[Question #2057] Herpes

45 months ago
I recently had an unprotected interaction with an exotic dancer.  Starting two days later, I have had an intense pain in my right leg, mostly in the inner thigh.  I have had it everyday since.  It spreads down my right leg and sometimes is in the pelvic region.  I am now starting to have some pain in my left leg in the inner thigh and but more so near the left hip bone.  At times, I feel it where the belt touches the pelvic bone. I also had burning in my urethra, which went away with antibiotics.  

I have had multiple blood tests including 2 HIV viral load tests.  Everything is negative.  At the three week point, I had a herpes blood test, which was also negative.  I believe the physician said it was a 91 and that he felt confident these symptoms were not from herpes or any STD.  I have not had any sores or lesions and I have never has herpes before.  Could this possibly be herpes?  Have you ever heard of similar symptoms?  I am thinking about seeing a neurologist.  Is there anything particularly I should say to him?


Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
45 months ago
I am assuming that you have not had any genital lesions at all.  I would expect some kind of lesions if you had brand new infection.  How long ago was this encounter?  You say you've had the leg pain every day since the encounter - how long a period is that?

Good that you got a herpes baseline test at 3 weeks - there is a 50% chance it will stay that way if you test again in the future.

I seriously doubt that this has anything at all to do with genital herpes but I can see how you might wonder, given the timing.

Terri
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45 months ago
Terri:

Thank you so much for your quick response.  I cannot begin to tell you what a relief it is to have access to this service.  The event happened 22 days ago, and I have had leg pain for about the last 19 days.  I have been taking antibiotics since day 3, could they have altered the results of my  IgG test?  The pain started on day three and was mild in my right thigh.  It has spread up and down my right leg, often in the pelvis area and inner thigh but now sometimes in the feet and calves.  It just started in my left leg about a week ago and is more or less in the pelvis area there.  In the morning I barely feel it, but it gets far worse as the day progresses, but 7 pm it is really bad.  

I did not at first think herpes either because I have had no sores or lesion at all (and still don't).  However, I read on several websites that inner tight and leg pain is a symptom of herpes.  One message board I read said people could get herpes and be in a prodrome state with intense legs pain for months?  I assumed that meant they could have intense leg pain for months without a breakout.  Is that accurate?

Could you explain how leg pain with herpes normally works?

Other than getting retested at 4 and 6 weeks is there anything else you could recommend?   Could you think of any other STD which would cause this?

I am so so thankful for your advice.  
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
45 months ago
I know the messages boards have many posts related to nerve pain in the leg.  It is important to remember that not everything that happens in the bodies of people with herpes IS herpes related.  Normally, prodrome lasts a few days prior to an outbreak and may well be present during an outbreak.  But for it to last for weeks, with absolutely no lesions, would be extremely unusual.  Herpes becomes active on the sacral nerve, which supplies nerve sensations to the lower part of the body, down the leg and into the foot.  I can't tell you that these people aren't having pain for months related to herpes but I can tell you that it is very unlikely - and even more unlikely to have this and have it be herpes and have absolutely no lesions.  I can't honestly think of another STI that would cause it but I assume since you are taking antibiotics it is related to this experience?  What did you take and for how long?  Antibiotics have no influence on herpes testing - antibiotics are for bacteria and herpes is a virus.

Terri
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45 months ago

Terri:

Since my first two questions, I have seen a neurologist, who believes that I may have Herpetic Radiculopathy.  The question now is just whether this is being triggered by HSV-2 or Herpes Zoster.  I am entering the 5th week, still without an outbreak though the pain in my legs (associated with the Radiculopathy) is still strong.  As this is my last communication and I am still looking for information, I have a few specific follow-ups.  If you are unfamiliar with Herpetic Radiculopathy and one of your colleagues is, could they answer the final question.  Most of the questions are general:

a.    How effective (%) is the IGG test at 6 weeks?  You indicated it is 50% at 3 weeks?

b.    If the IGG is still negative at 6 weeks, should I get a Western Blot?

c.     I have spent some time trying to research the Western Blot, but I am still having a hard time figuring out the process.  Is there a number I could call or a good website?

d.    If I were to start to take antivirals, would they impact the results of the IGG for future weeks?

e.    I know that antibiotics do not impact viruses, but could antibiotics kill antibodies picked up in the IGG?  Could antibiotics lead to a false negative for the IGG?

f.      What is the likelihood of not having a breakout within 4 weeks after exposure?

g.    How effective is condom usage at permitting a transmission of HSV-2?

        Most importantly, do you have any thoughts as to whether this sounds like HSV-2 or Zoster?

 

I am really trying to do everything I can to determine if these symptoms are from Zoster or HSV-2, and I also want to make sure I do not infect my soul mate.

 

Thank you

Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
45 months ago
At 6 weeks, the IgG test will pick up 70% of infections with HSV 2.
If the IgG is negative at 6 weeks, I think you should interpret that as a good sign and get a final test at 12 weeks.
For the western blot, you would call 206-520-4600 and ask them to send you a herpes western blot kit.  Then you take the kit to a clinician or lab and have your blood drawn, spun and shipped back to the University of Washington.  You will need a clinician to order the test itself - you cannot order that yourself (though you can order the kit yourself).  If you are unable to find a clinician to order the test, I can help you with that.  You would need to arrange a video conference with me at my westoverheights.com website so you could become my patient.  Then I would send you a lab requisition all filled out with our information and you could include that lab req with your sample and payment for the test when you ship the blood back to UW.  Does that help?
Yes, if you start antiviral medicine it can most definitely impact your IgG test in the future if you take it now - it can make the test look falsely negative.  This is a precaution now even written on the western blot results - if you take antivirals, this test may not be accurate.
No antibiotics have no impact whatsoever on herpes antibody testing.
It's difficulty to say how likely it is that you would be infected and not see lesions.  If you are truly negative for HSV 1, it would be less likely.  But the IgG test misses 30% of HSV 1 infections so I'm not sure how much you can count on your negative HSV 1 status at this point.  We know that many people have herpes without symptoms or at least don't recognize them so I don't have  perfect answer for that question.
Condoms worn by males who have herpes having sex with someone who doesn't have herpes offers about 95% protection against infecting their partner
when worn with every sexual encounter
I'm curious about how your doctor arrived at herpetic radiculopathy.  Was imaging done of your spine to determine that you had no spinal column abnormalities - no disc compression or spinal stenosis that could be causing you pain?  I think with a negative IgG test, a single unprotected sexual encounter with someone whose herpes status is unknown, and no lesions, that's quite the jump.  You've had no zoster symptoms either so I'm just not sure what drove the diagnosis there 
And yes, after 33 years of specializing in herpes, I am familiar with the concept of herpetic radiculopathy.

Terri
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