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Medical Forum / Diseases and Disorders / Herpes / October 2003

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exposed...now what?

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girl_simple - 09 Oct 2003 18:30 GMT
I was exposed to genital herpes during sex 3 weeks ago.  This was with
my long-time boyfriend who has hsv2, and though we usually are pretty
careful about protection, we've recently been "forgetting" condoms
sometimes.  Well, during penetration, he felt something, withdrew, and
there on his penis was a bump.  This horrified us both, and he raced
home and got some valtrex and brought it over.  Meanwhile I showered
and douched.  He's on valtrex, so the bump he had never materialized
into anything (it flattened out and then faded to a dull reddish
spot).

So, I started that night 3 weeks ago taking 2000 milligrams of valtrex
a day (2 doses of 1000), and keeping my fingers crossed.  Within a day
or so of exposure I started feeling classic prodrome symptoms
(tingling, shooting pains in legs and butt), and some discomfort in my
lower spine.  This lasted a few days and then went away.  I hoped to
write these off as side effects of the medication or physical strain.
Then, about a week ago, spots!

The spots are flat, about 1/4 inch in diameter, round, with slightly
irregular borders.  None of the spots could be considered to be on the
vulva (I have a couple on the bikini line and a couple on the inside
of my thighs, and if it's even the same thing, a couple on my hips).
Most of the spots are currently very red (starting out kind of faint
and growing redder over time); they itch a little but don't hurt.
They never presented blisters or ulcers, but as they heal (I got them
at intervals, so some are older), I detect slight scabbing...sort of a
whiteish dry film and they shrink a bit and get paler.  All in all
they look and feel like minor bug bites.  I leave them alone for the
most part.  The one on my hip, however, I scratched (I mean, I was
aware that I might experience some hsv symptoms, but I really wasn't
thinking it would show up on my hip), so I scratched it absently one
day while I was walking.  This is the only spot that stopped itching
right away.  The others itch continually off and on until they get to
the stage where they get that little bit of dry white scab over them.

Day before yesterday, after not having prodrome feelings for a couple
of weeks, again I had what I think to be a prodrome feeling in my legs
and butt.  I'm watching for new spots as a result, but nothing yet.

My questions are:

1) Should I stay on Valtrex (i.e., is the Valtrex helping me not
experience a bad breakout; is there any evidence it is helping keep
the virus in check or by staying on it, am I keeping the virus from
taking up residence; and lastly, should I go off of it so I can have
an outbreak?  If I go off valtrex, will the disease get a better
foothold?)

2)  Without blisters to make a positive culture, can I get a physican
to prescribe acyclovir?  I don't have insurance, so I don't want to
pay for an office visit if I'm going to go away empty handed.
Angela - 09 Oct 2003 19:00 GMT
First of all ~ if this is a long time boyfriend and not the only partner
that you've ever had ... then it's really difficult to know for sure when
you were actually exposed to herpes. You could still have been exposed to
herpes even with condom use.
You best bet at this point is if you have a flare up to get a culture within
24 hours of the sores/bumps developing. If you don't have anything you can
culture ... then you need to have a type specific blood test done. They say
anywhere from 12 to 16 weeks from when you last thought you might have been
exposed.

If you don't have herpes ... staying on Valtrex isn't going to do a whole
heck of a lot.
Although I have heard of non-infected partners taking Valtrex ... but the
story still remains ~ do you have herpes?
You still have to find out if you have herpes or not.

You are going to have to pay for an office visit no matter what you decide
to do.
You could go to planned parenthood and tell them that you need to be tested
for herpes. I believe they will work with you on a payment plan or go by
your income.

If you need to research herpes further ... here's a good place to start:
http://members.cox.net/yoshi2me/Links/Links.htm .

Angela

> I was exposed to genital herpes during sex 3 weeks ago.  This was with
> my long-time boyfriend who has hsv2, and though we usually are pretty
[quoted text clipped - 47 lines]
> to prescribe acyclovir?  I don't have insurance, so I don't want to
> pay for an office visit if I'm going to go away empty handed.
mishaisacat - 10 Oct 2003 20:18 GMT
First, I am _so_ not an expert, so for the more technical questions trust
others, but I'll offer my simple knowledge below.

> 1) Should I stay on Valtrex (i.e., is the Valtrex helping me not
> experience a bad breakout; is there any evidence it is helping keep
> the virus in check or by staying on it, am I keeping the virus from
> taking up residence; and lastly, should I go off of it so I can have
> an outbreak?  If I go off valtrex, will the disease get a better
> foothold?)

First, I don't know if there have been any studies about exposed people
taking valtrex for prevention (only the infected partner), but in my common
sense way of thinking about things, I think it's gotta help.

If I remember correctly, when the infected partner takes valtrex for
transmission prevention, it lowers their shedding, which lowers risk of
transmission (duh, so far, right).  Also, when transmission does occur, the
cases are usually milder.

Given that and that the valtrex, I think, works to stop the reproductive
cycle of the virus, I think if you've been exposed, valtrex won't keep you
from contracting it (sounds like you might have) but that it weaken the
virus and let you be one of the people in whom the virus acts pretty mildly,
hopefully almost unnoticably.

If you ask me, I think the hip and bikini-line are strange places to get
symptoms, not impossible, just strange.  Is it possible there could be razor
burn or ingrown hairs or something (not to say you wouldn't have herpes, but
that it's possible even if you do that the spots may not necessarily be
herpes)?

> 2)  Without blisters to make a positive culture, can I get a physican
> to prescribe acyclovir?  I don't have insurance, so I don't want to
> pay for an office visit if I'm going to go away empty handed.

Probably depends on the doctor.  A western-blot blood test is effective only
if you've had 12-16 weeks to develop antibodies.  But I've heard of other
tests that check for more immediate forms of antibodies that would indicate
a recent infection.  Someone else with more knowledge will probably clarify.

A visit to your local health clinic might be a good place to start.  It
would probably be cheaper and, if they couldn't prescribe acyclovir
immediately, the could probably give you some kind of test, so it wouldn't
be a waste.

Best,
Mishaisacat
girl_simple - 13 Oct 2003 19:01 GMT
Thanks mishaisacat for your quick response.  I went ahead and went to
the doctor (boyfriend said he'd pay for it, thus removing the last
barrier; but also because the itching was subsiding and the more
recent spots were beginning to scab over and I felt that I might not
get any new ones...I had been waiting all along to get some
blistery/moist ones).

Based on my description, the clinician didn't think it was herpes.
Upon seeing the sores, she said it didn't look like herpes.  She did a
scraping to culture  for herpes (I'll know more this coming Friday, at
the earliest).  She also did a scraping of something she called the
Herald Spot, which was a lesion 2 or 3 times bigger than the others
and much farther away (on my calf).  She and I both looked at the
scrapings under a dual microscope for signs of yeast.  She panned up
and down, pointing out this thing as a synthetic fiber, this thing as
a air bubble, this thing as a natural fiber, etc.  No signs of yeast.
Based on what she saw, and the tests she was able to make, she
diagnosed Pityriasis Rosea and wrote me a prescription for a
corticol-steroid (topical) to help the sores heal a little faster.

We looked at some pictures of Pityriasis Rosea and I would have to
agree with her, that the spots could be that.  Mostly, when you see
Pityriasis Rosea, a large area of the person is covered with these
spots, whereas I had less than a dozen.  Also, I had had Pityriasis
Rosea when I was a teen-ager, and from what I remember, it took off
like wildfire, covering my trunk, then migrating up onto my chest and
neck.  I stayed home from school for weeks, as I remember.  But,
nonetheless, the way the Pityriasis sores looked in the pictures
resembled mine, especially in the way they are sort of strawberry in
the beginning and redder later, and then also because of the way they
get these thin white papery scabs in the center, and of course, the
appearance of Herald Spot...all very characteristic looking.  The
Herald Spot, by the way, comes on much earlier than the outbreak.

I was disappointed she didn't suggest an ELISA (I know I wouldn't have
enough antibodies yet if I was only recently exposed, but I have had
the same HSV-2 positive boyfriend for over a year), so I asked for
one.  She complied, and drew some blood, and then marked the sample to
be tested for all STDs.

The whole visit, including the tests and exam, came to just over $100.
Not bad for peace of mind.  I know technically I'm not out of the
woods, but my relief is profound.  I learned something about myself
during this whole episode, what it would mean to have herpes, and I
discovered the worst part (after the waiting/wondering) was how it
killed sexual desire (or, in other words, how much I perceive my
sexual attractiveness to be based on everything looking all nice down
there).  I would assume that would pass with time, especially as
recurrent episodes would produce less lesions, probably, and I would
have long gaps in between.  But, I felt as though, if I didn't end up
having it, I would most likely break up with my boyfriend.  It
wouldn't be the primary reason, of course, because we have been
talking break-up for awhile, but, as you know, wake-up calls can be
very powerful forces for change.

I stopped taking the Valtrex after my doctor's visit.  I didn't fill
the prescription for cortisone cream.  The sores are going away.  My
boyfriend and I had lots and lots of celebratory sex over the weekend.

Thanks for having such a nice, supportive list.  It is really hard to
have shockingly colorful and itchy things on the sex organs.  I wish
you all the best and I'll report back when my ELISA and culture
results come in.

GS
Grant - 14 Oct 2003 02:24 GMT
Hi GS,

Just a few things, make sure that the blood test does get tested for herpes
because herpes is not included in the regular std testing.

Also, if your sores were herpes, then you've waited too long for the culture
to be of any use.  You will more than likely test negative but the culture
won't be conclusive because the chances of getting a false negative go up
the longer the sores have been present.

I have no idea what the rosea is.

Please keep us informed on how you're doing.

ar

> Thanks mishaisacat for your quick response.  I went ahead and went to
> the doctor (boyfriend said he'd pay for it, thus removing the last
[quoted text clipped - 61 lines]
>
> GS
M.L.S. - 14 Oct 2003 02:48 GMT
<snip>

>I have no idea what the rosea is.

I didn't either but this seems to be a good page:

http://www.emedicine.com/emerg/topic426.htm

Interestingly, sunlight might help make it go away.

Mike
girl_simple - 20 Oct 2003 19:39 GMT
Hello again, all.  

I have my test results back and they're negative.  That is the culture
of a scraping of one of the spots the clinician diagnosed as
Pityriasis Rosea came back negative, and the ELISA blood test was
negative for HSV-2 (positive for HSV-1, but then I've always tested
positive for 1).  They tested for all the other STDs, and they're all
negative as well.

The spots themselves, they are beginning to fade away though are still
a little scaly, which would be due course for Pityriasis Rosea from
what I know.

I'll probably wait the required period and go back for another HSV
type-specific blood test, in case I was infected on the night my
boyfriend and I had unprotected sex and he noticed the spot on his
penis.

Thanks to everyone who paid attention to my post, and for all the
helpful comments.  It's nice to know you're all here.

GS
Grant - 20 Oct 2003 19:51 GMT
Thanks for the update.  :)

ar

> Hello again, all.
>
[quoted text clipped - 18 lines]
>
> GS
Angela - 20 Oct 2003 21:49 GMT
Sounds like you have herpes type-1 in your body. Herpes type-1 can be
located orally or genitally . . .

Angela

http://members.cox.net/yoshi2me/Links/Links.htm
http://members.cox.net/yoshi2me/USA/USA.htm
http://members.cox.net/yoshi2me/Stories/Stories.htm

> Hello again, all.
>
[quoted text clipped - 18 lines]
>
> GS
girl_simple - 21 Oct 2003 18:32 GMT
> Sounds like you have herpes type-1 in your body. Herpes type-1 can be
> located orally or genitally . . .
>
> Angela

That's true, what you say, Angela: my hsv-1 could shed anywhere.  I
don't have any memories of oral cold sores or genital sores.  I'm 43
now, became sexually active at 16, and probably have had somewhere
near 100 sex partners.  I had my first type-specific ELISA blood test
last year, which showed hsv-1.  My assumption was that I got it as a
child the conventional way through kissing.

They oughta round up people like me and put us in a study like the one
they did at the University of Washington where they had women with
active genital herpes swap their genitals every day with a giant Q-tip
and send it in.  In that study, you probably all know, they discovered
that there's a lot of viral shedding going on asymptomatically.

GS
Tim Fitzmaurice - 22 Oct 2003 11:06 GMT
> That's true, what you say, Angela: my hsv-1 could shed anywhere.  I

Well it'll shed where it has infected. Its pretty unlikely to shed
anywhere on one individual.

> don't have any memories of oral cold sores or genital sores.  I'm 43

Yup you'll fit in with the 80% or so of people that say the same.

> They oughta round up people like me and put us in a study like the one
> they did at the University of Washington where they had women with
> active genital herpes swap their genitals every day with a giant Q-tip
> and send it in.  In that study, you probably all know, they discovered
> that there's a lot of viral shedding going on asymptomatically.

I'm fairly certain there's been something done on that level already. Need
to check the database to be sure though.

Tim
--
When playing rugby, its not the winning that counts, but the taking apart
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