[Question #2984] Dermatomyositis and possible STI

41 months ago
Hello Doctor,
Approx 4.5 months ago I received oral sex and had vaginal sex with a sex worker (I've had sex with approx 10 different sex worker).
3 days later I experienced intense itching around my anus and balls. I also had a disctinctive red rash on my hand. I visited the gp. She couldn't see any visible symptoms around my anus or balls. She tested me for any std, except herpes. The results came back negative. The red rash appeared to be dermatomyositis. She did not make a big deal about it. untreatable according to her. 1 week later, my itching was the same. The gp again saw no symptoms of and std. I also experienced several headaches and fluish symptoms. Itching increased during night, sometimes my ears and nose would itch intensly. Itching was mostly isolated to one region at a time.
4 weeks after day 1, itching gone but mild pain in hand, upper arm, shoulder and slight trouble breathing. Made appointment with derm and reumatologist. At this point red rash on hand dissapeared with 85%. No visible symp. Blood value reaumatologist negative for dermatomyo. 6 weeks after day 1, itching returned preceded I believe by stingy feeling at anus. Pains symptoms cleared up at this point. Itching much less intense, headaches fewer, saw some redness under penis head for 1 day. As itching dissapeared, pain came back. Last Month itching was at approx 15% of baseline, itching and pain seem to be connected.  I don't feel the itch when i sit down and it only lasts for several hours. Got every test done for Herpes 1 week ago, all negative. Tried valtred 5x800Mg6days during itching+ 6x400mg without effect( no more valtrex). I feel as if resolving the itching could resolve or lessen my dermatomyosits. I long thought that herpes could be the culprit but at this point i don't know anymore.
Please help.
Edward W. Hook M.D.
Edward W. Hook M.D.
41 months ago
Welcome to our Forum.  While Terri typically answers our questions related to herpes I will be answering this question since while I am not a rheumatologist, I am more familiar with dermatomyositis than she is.  Let me first however address your concerns that your symptoms may be due to a herpes infection acquired through sex from a commercial sex worker.  This is almost certainly not a herpes infection. The rash you describe in no way sounds like a herpes infection (or any other STI for that reason). Herpes would not be expected to persist as long as your rash has, and the lack of response to valacyclovir also indicates that this is not a herpes infection.  Further there are no other STIs which would cause the sorts of symptoms that you have had for as long as you have had them (now several months).

I am confused by your diagnosis of dermatomyositis.  Are you sure this is what you have?  Have biopsies or blood tests been performed?  What you describe sounds far more like a non-STI dermatologic process than anything else. At this point I would not worry further about herpes or other STIs and work with your dermatologist to determine what is causing your symptoms. EWH
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41 months ago
Thank you for your reply doctor.
Concerning the dermatomyositis:
My Gp called the red rash on my hand the sign of gottron. She could also see several calcium deposits on my thumb.
My blood has been tested 3 times for creatine kinase and several other enzymes. Each blood result came back negative. There was also a 3 - 4 day delay between my symptoms and the blood test. I've read that alot of people with dermatomyositis don't have a positive blood test, hence the need for a  biopsy. The dermatologist wasn't convinced that a biopsy would make a difference. At the point I visited her, the rash on my hand had diminished to about 15%. Till this day the rash is still at 15% but does fluctuate alot in redness and somewhat thickness. Lets say it goes from 5% in the morning to 25% whenever i feel pain.

A bit of history: my grandmother suffered from some form of myositis I believe. She had extreme muscle pain and strength loss. At the end, she could not get out of her bed, nor lift her hands over her head. According to my parents she was treated with cortisone. She died at the age of 60 due to unknown causes. This took place about 20 years ago. From the age of 14 i've had inflamed nail beds and a chronic folliculitis that tested negative for anything. The explanation the dermatologist gave was that the follicultis could be due to an auto immune disease. A person from the reumatology society here in belgium told me that these systemic diseases often start at puberty.

Could you please awnser the following questions that linger in my mind.

1: In light of this new information. How likely do you think I have dermatomyositis. I understand that a diagnosis through the internet is everything but ideal.
2: I came across several studies concerning viral myositis. The herpes virus ( pretty much all of them) appear to be able to activate a myositis. Is it possible that a herpes infection could manifest itself in the way that my symptoms show up? Basically, a person who might have a compromised immune system might have a different set of symptoms than a person without a compromised immune sytem? Or does this change nothing about your opinion?
3: Any idea what the stingy sensation might be? Could this be a prodome?


Edward W. Hook M.D.
Edward W. Hook M.D.
41 months ago
Thank you for the additional information.  I do not want to get between you and your doctor and the purpose of this Forum is to provide information, not to practice medicine.  Having said that, with negative blood tests and a persistent, extensive rash, my own desire would be to try to have a somewhat better understanding of the rash and any other health issues which might accompany them.  I realize that in brief communications on this forum this cannot be done.  I am not accustomed to having dermatomyositis be diagnosed without positive tests of some sort or being untreated.  You may wish to discuss this with your doctors or get a second opinion.  You are in a better position to make this judgement than I.  Regarding your specific questions:

1: In light of this new information. How likely do you think I have dermatomyositis. I understand that a diagnosis through the internet is everything but ideal.
Please see my comment above. 

2: I came across several studies concerning viral myositis. The herpes virus ( pretty much all of them) appear to be able to activate a myositis. Is it possible that a herpes infection could manifest itself in the way that my symptoms show up? Basically, a person who might have a compromised immune system might have a different set of symptoms than a person without a compromised immune sytem? Or does this change nothing about your opinion?
My assessment is unchanged.  Some viruses can cause myositis and in immunocompromised persons the related illnesses can be quite severe but nothing you have described raises any concern for your signs and symptoms to be due to HSV. 

3: Any idea what the stingy sensation might be? Could this be a prodome?
Stinging and itch are quite non-specific and could be caused by many different processes.  Having said that, again, nothing you describe suggests a herpes infection.

I hope my further answers are helpful.  I am confident that the problems you have described above are not manifestations of an STI.  EWH
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41 months ago
Thank you for your opinion doctor.
I have an appointment with a specialist in systemic diseases 10 days from now. He should be able to accurately  define my symptoms.
I also plan to visit the sex worker that presumably gave me something. I noticed she had a small white sticker on her buttocks the week before she had sex with me.

Kind regards
Edward W. Hook M.D.
Edward W. Hook M.D.
41 months ago
I think that is the right course of action. 

This will complete this thread which will be closed later today.  I wishyou the best.  EWH
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