Medical Forum / Diseases and Disorders / Herpes / October 2003
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 ICQ: 5178568
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