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PostPosted: Sat Sep 01, 2007 12:06 pm 

Joined: Wed Aug 01, 2007 11:09 am
Posts: 251
betsyb1967, how reliable is a visual diagnosis of herpes in your experience?


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PostPosted: Sat Sep 01, 2007 1:17 pm 

Joined: Mon Feb 05, 2007 11:47 am
Posts: 5443
Location: PA
One study showed that even with herpes experienced clinicians - a visual diagnosis is still wrong ~ 1/3 of the time. The CDC recommends follow up confirmatory testing for every visual diagnosis of herpes. It's also important to know which type you have which is one more reason why additional follow up testing is needed. You should begin treatment based on a visual diagnosis but always pursue additional testing to confirm it.

betsy

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PostPosted: Sat Sep 01, 2007 3:14 pm 

Joined: Wed Aug 01, 2007 11:09 am
Posts: 251
Thank you, betsyb1967.

I woke up with a sore, red, swollen area on my genitals and went to the walk in clinic. There was some whiteness in the red area too. I had applied Aldara the night before and I was wondering if this redness/soreness was associated with the Aldara application (I have taken it for 8 weeks and once in awhile it is unbearable, usually around the time I have my period, and I need to wash it off), if it was a new wart, or something else (i.e. herpes).

The doctor looked at it and prescribed medication for herpes. He also gave me a requisition for a Western Blot blood test, and I was able to get to a lab to have my blood drawn, but I won't know for a few weeks.

I have not filled the prescription yet, although I washed the area with water.

6 hours later, the area is no longer swollen, and the redness is localized to the specific spot - now about 1 milimetre in diameter, and it just looks like there is a skin abrasion there - no blister or pimple.

I read that side effects of Aldara include the following:

Precautions: General: Local skin reactions such as erythema, erosion, excoriation/flaking, and edema are common. Should a severe local skin reaction occur, the cream should be removed by washing the treatment area with mild soap and water. Treatment with imiquimod cream can be resumed after the skin reaction has subsided.

I am wondering the following:

1) The swollen are and redness are subsiding within 6 hours. Is that possible when there is a herpes outbreak? Does herpes clear up that quickly in some people? It is definitely getting better, not worse.
2) There are no blisters or pimples per se, but a red skin abrasion - does herpes manifest itself as an abrasion?
3) I can go to yet another clinic and get a sample taken from the lesion, but not until Tuesday. Should I wait and not take the herpes medication in the hopes some of the lesion will remain and I can get an accurate diagnosis/test performed on the lesion? Or, just in case, should I take the herpes medication although it appears that the symptoms are subsiding?

If it was just sore and red I would think it was a reaction to the Aldara, but because there is this abrasion (which I have not yet experienced while on Aldara), I am concerned that it could be herpes.

Many thanks.


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PostPosted: Sat Sep 01, 2007 6:04 pm 

Joined: Mon Feb 05, 2007 11:47 am
Posts: 5443
Location: PA
I think this has been talked about a few times on the hpv board too. What you've been going thru is quite common with aldara use. Most folks I know who use it end up very irritated. Following up with the blood work is the best idea though why the doctor didn't do a lesion culture I have no idea. If it's been less than 3 months since the last time you had sex, you'll have to wait at least that long for the WB to be accurate :(

betsy

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PostPosted: Sat Sep 01, 2007 6:08 pm 

Joined: Wed Aug 01, 2007 11:09 am
Posts: 251
Betsy, many thanks for your feedback, I really appreciate it.


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PostPosted: Tue Sep 04, 2007 8:59 pm 

Joined: Wed Aug 01, 2007 11:09 am
Posts: 251
Betsy,

I followed up today with another doctor and they took a lesion culture, so thanks for mentioning that. The doctor said it would be big enough for an accurate read, so hopefully it was not too far after the initial appearance of the lesion. She seemed to think it was Aldara side effects, which I hope is the case so I can deal with one STI at a time.

Thanks again,

Infoseeker


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PostPosted: Thu Sep 27, 2007 6:12 pm 

Joined: Wed Aug 01, 2007 11:09 am
Posts: 251
Hi Betsy,

The lesion culture came back negative, but it was done after 72 hours not 48 hours from appearance of lesion.

The blood test came back as follows:

Test Name: Herpes Simplex Virus (HSV)

Immunoblot IgG HSV-1 Negative
Immunoblot IgG HSV-2 Negative

I am not sure what test was done (doesn't seem to be the Western Blot).

It is possible that I was exposed less than the min 4 weeks for antibodies to appear on the blot test, and I did the lesion culture a little late for it to be 100% accurate.

However, it seems that it is likely the symptoms were caused by Aldara.

Do you think I should get another HSV blood test in 4 weeks to be on the safe side, or is it overkill? I am a lot less worried than I was initially, but do want to be sure.

Thank you,

Infoseeker


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PostPosted: Fri Sep 28, 2007 1:18 am 

Joined: Mon Feb 05, 2007 11:47 am
Posts: 5443
Location: PA
I wouldn't bother unless you really know you won't rest easy unless you do.

aldara can do some nasty things to the skin :(

betsy

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