[Question #3313] Persistent Symptoms

39 months ago
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Hi Dr,

Would appreciate if you could read my first post on the herpes forum for  background on my symptoms and context.


Here once again because I tested negative at 12 wks and wish to explore the possibilities of any other infection that could explain my current symptoms. 


I'm having persistent throbbing pain & twitches in my thighs, calves, aches in my feet, soles and heels. The feet discomfort sometimes manifest as a fairly painful pins and needles sensation. To a lesser extent, I sometimes get this in my fingers as well.


Periodically, I get pain in both armpits similar to when I had swollen nodes(left armpit only) 3 days post exposure. I've subsequently had similar swelling in both armpit which disappears in about  two days. The pain however is more frequent.

I tried establishing a connection between the symptoms and the recurring lump on my left buttock in case they constitute a prodome but the link is tenuous at best. The lump has recurred 4 times over 2 months at the exact same spot. It has a head, but doesn't itch or turn into an open sore or contain any fluid I've seen.  It recedes dryly in about 5 days. I feel a small hard lump under the skin when I run my fingers over the spot which is now somewhat hyperpigmented. There's also pulsating pain there sometimes but a full blown outbreak never materialises.


Since a kid, I've had this funny leg feeling before any illness onset so I've always been acutely aware of my leg sensations. These new sensations are ones I've never felt before. I check my CBC every 2 months and it's always been normal.  5 days post exposure, when I had flu-like malaise my lymphocytes were at 19% and .8 absolute. Conversely, I've had persistent mild neutropenia from 40 days post exposure; low neutrophils at appx 35%, 1.4 absolute and 3.2 wbc with low normal being 4. This worried me. I've never had this going back 2 years in records.


For the first time, I saw genital warts on my scrotum 2 weeks post encounter. I might be wrong but this tells me my immune system had been compromised?


In light of the negative hsv2 test, what are some other possibilities if hsv has been ruled out or has it? Thanks.

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
39 months ago
Welcome back to the forum. However, I'm afraid we can't help as much as you might hope.

There are no STDs that cause symptoms like these. Even herpes does not. You misunderstand herpes prodrome:  it doesn't occur, or only rarely, in association with an initial herpes infection; it's an issue only for recurrent herpes; and even then, prodromal symptoms don't last more than a day or two, and are localized to the area where a recurrent oubreak occurs within a day or two. Even if your blood test had been positive for HSV2, I (and undoubtedly Terri) would contlude you have an asymptomatic HSV infection plus some other explanation for these symptoms. In any case, with the combination of symptoms not typical for herpes plus the blood test results, for sure that's not the explanation. 

As for "genital warts on my scrotum":  Was that diagnosis professionally confirmed, or your own observation? Are they persisting? Warts can occur on the scrotum, but the penis is a much more common location. If you do have warts, they are not from an exposure 2 weeks previously. Warts typically show up 3-6 months after acquring HPV, often up to a year -- and probably never sooner than ~6 weeks, even in people with severe immune compromise. And warts would never be the only symptoms of impaired immunity, and your many other symptoms also do not suggest immune deficiency of any kind.

My best guess is that your symptoms are primarily psychological, perhaps the result of anxiety over the sexual exposure you are concerned about. Anxiety and stress can greatly magnify minor symptoms or even normal body sensations that otherwise would be ignored or perhaps not even noticed. This also might fit with your long history of "funny leg feelings". This also fits with your apparent compulsion about health, which I assume from having CBCs every 2 months. What's that all about? There are few no health problems that would first appear as a blood count abnormality before symptoms you would feel.

So I advise against any more HSV tests and I do not recommend any testing for other STDs. If your symptoms continue and are bothersome, work with your doctor to learn the cause.

This may not be what you were hoping to hear, but I hope my comments are helpful. Let me know if anything isn't clear.

HHH, MD
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39 months ago
Thanks for the response Doc. I do understand that prodome symptoms are characteristic of recurrent episodes. From my initial post (herpes forum), I detailed skin issues I had which matched initial outbreak timelines, albeit atypical in presentation. I do have oral hsv1.

Yes, my warts were diagnosed and removed by a dermatologist via electrocautery. The warts were on the scrotal skin but quite near to the base of the penis. They've not occurred since removal 2 months ago. It was my uninformed understanding that most people are not symptomatic of hpv but pending it's clearance, an immune system 'lapse ' as a result of a future unrelated illness could be exploited by the virus and result in warts? At this moment I'm unconcerned about this as it hasn't recurred.


I admit I'm prone to health anxiety tendencies but I do believe that I override this with my logical thinking proclivity. My funny leg feeling, which happens in my knees is something I noticed precedes a bout of malaria as a kid (I live in a tropical country). It hasn't failed me since in predicting a flu or malaria bout :-)


I'm concerned because the pain i'm feeling is quite real. Sometimes quite sudden and intense to the point that unconsciously exclaim 'ouch' even in company. That coupled with the neutropenia gives me the unshakable feeling that I did catch something from the encounter. The lump that recurred also adds to this. 

My initial blood test which showed the low lymphocytes was prompted by malaise which drove me home from work because I couldn't cope. This was 5 days post encounter. I had the 'pubic pimple' 4 days after this and scrotal rash 3 days afterwards. 
Though I'm entertaining the thought of late hsv seroconversion, I'm not fixated on hsv at all, just hoping to get to the bottom of this, treat it and live my life.  . 


What are the possibilities of ebv or cmv being the culprit? I do know that most adults in the US have this but I'm unsure if this statistic applies to my country as well. Could my symptoms be consistent with a newly infected adult? 

Many thanks for your help once again.

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
39 months ago
Is it possible that sometimes previously asymptomatic HPV infections develop into warts in immunodeficient persons. But if so, it is rare and certainly appearance of warts is not in itself evidence of immune deficiency.

I did not say or mean to imply your pain is not real. I'm sure it is. But that says nothing about the cause. Everybody understands that tension headaches are real, even though they typically are triggered by stress etc (as the name implies). It's the same for numerous other kinds of pain.

Your other comments do not change my evaluation or advice. Neither HSV (with late seroconversion, which occurs rarely if ever), EBV, nor CMV are likely causes of these symptoms. In much of the world, the frequencies of EBV and CMV tend to be higher than in the US, but I'm sure there are exceptions.

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38 months ago
Much appreciated Doc. My final questions please; is there any type of swelling or bump that can be preceded by a buzzing/crawling sensation in the affected area or this is an hsv thing? And also, does hsv2 impact your blood count at all transiently at any stage and if it does what would this look like? Thanks in advance.
38 months ago
I missed one last question sorry. Can a genital hsv exposure cause armpit node swelling 2 to 3 days post exposure? 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
38 months ago
Neither HSV nor any other STD causes symptoms like this, and HSV2 is not a likely cause of an inflamed or enlarged lymph node in the armpit. None have any effect on routine blood counts.

You clearly have no STD problem. Do your best to believe it and move on!

That concludes this thread. Please note that repeated anxiety driven questions are closed without response, and without refund of the posting fee. Not only are most anxious persons not helped by hearing the same replies as before, but such questions have little educational value for other readers, one of the main purposes of the forum. Thanks for your understanding. Best wishes and stay safe!

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