[Question #2396] Worried this is HSV, not sure what medical help to seek

46 months ago
I asked a question a little earlier about a herpes diagnosis.  It was probably really terse -- I was trying to get my timeline in there in under 1500 words, and after re-reading it, I found that it was pretty hard to follow.Here's (hopefully) a better version:

About 9 weeks ago, I came down with symptoms that might be herpes (pain on my glans, sore throat).  

It lasted for about 2 weeks, and  I got about a 10 day break from the penis pain (still had the sore throat), and I never had blisters.  I say my doctor on day 4, he had me use hydrocortizone cream. 

After the 10 days, pain in the glans returned, and I went back to my doctor.  He diagnosed herpes and prescribed valtrex, but he told me he isn't convinced this is the problem because the symptoms don't seem quite right.

About a week after my doctor visit (hence a week on the valtrex) I did develop 2 blisters on my penis that healed completely in 3-4 days.  Other than those 2 blisters, there was no rash down there.  I also have a lot of pain on my tongue and gums, and once my lower lip began to swell up, but then went back down.

At 7 weeks, used an online service to order an STD lab test. (Herpes, HIV, Hepatitis, Syphilis, Chlamydia, Gonorrhea).  It came out negative for all.

Now I'm on on week 9 since symptoms, and I'm still in constant pain (aside from the 10 day "break").

Does this sound like herpes?  I know that 7 weeks is early for  herpes test, but should that offer me any hope that I don't have it?  
What impact does Valtrex have on the accuracy of the igc test?  

If Valtrex impacts the test, when should I be tested again, and how long should I stop taking the Valtrex?

If this doesn't sound like herpes, what other tests should I get?  Could this be thrush, a staph or strep infection?  

Something else?  

I'm still in a lot of pain, and I don't know what to do next to try to get better. Thank you so much for hosting these forums -- it's been really hard to find advice.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
45 months ago
Jeremy, I'm so sorry for the delay in answering your question - I normally receive a notification that there is a question waiting for me and I didn't receive one for htis post. 
Valtrex can impact the test, yes, but usually only if you take two weeks or more of the medicine.  How much did you actually take, do you recall?
Write me back and I will allow an extra post, if you wish, given the tardiness of my responses.
I think I answered your other questions with the other post.

Terri
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45 months ago
Hi Terri. I forgot to ask 1 question when I posted my 2nd response on my other post, so I'll ask it here:

You said that 2 weeks on Valtrex should not have much impact on the test, and to maybe wait 13 weeks. 

I actually was on Valtrex for a total of about 3 1/2 weeks (I had been on it for 2 weeks when I  had my Igc test, but it was another week and a half before my doc took me off)

Should I still be good to take another test at 13 weeks or should I wait longer?
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
45 months ago
If you were my patient, I would suggest that you wait an extra two weeks total, so 14 weeks should be OK.  We are not worried about Valtrex use when someone is concerned about a far past encounter, but if we are talking about a brand new possible exposure, the University of Washington is concerned, for example, about the medicine's impact on the western blot results so I believe that would also be true for the IgG test.  Just wait a bit longer to be tested for greatest clarity.

Terri
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45 months ago
Hi Terri:
I am on week 12 of my wait to week 14 to take my herpes test.  I have scheduled a video conference with you to set up a WB so that I can know for sure whether this is herpes.
In the meanwhile, since this may or may not be herpes, I've talked to some dr's in case this is something else.

A couple of questions for you:

1.  The burning in my mouth seems to be getting better.  I saw an ENT, and told him all of my concerns.  He said he saw no sign of infection and believes it is autoimmune, perhaps an allergic reaction to something.  I have noticed that when I eat it actually reduces the pain in my mouth, sometimes for hours (kind of like burning mouth syndrome).  I have read that the mouth sores caused by an initial HSV outbreak can make it too painful to eat.  Is relief from pain after eating something that you would expect if it were herpes?  Is this a mark against herpes, for herpes, or neutral?

2.  My dermatologist is treating me for balanitis for my genital pain (he also says he sees no sign of infection).  I have also shared all of my concerns with him -- no holding back.  A 2 week course of steroids (first a prescription, and then over the counter hydrocortizone) did not help my pain.  (I'm in week 7 of "outbreak" if this is in fact an initial outbreak) 

He has prescribed Tacrolimus ointment.  When I got home, before I used it I looked it up on the internet.  It is an immune suppressant.  I'm worried that if this is in fact herpes, that using this ointment could cause it to worsen.  Should I be concerned about using this before I have my test results?

3.  If my dermatologist's balanitus diagnosis is correct, could a herpes outbreak have triggered the balanitis?

Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
45 months ago
1.  Yes,I believe this is most certainly a mark against herpes.
2.  Normally, steroids do make herpes worse as your body needs the immune system to fight herpes.  You should not be concerned about using this before your test, no.
3.  No, herpes doesn't make balanitis worse at all.

Terri
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