[Question #1831] Initial herpes symptoms on day 23?

43 months ago

Dr. Hansfield,

I had condom protected sex with a stripper/sex worker 27 days ago. We did some rolling around without condom so there may have been some direct skin to skin contact. I did not have any symptoms until day 23 when 3 or 4 stinging red bumps appeared at tip of penis. Bumps appeared suddenly upon return from swimming in ocean. At first I thought maybe it was a jellyfish sting. One bump is slightly inside penis hole and other small 3 bumps are to right and below hole.

Bumps stung a good bit for about 12 hours (stinging urination for several hours). Since then there is not much stinging or pain (no itching) and appearance of bumps has not changed much. On 25th day(this Wednesday) I had full STD work up and was negative for everything  (IGg less than 0.91). It is my understanding that result is about 50% accurate after 3.5 weeks.

I went to see doctor today. She examined bumps. She could not rule out herpes, but seemed to think it was more likely fungal/yeast (sitting in wet bathing suit). She said herpes site would typically hurt first and then a bump or blister would form. She also said bumps were very small and appeared to be healing (3 days following onset). On a side note I have been itching a good bit lately. That is not that unusual as I have frequently had jock itch and dry skin.  I had shingles once or twice. Doctor prescribed me one fluconazole pill and clotrimazole cream.

Based upon this information how likely do you think I have herpes? Doctor acknowledged 23 days is a long time for initial symptoms, but said I could have been asymptomatic or not noticed irregularities. Any other ideas as to cause of bumps? If it is fungal would it have been acquired through sex 23 days before onset? Also, please confirm accuracy of IGg test at 25 days.

Thank you for your help. Your online postings much appreciated. If I manage to come out of this episode I am giving up alcohol and sex.Please respond as soon as you can. Needless to say I am very concerned.

Chris

Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
43 months ago
Day 23 would be unreasonably long for a brand new herpes infection - the range is 2-10 days with the average being 5. 5 days from exposure to new symptoms
I think it is far more likely that something in the ocean was causing your symptoms.   If you had no symptoms before going in the ocean and emerged with stinging bumps, that totally makes me think it was something from the sea. 
Also, the condom that you used (good job, btw) would be very good protection against acquiring an STI. 
I am concerned about you saying that you've shingles once or twice.  Would you be willing to expand on that comment - how did that look, what testing if any was done, how was the diagnosis made?  Are you saying the antifungals were prescribed for the shingles?
The accuracy of IgG testing for HSV 2 at 25 days is about 50% - that is, there is about a 50% chance that the result that you obtain on the test at 3 weeks will remain the same at 12 weeks. 
Though the test isn't useful for this encounter, it does give you a baseline result which is very useful!  We know now that you weren't infected (with 95% certainty) with HSV 2 prior to this encounter.  And since this encounter was condom protected and a single encounter, I think the chances of you becoming infected at this encounter are extremely low

Terri
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43 months ago

Hi Terri,

When I had shingles I was not given any tests. An area on my chest was extremely sensitive to touch (very painful). My dermatologist made diagnosis based upon my symptoms. I did not have much of a rash. I was given medicine (don't recall name) and got better in fairly short order. I did have chicken pox as a child and then again in my early 20s (now 47).

The fungal medication was given to me by another doctor at a clinic I visited on Thursday. In her opinion most likely diagnosis of bumps is fungal/yeast infection on tip of penis.

I noticed bumps about an hour or so after swimming in ocean when I was taking a shower. I do not recall any stinging or pain while I was swimming.

Today (5th day) bumps are less red with basically same shapes. After initial onset stinging gradually subsided. However, today I am getting some stinging with urination.  There has not been any  itching and bumps are not really painful to touch. I have not noticed any water filled blisters, but the stinging concerns me. I have been using fungal cream (clotrimazole) for almost 3 days. Are these symptoms consistent with yeast/fungal infection? Do you still think herpes is unlikely? Any thoughts are much appreciated. 

 



Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
43 months ago
Thanks for the heads up on the shingles diagnosis.  I was thinking if the shingles symptoms were genital, we needed to reconsider the diagnosis, but that's not the case so we won't worry about that.
I'm so glad that you were seen in person and that a visual diagnosis was made of a fungal infection. 
There is a condition called candida balanitis.  You can look up pictures.  It causes red bumps on the head of the penis - quite common actually.  So the skin symptoms that you describe are consistent with a fungal infection (candida balanaitis is a fungal infection) but the stinging with urination is not likely due to this skin condition though  I guess is possible.  Do you notice any discharge from the end of the penis?  If you continuing to have pain with urination, you should be worked up for any urethral infection you might have.  I do think herpes is really unlikely here, given that the physician didn't think it was herpes and you don't describe any water blisters.  If this continues please don't rely upon an internet resource such as this - you need to be seen in person for that as well - probably a different problem but that's a guess.

Terri
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43 months ago

Hi Terri,

I was concerned about stinging and went back to clinic. Doctor thinks I got anti-fungal cream in opening of penis. Doctor said bumps are almost certainly fungal infection or general skin irritation as opposed to herpes (late onset, lack of change in bumps, no water blisters, lack of painful ulcers). Doctor checked my urine for infection (negative), gave me a stronger oral anti-fungal and told me to be more careful applying cream too close to opening.

The stinging has mostly gone away. I feel a whole lot better all around (glad I went back for second visit) and anticipate getting back to normal shortly. I'll drop you a note here when I do. At some point I may get a final STD test although it probably isn't necessary.

There is so much generalized STD information on internet that tends to lead people to think the worst with any ailment. Reading the questions and answers on this forum gives some real world perspective as to STD transmission. Keep up the good work.



Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
43 months ago
I'm so glad that's all it was, whew!  I'm very happy that you went back again to check out the burning instead of just worrying.  Good job and thanks for the kind words

Terri
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