The second day was the worst, and they've been improving every day since then and are now almost gone.

Ever since my first (mis)diagnosis, I have read and learned a lot about herpes. From what I've read, there's arguments for and against whatever I have being herpes:

- I could have it without transmitting it to my (now) husband, because it's easier for women to contract.
- This last outbreak occurred during a time my immune system was weakened.

- Sores don't look like herpes, from the photos I've seen and what my doctor said.
- It doesn't hurt to urinate - in fact, it's sort of a relief, because mostly what I feel is dryness.
- The first outbreak is supposed to be the worst and occur shortly after first contracting the virus, but my "first outbreak" was years after being with any guy who could've given it to me.
- Sores clear up in about a week - regardless of whether I use any medication or not. They don't crust or scab over, they just sort of close up.

Could what I have be herpes, even though it doesn't really look or act like herpes, and three tests have come back negative? If it's not, what could it be? My personal theory is that it's some sort of irritation (from detergent, clothing, or even latex condoms?), which leads to dryness, and then the dry labia rubbing against each other irritate each other, causing the sores, which is why they always seem to mirror each other on each side of my labia. Does this sound plausable? Any other theories? Thanks...
posted by anonymous to Health & Fitness (11 answers total)
Do you know the specifics of the tests run? You can get HSV-1 or HSV-2 almost anywhere on the body, meaning you can get cold sores on your genitals and the STD on your lips or both in both locations. If both you and your former partner were tested for HSV-2 only you may have HSV-1 genital infections. HSV-1 can be spread like HSV-2 so take the same proper precautions until your sure, and then after. Also herpes can manifest in a variety of visible ways or not be visible at all and still be infectious, unless your doc sees a lot of herpes patients you may want another opinion.

Get what tests you can, and always inform partners. Both types of herpes mean different things to different people, but no one should be exposed without being informed.
posted by Science! at 5:20 PM on March 1, 2009

Could what I have be herpes, even though it doesn't really look or act like herpes, and three tests have come back negative?

It's not very likely.
posted by delmoi at 5:20 PM on March 1, 2009

Oh and most (60-90%) people in the USA have been exposed to HSV-1, so if you're tested positive for it and the condition you're concerned about turns out to be something else entirely don't worry you're not alone.
posted by Science! at 5:24 PM on March 1, 2009

Have you been tested for HPV? I only ask because they sound similar to genital warts but don't seem to be acting like them, but there are hundreds of strains, so you might as well rule that out with a test. This is nothing they will test for unless you specifically ask for it, so I recommend that, just for peace of mind.
posted by Unicorn on the cob at 5:45 PM on March 1, 2009

It could be an yeast infection that's manifesting itself mostly externally. They don't always present with the typical chunky discharge and yeasty odor. YIs can definitely dry out your labia and can cause some ulceration if they're severe enough.
posted by thisjax at 5:50 PM on March 1, 2009 [2 favorites]

It definitely doesn't sound like HPV. It does, however, sound like it still could be HSV (herpes). Swab cultures can be really unreliable unless whoever is doing it makes sure that the lesions are unroofed (that is, that any skin/crust over them is removed) and the base of the lesion is swabbed well. Just quickly swabbing of the top may not be sufficient because the test typically looks for viral inclusions in the cells, and if you don't get live cells from the base of the lesion, you may get a false negative result.

As for the blood test (serologies), you need to ask your doctor what serologies they ordered. They should've sent a serum HSV-1 and HSV-2 IgM and IgG. A high IgM and low IgG is typically consistent with primary outbreaks. You make IgM antibodies before the antibody producing cells undergo a "class switch" to make IgG. Once that's done (which may be after the primary outbreak resolves), you will have a high IgG and low IgM. However, the height of the IgG response tends to be higher during an outbreak and lower during remission (due to the fact that if the virus is 'active' your immune response will be active, thus your plasma cells will make anti-HSV IgG).

So if you haven't had an outbreak for a while and get a random HSV serology, your IgG and IgG may be low, giving the impression of a negative test.

My advice: ask your doctor to explain the test results in detail, and ask him what he/she feels the false negative rate is for the tests, and ask whether or not it is possible that the serologies you had obtained could be false negatives because you were not having an outbreak.
posted by scblackman at 6:02 PM on March 1, 2009 [2 favorites]

I would also see about a culture for staph. As odd as it may seem to many, some staph infections are recurring and once they are 'gone' they are not necessarily gone. It's not fully understood and some people get the sores just as you describe in the same general area over and over again. There is even a possibility with CA/HA MRSA staph and that can also go away on its own. If diagnosed, a course of antibiotics (they'll have to test for resistance to prescribe the correct one); maybe Clindamycin, Bactrim or Vancomycin could be in order and you could possibly finally rid your body of the infection. The antibiotics you have taken before may or may not have had anything to do with the healing. There's always the possibility they may have healed anyway and you still haven't had the correct (and powerful) antibiotic.

Out of curiosity, and this doesn't necessarily mean a thing with the prevalence of CA-MRSA, but was your first 'outbreak' of these sores after a recent hospitalization for another purpose? Remember, you can pass further anonymous comments to the same thread through AskMe admin.
posted by Gerard Sorme at 6:49 PM on March 1, 2009

My medical professional wife would reccomend you go to a dermatologist. It could very well be fungal or an irritant, or there could be an underlying condition that makes you extra sensitive.
posted by mzurer at 6:58 PM on March 1, 2009

TMIfilter: I had the exact same symptoms, including no unusual discharge, but I knew due to my history that it was definitely not herpes. The doctor was really sure it was staph, especially since I'd had MRSA on my face before. To everyone's surprise it was a yeast infection (the only one I ever had). Because of the time it took between the symptoms starting, me getting in at my doctor's office, and the culture coming back, it went away on its own before I even got a prescription for anything. I used the prescribed meds anyway just to be safe.
posted by fructose at 7:01 PM on March 1, 2009

I second the staph possibility and also the poor swabbing technique theory and I'll also introduce the possibility of chancroid. It's uncommon here in the US - were any of your exes from other parts of the world? Syphilis should also be ruled out (you can do that with a blood test).
posted by serazin at 9:28 PM on March 1, 2009

Could be early lichen sclerosis.
posted by Bunglegirl at 11:07 PM on March 1, 2009

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