[Question #3418] Unusual HSV2 symptoms or something else?

38 months ago
Hello Doctor. I'm hoping that you can help me and that you find the following case interesting. I recently found out that an ex-girlfriend was HSV2 positive and as such was at risk of infection since we often had unprotected sex during a five month period - even though she was (apparently) taking antivirals daily. About two weeks after last contact with her I noticed a mild discomfort/pressure in the lower abdomen/bladder which lasted about two weeks but nothing else - no rash, no tingling, no lesions etc. I went to get a STD check up and had all tests come back negative (including herpes urine test). Then about six weeks later the same symptom recurred. This time after about a week I noticed a tingling/itching in the groin (both sides) and finally a few days later a rash on the skin surrounding my anus which lasted a couple of days but no lesions. This time start to finish was about three weeks. Finally, about one week after this initial recurrence ended I am developing the abdomen/bladder symptoms again. I am confused about whether this is herpes or not. I am waiting to get to the 12 week point before getting an IgG test which should hopefully settle the matter. On the one hand it could be herpes due to the recurrent nature of my symptoms and risk profile and some similarities to the typical symptoms (itching, rash). I also don't know what else it could possible be. But on the other these are not really typical symptoms - they are relatively mild but last longer than typical outbreaks (i.e. 2 weeks+) and the recurrences are seemingly becoming more often not less! I am wondering what you think about this case and what I should do in either test result scenario. Even if the IgG test is positive it seems like it could be that this condition is something else entirely! 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
38 months ago
I seriously doubt that the bladder symptoms you are describing have anything to do with herpes.  Having said that, I also doubt that any herpes urine test would be useful for helping to rule our or include herpes in a diagnostic profile.  I would agree that even of your IgG test is positive that these symptoms likely have nothing at all to do with having (or not having) herpes.  Are you able to describe that rash that you experienced around the anus?

Terri
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38 months ago
Hi Terri. The rash was relatively mild and uniform, forming an equally proportioned triangle shape with the anus in the middle of the triangle. No blisters formed. No discomfort inside the anus of any kind. I have a photo if that helps?! I also noticed a mild redness in the groin area (both sides) along the connection of the thigh and pelvic joint. I should also mention that I experienced mild digestive issues during the second episode and less solid feces. 

I understand that herpes is normally localised and appears in one area or side of the body (?) My symptoms don't seem to comply with that. The bladder discomfort is also not a typical feature as I understand it and if it did happen I would be in much more pain than I am?
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
38 months ago
We don't look at pictures here sorry.  The rash sounds nothing at all like herpes but perhaps something like a mild fungal infection or jock itch. Herpes would not cause the bladder discomfort, I'm quite sure.  I'm not sure that I understand your question about being in more pain?  You mean if you had herpes would you have more pain?  I don't understand the question, sorry

Terri
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38 months ago
Hi Terri

I've read online that HSV can cause bladder pain via blisters in the urethra, but that this is rare and would cause more pain than I am experiencing. Having said that, I found that the information online about HSV and bladder issues was not particularly clear.

It sounds to me that what you are saying is that neither the bladder symptom or the rash symptom have anything to do with herpes. I just find it strange that both these things happen immediately after a period of risk from HSV infection and at the same time. It would basically mean that I have/had two separate non-HSV related conditions (one causing bladder issue and one causing rash) at the same time immediately after being at HSV2 risk for several months! Even if the risk is the low due to her taking antivirals it still seems like a strange coincidence!

1. Is there anything that could connect the two symptoms?

2. Is it true that with HSV 2 if you get a rash or blemish then it is localised and almost always develops into blisters? If so then it sounds like my rash is not connected to HSV. 

3. Given that the rash is now gone I presume I don't need to see a doctor about that specifically, unless it comes back?

4. Have you ever had a case of HSV2 that caused bladder discomfort? Is there any possible link?

5. My plan is to get the IgG test to see what that says and if it is negative and the symptoms return to go and see a doctor for further diagnosis. Does this sound like a logical way forward?

Many thanks!
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
38 months ago
Lesions in the urethra would cause urethral pain, not bladder pain, in my opinion.  Not everything we read on the internet is necessarily correct.
Having said that, you may have herpes from your contact with and HSV 2 positive person and the bladder symptoms might not be related. 
Yes, a herpes outbreak consists of blisters that break open and form ulcers and then crust over.  There is really no such thing as a herpes rash at least the way I think of a rash.  To me a rash is more like what you described that you are having - sort of consistent or spotty but not blisters.  I don't think you need to do anything about the rash at this point but if it comes back, yes,do have it evaluated by someone - a dermatologist is the best bet. 
I have not see herpes cause bladder pain, no. 
And yes, getting an IgG sounds like a plan given an infected partner and certainly you should see someone if you get any blisters at all.  You are on the right track!

Terri

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