[Question #2909] HSV Scare

41 months ago

I'm a 27-year-old gay male, currently in a monogamous relationship for 10 months. I was diagnosed with prostatitis in January of 2016. I also was diagnosed with HPV genital warts in April of 2017, having a very small recurrence in September.

I recently discovered a small red bump with a white mark on my penis. Partly out of panic, I ended up popping it on the spot. A tiny amount of pus came out, and by the time I looked at it again at home about an hour later, it was difficult to find and left only a small red mark that required magnifying and light to see well.

By the next day, it had turned into something more like a flat red mark, and if you zoomed in with a phone camera, it looked slightly like a crater. I had moderate pain in the penile region, very intermittently, after popping the bump but not before. After 2.5-3 days, the mark was largely gone and almost completely healed.

Around the last day of it being truly visible by the naked eye, I started developing very minor, intermittent nerve pain in my legs, predominately in the left one. Occasionally my arm and neck. Not painful to the touch, but the nerve pain is still occurring post-healing.

My dermatologist looked at it very closely for several minutes, and upon seeing debris and a small hair in the mark, determined it was nothing to worry about. Seeing my general doctor agreed, she agreed with the diagnosis. The bump is gone and penile pain with it, but the nerve pain worries me.

What should I make of it all?

Terri Warren, RN, Nurse Practitioner

41 months ago

sometimes a pimple is just a pimple and this sounds like that to me. But the best news is that the people who saw this in person were not concerned and did not think it was herpes. There is just nothing quite as good as an exam in person. I wonder if you had not had the bump if the nerve pain would have really been a concern for you? Genital infection would not have caused neck and arm pain either.

Terri
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41 months ago

Thank you, Terri. That is reassuring. I think I got it in my head convinced that I had herpes, and I was prepared for the dermatologist to agree. She inspected it for over two minutes, poking and prodding, and said it was like a pimple or infected hair. I only then asked if it could be herpes, and she said she was quite sure that I had a clean bill of health.

My only other concern, related to the nerve pain, is if I could have genital herpes in the anal region and was misdiagnosed with prostatitis in 2016. When I had my first bout of it, I had intense pain in the anal region and in the scrotum, though not the penis. Erections were painful for a while, and I was unable to urinate, causing intense pain. At first I was diagnosed with hemorrhoids in the emergency room, but subsequent urologists diagnosed me with prostatitis. I have had persistent lower back pain ever since, and I have suffered chronic constipation ever since the initial episode. Due to that that the "straining" involved, I often get an irritated anal area and sometimes, what has been diagnosed to me, anal fissures and hemorrhoids. No never pain involved.

Do you think there is any credence to there being a misdiagnosis and that could have been my initial herpes attack? I had no symptoms other than pain -- no fatigue, fever, etc.

As a gay male, when I was diagnosed, I had only received anal sex a total of 5 times, and all 5 times were protected.

Does that sound at all like it could be misdiagnosed herpes?

Terri Warren, RN, Nurse Practitioner

41 months ago

No, this does not sound herpetic to me. If all of your anal sex encounters were fully protected, they don't sound like a possibility for infection. How about if you have been the top partner, have you always used condoms for those encounters?

Terri
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41 months ago

I have had unprotected sex with my now boyfriend I believe 3 total times this year (all as "top"). Beyond that, not that I can recall.

I will go ahead and assume it is what the dermatologist said and just keep an eye out if anything changes in the future. Since this is my final follow-up I can ask, I am also curious if you could answer a few questions, just in case my status does ever change:

1. If I had anal herpes, how often would my penis be asymptomatically shedding as well (assuming HSV2)? Would it be less than the anal region? The same?

2. Are there any accurate statistics that you know of about same sex partner transference rates? I have found a lot for male to female and female to male rates but none about male to male or female to female.

3. I know some people say nerve pain, particularly down one side like mine is (95% is in my left leg) is often a prodrome sign, but how often is a symptom like that something that starts either during or after the sores and continues past them healing? Perhaps I have a very minor case of sciatica. I have a family history of it.

4. How likely is having been the "top" partner for herpes to show up predominately in the anal region instead? Is it possible to have herpes sores on the anus and penis at the same time?

I don't think I will get to respond to any of your questions without paying again, but I do want to thank you for taking the time to help me. I'm very glad I found this site and resource when I needed it.

Terri Warren, RN, Nurse Practitioner

41 months ago

A study done at UW found that people who have anal outbreaks also shed from the penis about 1/4 of the days from the penis as well
I'm sorry but we don't have same sex couple transmission rates.
If the symptoms of nerve pain are pretty constant, that suggests that it is not herpes related.
It is possible to be have sores on the anus and penis at the same time, yes, just as we see have genital and oral outbreaks at the same time. Some little change in the immune response can trigger the virus to come out and be active. Have you had an antibody test to see if you are infected or not? If not, you might want to think about doing that.

Terri
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