[Question #3605] HIV and HSV Scare Dr Hunter Handsfield Please help. 10 weeks post exposure.

36 months ago
Dr. HHH. I had protected vj & oral sex from csw 10 weeks ago.  She was on my top for 1 min and I did it from back for another minute. I checked the condom was tight and intact. I developed itching in between thighs and scrotum badly in 4 days. I had overitched my skin between thighs that caused my skin to erupt. Site healed in two days but anal itching started. Went to n he Doc did urine and said he found some wbcs and no herpes. Went to 3 dermatologists and 1 prescribed cortisone shot and stroid cream to prevent itching, I was badly itching back then. This itching lasted 4 weeks and reduced but did not go away. Perineum, anus, scrotum, thighs have been itching constantly even now. 4 & 7 week hsv 1&2 IgG testing negative, hiv 4th gen anti body neg. I lost 6 lbs of weight.

Scared of herpes and hiv. No sores till date but very sensitive anus and scrotum. I read many of yours and Terri’s posts which says itching and tingling without sores can’t be herpes.pls read below I am scared to death as I am married and can’t pass that to my wife. https://patient.info/forums/discuss/symptoms-without-an-outbreak-540056. The lady explains that she has no sores and only itching and tingling and found she has herpes after testing. I found few more cases like this on forums. 

1. Can I be same as those atypical cases? 

2. If I had briefly why would my anus itch and perenum itch when my thighs and genitals came in contact? Isn’t it herpes site specific?

3. I felt feverish and cold during my 4th week following exposure but no fever. Are my tests not reliable For herpes?

4. Should I repeat hIV & HSv at 10 wks?

5. Can this be hsv1 genital which does not show sympt? 

6. I m have developed constant tingling itching on nose inside nose and on mouth. Could I have autoinnoculated myself. I had few canker sores inside my mouth few weeks back back to back. 

7. PCP said it is fungal and have fungal cream which I am using for 2 weeks but it does not seem to reduce the itch & crawling. Can it be O&G HSV1/2?


H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
36 months ago
I'm sorry you remain so obsessed with this problem and are having trouble understanding (or believing?) what you were told in your two other threads with Terri Warren. My replies will be succinct.

1) There is nothing in your symptoms that suggests genital herpes and your test results confirm you do not have it. The tests also prove you do not have HIV. It is true that some people with atypical symptoms turn out to be herpes. However, in the link you provided, that lady's symptoms probably were NOT due to herpes. She had asymptomatic HSV2, as shown by her blood test result, plus some other cause of her itching and tingling.

2) There are many causes of gential or anal itching other than herpes. And herpes does NOT cause itching as the main or only symptom.

3) These symptoms do not suggest herpes (or HIV); but in any case, they make no difference in reliability of your test results.

4) The HIV antigen-antibody test ("combo" or "4th generation" test) is conclusive any time 6 weeks or more after exposure. Feel free to be tested at that time if you remain fearful of HIV. But there is no reason to test again at 10 weeks. The HSV blood tests require 16 weeks for maximally reliable results. Your symptoms and exposure do not suggest herpes, and you can be sure you don't have it. But feel free to be tested again if you feel the need. If so, wait until 16 weeks.

5) There is nothing in your story that suggests either HISV1 or HSV2.

6) You cannot autoinoculate yourself if you don't have HSV to begin with.

7) No, your symptoms cannot be either oral or genital herpes.

Your symptoms are strongly suggestive of anxiety, nothing more. If they continue, speak with your doctor about professional counseling. I suggest it from compassion, not criticism.

HHH, MD

---
36 months ago

Thank you for the detailed responses.


I wonder why would it continue to itch every now and then in perineum anus and scrotum when I don’t have herpes? The doctor has put me on antifungal cream for more than two weeks and it still does not go away. I feel needle pricking like sensation in rectal, scrotum between thighs and on pelvic area. The scrotum once I itch at the base, the itch sensation intensifes 2-3 times. The perineum turns red in color if I don’t apply any cream for few days as I start itching that area. For it to be fungal I have been using antifungal cream (athletes foot) for more than two weeks so it should technically go away completely. I don’t see any flaking of skin or any raises areas like a real fungal infection or ring worms sort of thing for it to be called fungal infection.


  1. Any idea as to what this could be if this is not herpes? 
  2. Can HSV1 be transmitted genital to genital? As it is hard to find on blood tests sometimes. 
  3. I see itching mainly in the areas folded such as base of scrotum and shaft, thighs, perineum, rectum and below but crack but ZERO on penis(is it because it is protected during sex)? What could cause the itch to flare up every few times in the day and night ? 
  4. If I am swabbed and found out not to have fungus and bacterial what else this issue could be? Are we missing any other infection that can be transferred?
  5. HIV I have taken was at 4th week, do you recommend one more what are the odds the result will change from negative? I am trying to eat a lot but still not gaining weight. Feel worried about it. 
  6. The crawling feeling in my nostril has increased five times and the tip of nose is very painful. I am assuring myself that it not herpes. What else could cause it? Without anything showing up physically and constant tingling on nose and face? Neuralgia?
  7. Do you think it is a good idea to swab test these areas which are itchy for fungus or bacterial or anything else?
  8. Can you explain what are “atypical” genital herpes symptoms? Have you seen any such cases in your career and can you explain how they look or sound like? 
  9. Can I resume sexual activity with my wife or do you recommend testing western blot HSV and hiv antibody before I do anything? How do I ask for it? Should I see an infectious specialist?

My PP and Dermatologists don't understand what is causing this itching and tingling and irritation that is coming back on my perineum have you seen any similar cases before and would you recommend any differential diagnosis? 

Extremely sorry for asking too many questions.

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
36 months ago
1,3,4) The main causes of genital itching are fungal infection, other kinds of dermatitis, allergy, irritation from moisture (sweating), inadequate hygiene, and many others. All these are more common than herpes, which never causes itching as the only symptom. You probalby have read lists of herpes symptoms that mention itching. However, most such lists don't make it clear:  Herpes lesions may itch, but itching without sores/blisters is never herpes. Beyond that, I won't speculate:  we don't try to diagnose or provide detailed advice for non-STD genital symptoms.

2) Genital to genital transmission of HSV1 can occur, but is rare. In my 40+ years in the STD business, I've never seen a case. Virtually all genital HSV1 is acquired from oral sex.

5) Based on your exposure, there is no chance another HIV test will be positive. But feel free to be tested if you wish. HIV doesn't cause weight loss as the main or only symptom.

6) Same answer as for genital itching. Many possibilities other than HSV, HIV, or other STDs.

7) If examination by a health care provider shows normal appearing skin or tissues, swabbing for a bacterial infection won't help and shouldn't be done.

8) Usually the symptoms of "atypical" herpes are actually typical but unrecognized. For example, a small sore that isn't really noticed.

9) Since there is no evidence you have herpes, HIV, or any other STD, you can and should resume normal sexual relations with your wife.

10) I can't help that your doctors can't find a cause. If they can't figure it out by direct exam, you should not expect an expert on a distant online forum to be any more able to do so. I'll just add that in the large majority of persons with these sorts of symptoms the cause is anxiety magnifying trivial symptoms or normal body sensations that would otherwise not be noticed. You should discuss this likelihood with your doctor(s). If they agree, then perhaps consider professional counseling.
---
36 months ago

Hello Doctor,

I have seen a bump or two popping up on my pelvic area, one right next to the left thigh -above scrotum. Can you please take a look and advise what this is? Does this look like a Herpes blister?

I have posted this in a form as I did not know whom to ask. The bump does not pain by itself but it hurts slightly when I touch it. I feel my left neck is stiff. Is this something I should be worried about?

What are the herpes blister symptoms in general?

This bump does not itch but hurts very slightly if I press or touch it.

https://honeycomb.click/topic/75201-is-this-bump-herpes/

If this is Folliculitis do you know why do we get folliculitis? I am over anxious and checking this every now and then to see if it is growing in size.

I had one similar one on my forehead but does not pain. It feels hard though. Should I get it checked?

How reliable is my 7 week antibody test for herpes?

Have you seen blisters showing up 10 weeks after exposure in your service? Please advise. Sorry for bothering you and Thank you for response.

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
36 months ago
Most of these are the same questions as before, just using different words. 

We don't examine photos of skin lesions; it comes to close to practicing medicine from a distance. You've already been given strong reasons why this problem almost certainly isn't herpes. You can google herpes for innumerable photos of what it normally looks like. Folliculitis affects all humans, some more than others, sometimes more common, sometimes less -- but I'll bet that at any time 90% of adults have one or more folliculitis lesions somewhere on the body. The exact reasons aren't known, and usually it isn't necessary to see a doctor or get treated, unless especially widespread or severe.

Around 80-90% of newly infected people would have positive HSV blood tests by 7 weeks.

No, initial herpes never shows up 10 weeks after exposure.

That completes the two follow-up comments and replies included with each question and so concludes this discussion. Please note the forum does not permit repeated questions on the same topic or exposure. This being your third, it will have to be your last; future new questions about this exposure and your fears about HIV, herpes, or other STDs will receive no reply and the posting fee will not be refunded. This policy is based on compassion, not criticism, and is designed to reduce temptations to keep paying for questions with obvious answers. In addition, continued answers tend to prolong users' anxieties. Finally, such questions have little educational value for other users, one of the forum's main purposes. Thank you for your understanding.

---