[Question #1175] Herpes

50 months ago
Hello doctors,

I recently had quick unprotected oral shared sex with a partner whose sexual health was unknown. Six days later developed at first severe lower left side back pain, which subsided over a few weeks but always seems to be there, in that same spot where the joint is. Feels better now, but all told over a month and a half. Also 22 days after the back pain developed a rash the looked like small paper cuts that several doctors identified as jock itch. Used steroid creme and ketoconozole (?) on that, getting quickly rid of the physical signs of the rash, but there is still some burning there with minimal signs of a rash. That has lasted now over one month and two weeks, with some burn and sometimes not. I think about it and it makes it burn it seems (sometimes). Now using Lotrimon which seems to have calmed it down. I was IGG tested for HSV2 at 2 weeks (0.07), five weeks and one day (0.08) and six weeks and six days (0.08). Going back again at twelve weeks to get definitive (?) answer. No other symptoms, if those two described above were indeed symptoms. Does this sound like herpes? I am now nine weeks post possible exposure. every doctor I have seen has denied that the back and rash were related to possible HSV2. HSV1 readings were two weeks (0.12), five weeks (0.1) and six weeks and six days (<0.01). Would like to hear what you guys think. Thanks.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
50 months ago
Greetings and welcome to the forum. Thanks for your confidence in our services. Herpes related questions normally are answered by Ms. Warren, but we also seek to respond to all questions within 1-2 days.

Most experts, including I and almost certainly Terri, would not have recommended you be tested for HSV after such an exposure or on the basis of your symptoms. I agree with your doctors that your symptoms are not at all suggestive of herpes. Herpes doesn't cause back pain like yours; and herpes and jock itch have pretty different appearances and are unlikely to be confused with one another. Also, initial herpes typically involves sites of maximum friction during sex, i.e. more likely would have occurred on the head and/or shaft of your penis, not the areas typically involved in jock itch.

Finally, your negative test results show with near certainty you were not infected during the exposure several weeks ago. While it can take 12 weeks for conclusive results, the large majority of newly infected people develop measurable antibody and hence positive tests by 6 weeks.

As I said, I would have recommended against blood testing in this situation. But now that you have started down that path, it would be reasonable to go forward with a final test at 12 weeks. You can expect it to remain negative.

I hope this has helped. Let me know if anything isn't clear. Best wishes and stay safe--  HHH, MD
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50 months ago
Thanks Doctor for the reassurance, and I look forward to testing for HSV2 for the final time. Not sure if this is then unrelated to the original question, but I was just wondering, if the slight rash/occasional burning on my right inner thigh that was diagnosed as jock itch should be persisting for almost six weeks. Sometimes there is some redness, but more the burn concerns me. I am now applying Lotrimin and Triamcinolone simultaneously a few times a day, and keeping the area as dry as possible. Thank so much, and it was an great to have you answering my original question.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
50 months ago
Thanks for the thanks.

There are other possible causes for a rash in that location other than jock itch (none of them STDs), including certain bacterial infections that do not respond to antifungal drugs like Lotrimin; as well as fungal infections that require different kinds of treatment. Also, without the right anti-infective therapy, triamcinolone could make it worse. Check back with your doctor, or perhaps ask for referral to a dermatologist.


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50 months ago
I have seen a dermatologist about this and they gave me the Triamcinolone. What are the other possible treatments to quell that occasional burn, either oral or cream? Thanks.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
50 months ago
In person diagnosis and treatment by a dermatologist is far more reliable than anything I could guess from this distance, so I have no further comment or advice about it. But I'm confident the dermatologist will help clarify things if you ask, or return for further evaluation. in any case, this sort of thing is an inconvenience, not a serious or dangerous health threat. Nothing bad is likely to come of it.

That completes the two follow-up comments and replies included with each question. Best wishes and stay safe.


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