One image of the mass would amount to multiple discussions.

The consistency (solid, cystic, polycystic, fluctuating, proliferate), and location (labia major v. labia minor) of the vulvar mass would help with differential diagnostics. Options include:

- Bartholin's cyst - a painful swelling adjacent to introitus, usually at the 4 to 5 o-clock positions. Infection agents include mixed bacterial flora (mostly gram-positive anaerobic). The cyst may drain spontaneously;

- Cyst of the Nuck's canal - peritoneal cyst adjacent to the round ligament;

- Mesonephric duct remnant - a cyst extending up lateral vagina;

- Accessory breast tissue in vulva - small nonspecific nodule, usually unnoticed until pregnancy;

- Epidermal (sebaceous) cysts - usually multiple, less than 1 cm in diameter, solid per palpation, non-tender if no infected.

As for the HSV-2, below are the frequency of the herpes silently shedding the virus based on
the HSV type and location (do note confuse this with transmission rates):

HSV-2 genital 15-30%
HSV-1 genital 3-5%
HSV-1 oral 9-18%
HSV-2 oral 1%.

Shedding occurs more frequently during the first 6-12 months of having herpes than it does subsequently due to building antibodies. Depending when the HSV2 was diagnosed, you could conclude about the association of the viral infection and the lamp.

If it was a blood test, then beyond 48 hours of the symptoms appearing, there is a risk of receiving a false negative test result. Viral culture is even less accurate during recurrences (positive in only about 30% of recurrent outbreaks). Blood tests can be used when there are no visible symptoms, but concerns about having herpes. Blood test does not detect the virus; it looks for antibodies (IgM and IgG). IgG is present soon after infection and stays in the blood for life. IgM is actually the first antibody that appears after infection, but it may disappear thereafter ( two weeks after the infection).

For more accurate diagnostics, there is a swab testing on symptomatic areas, called NAAT (Nucleic Acid Amplification Testing). This tests can differentiate HSV-1 from HSV-2. There is less chance of a false negative result with NAAT.

So: if the HSV-2 was diagnosed by the blood test, less than two weeks ago, and based on the IgM -positive results, then there is a 70 -85% chance that the mass is related to the HSV2.

Naira R. Matevosyan (Naira Roland Matevosyan)