[Question #3424] Follow up question #3340

38 months ago
Dear Dr Handsfield/Hook,

I wanted to follow up with persisting symptoms after a very low risk encounter where a masseuse wearing lingerie sat on my bare buttocks for 5-10mins. 

I am aware of my anxiety regarding this, of genitally focused anxiety and have been seeing a therapist to help with this but continue to have symptoms as outlined below:

- 24hrs slight burning thighs (I know too soon for any STD)
- 5 days. 3mm slightly raised red area b/w buttocks, hurt slightly if pressed. Possibly hair growing of it but hard to see
- 7-14 days intense burning in inner thighs, anus and right buttock near red area. Never blistered or leaked fluid when pushed hard.
-14 days intense burning in penis and entire groin area. Felt like whole groin was on fire.
-2 weeks - 5 weeks. Continued burning in penis head, mainly right side sometimes reaching 7/10 pain, resistant to painkillers and waking me up at night.
- 5 weeks noticed very small red dot less than 1mm under foreskin in area of burning. Not raised or blistered, not painful to touch just the whole area burns intensely, particularly when sitting down for longer periods.

I am aware these are not typical sores, and that the exposure was low risk. But I wonder if:
1) anxiety induced pain can be this severe or cause me to wake up at night? 

2) does herpes cause this almost persistent burning in penis head for 3 weeks and then present as a small red dot? The pain usually is absent in early morning and then increases throughout the day.

3) how early post-exposure can pain begin in other areas of the groin not in original contact? Only my buttocks made contact with her, yet my thighs and penis were feeling symptoms within 1-2 weeks which seems too early for a recurrent outbreak

4) the only thing that stops the burning pain is applying pressure to the area or holding something cold there. Would herpes outbreak areas usually be more tender to touch? This feels more like neuropathy.

Many thanks for your guidance as I work through this issue.

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
38 months ago
Welcome back, but sorry you found it necessary. Sorry to hear that you're in such discomfort, but I'm afraid the additional information does not change my opinions or advice.

1) I am not a mental health expert, but I know tfrom both professional knowledge and personal experience that anxiety can remain active when sleeping, so my answer is yes. Anxiety-induced pain can be severe and can wake persons from sleep. I suspect your therapist will confirm this.

2) In your other thrread I said herpes does not cause symptoms like yours. Period. Same for other STDs.

3,4) These questions are beyond the topics suitable for this forum; we are not experts in either mental health or pain related medicine. If you have not consulted with a physician about your pain, I suggest you do so. I'm inclined to doubt any cause other than psychological, but a careful medical history and physical examination always is a good idea, if only for reassurance that there is no potentially serious medical explanation.

If somehow your pain were due to herpes acquired during the massage event on your mind, a blood test for HSV2 would now be positive. When asymptomatic, it can take 4 months for HSV antibody to be detectable. However, testing generally is positive within 1-2 weeks after onset of symptoms due to HSV2. Therefore, a negative test now would be additional evidence your symptoms are not herpetic, so you might want to consider it. This doesn't mean I believe herpes is a possible cause, only that a negative result might help convince you about it. A final decision about such testing would best be made in collaboration with a physician you consult, as suggested above.