[Question #1761] Hsv or any other or just anxiety??

43 months ago
I had sexual encounter on 18,19,20 Aug 2016 with an Asian sex worker.
Protected Vaginal
Unprotected oral
Kissing

Below are the events

Week 1- 2, started developing jock itch
Week 3 to week 10 – jock itch became severe spread over entire genitals and thighs despite using topicals.

Week 11 – week 12 – started experiencing pain in the rectal/anal region. With itch/crawl feel all over lower body, specially legs, between butt cheeks, with joint pains (I thought may be because of terbinafine tablets, was taking tablets as suggested by doctor) I feel this is the out break and I missed it to notice. When I checked anal was red and no blisters visible outside around anal region, penile, thigh. Missed to see for blisters inside anal. I have observed lesion on thigh near scrotum.

Week 13 – visited new doctor, he said fungal infection and have been given topical and it worked well. I have been using all over genitals. Pain in anal region reduced. I did std tests- tpha, vdrl, chlamidiya, herpes, his all are negative.

Hsv 1+2 ; CLIA method
Igm <0.5, negative
Igg <0.5, negative

Week 14 to week 20 – use of topical cream

Week 21 – stated burn/pain in anal region. No visible blisters outside or may be I missed to notice . Didnt check inside anal

Week 23 – got hiv and hsv test again. Burn / pain in anal. Jock itch still not cleared. Visited internist, he said no std signs

Hsv 1+2, CLIA method
Igg < 0.5, negative

Week 25 – I have explored inside anal this week To my uttershock I found ulcer with white head. Rushed to general surgeon, he said there s a scar and ulcer similar to what we get in mouth. He said it’s not herpes. He gave antibacterial oral and a cream. I still have it, planning to get pcr but I don't know since how long it s there. I also started having pain in abdomen.

I live outside USA.

My big question now is Am I infected with HSV or anything else or just anxiety? 
Can I trust blood tests? I've already recently taken azythromycin 1g single dose and taking anti fungal oral.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
43 months ago
Welcome to the forum. Thanks for your question. My first reaction is to congratulate you on having safe sex last August; using a condom was the most important thing. From all the infromation provided, I am confident you have no STD from that event.

For sure you do not have genital herpes. Thare many kinds of evidence against it:  None of your symptoms are typical for herpes, and neither is the nature of your rash or its timing. The location also doesn't fit:  the virus has to be assaged into the tissues for infection to take hold, and therefore initial herpes generally occurs at the sites of maximum friction during sex, i.e. would have occurred on the penis and not scrotum, anal area, etc. Herpes does not cause tingling or other symptoms down the legs. All lab tests are against it, and were done sufficiently long after exposure to be conclusive. Finally, if I correctly understand, you have the professional opinions of 3 different doctors, all of whom gave you other diagnoses that fit with your symptoms.

As for other STDs, there is also no evidence of those. I don't understand why you took azithromycin or what you thought you might be treating with it. And an "oral antifungal" drug (fluconazole?) probably will not help the skin problems you describe. You don't mention other STDs, but since the vaginal exposure was condom protected, it is unlikely you have anything. (Oral sex and kissing both are low to zero risk.) For reassurance, you should have a urine test for gonorrhea and chlamydia and blood tests for syphilis and HIV, if these have not already been done. You can expect negative results.

In summary, I am certain you do not have herpes or any other infection from your sexual encounter last August. You ask whether some of your symptoms might be "just anxiety". Probably yes. Whenever someone suggests his or her own symptoms have an emotional of psychological origin, usually s/he is correct.

So do your best to move on. Stop worrying and stop testing for herpes. For sure you do not have it. If you have a regular sex partner, you can continue (or resume) unprotected sex without worry. I hope this information has been helpful, but let me know if anything isn't clear.

HHH, MD

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43 months ago
Dear Doctor, 

I'm very glad and happy to see your response. I live in India and it is my pleasure to get your expert advise. 

Below are tests that I have taken.. 

At week 13 I have taken HIV,  syphilis (TPHA, VDRL),  HSV 1+2,  Chlamydia (serum),  # All Negative 

Week 23 I have taken HIV,  HSV 1+2 # all Negative 

Week 26 I have taken HIV, HEPATITIS B,  hepatitis C  # all negative. 

Since I didn't take Gonorrhea test,  GP had given azythrocin. 

I m taking itracanazole for the fungal infection. 

2 out of 3 doctors told that its not herpes. 3Rd doc s not aware of exposure. 

Couple of things more-

I have got couple of scars on right hip joint. Does HSV cause scars?  

I feel I missed the outbreaks in midst of severe fungal infection.  

Can I trust HSV blood tests??  As much on Internet says blood test may miss antibody detection.  

Do I need to do any further tests? 











H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
43 months ago
HSV does not scar. You did not "miss outbreaks" because of the fungal infection. The conclusion that you do not have herpes is based not only on the blood tests, but your lack of any symptoms to suggest herpes. All your other tests also were negative, proving you did not catch any of those infections. And you had a safe sexual exposure anyway. You do not need any further tests.

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43 months ago
Hi Doctor,

I forgot to mention that I got flu 2 times since exposure and

I got couple of pimples on abdomen. 

First pimple had pus,  I flushed pus out and pus is white in color.  I didn't do swab trusting my blood report. May be 2 months back.

Second pimple didn't have pus.  it was hard.

Two days back I got another pimple with white head and hair in the center beside First pimple.  It is hard and no pus inside. 

I visited dermatologist today and he said it's HSV 2 and gave valcivir.  He said there s no enough vesicle to do swab test. 

I m having intermittent abdominal pain. 

Also skin texture over abdomen has changed,  it has become like an aged persons skin. I also observed penile head and penile skin have become tender.  


Is it really genital herpes?? Do I need to take second opinion?? 
Can genital herpes cause lesions over abdomen? 
Can herpes mimic fungal infection?? (white scale between thigh n scrotum,  penile) 


What are the other possible STIs apart from below listed ??

TPHA,  VDRL (syphilis) - Negative at 13 weeks
HIV - (antibody+p24) Negative - at 13,23 weeks
HIV antibody - Negative at 24th week
HEP B - Negative at 24th week
HEP C - Negative at 24th week

Gonorrhea - submitted urine for DNA PCR  
Chlamydia - submitted urine for DNA PCR

HSV - negative at 13,23 weeks,  submitted blood today again. 


Present Symptoms - 
1. Pimple on abdomen. Old pimple lesions on abdomen 
2. Tender skin of penile skin and penile head
3. Intermittent abdominal pain
4. Fungal infection between thighs (turned from white itchy scale to dark color now ; no itch) 
5. Scar inside anal 


What could be the infection ?? 


I'm just worried not knowing what to do.  My wedding is in couple of months. I don't know to proceed further or no for wedding. 




H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
43 months ago
It's difficult to argue with a dermatologist's diagnosis based on direct examination. However, I remain skeptical you have herpes. There is almost nothing in your description that would make me think herpes is likely. While recurrent herpes outbreaks can occur anywhere in the "boxer shorts" area (lower abdomen, buttocks, etc), initial herpes almost always shows up at sites that receive friction during sex; the virus usually has to be massaged into the tissues for infection to take hold. If you had acquired herpes, I would have expected the initial symptoms to be at the base of your penis, just above the condom. Herpes and tinea cruris (jock itch) cause entirely different types of skin problems, and herpes doesn't mimic this or any other fungal infection. Finally, false negative HSV blood tests are rare, virtually non-existant in people with herpes symptoms. For those reasons, I remain confident you do not have herpes, notwithstanding the dermatologist's opinion. I would have recommended against another blood test, but you can expect it to be negative.

The other test results listed are reliable and show you were not infected with any of the infections tested.

As for the other symptoms mentioned, no STD causes these things. I am 100% confident you have no infection of any kind from the sexual encounter last August. If some of the symptoms are related to that event, they are psychological, i.e. from anxiety over a regretted sexual decision. But for sure from no infection. 

That completes the two follow-up comments and replies included with each question, and so ends this thread. Do your best to move forward without worry about herpes or any other STD. Best wishes and stay safe.
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