[Question #3896] What test should be performed for me? Frustrated and Confused

33 months ago
30 days ago - unprotected oral sex with escort. Ihad a slight nic on penis from clippers day before.  The next morning intense burning and stinging on foreskin/head of penis. continious for the last 30 days at different levels of intensity. I have no lesions/redness/no discharge/pain urinatating. Everything looks normal  1) Many of your replies indicate HSV cannot present this fast.  Some sites say it can present in hours.  Can you clarify?  2) I completed STD panel 5 days after- all neg.  My ID doc told me to apply anti-fungal cream - no help. He dismissed prostate issues. What else should I test? 3) This feels like nerve pain. it tingles at times, burns/stingsat time.  What is proability of HSV1?  If not HSV1, what else can cause burning.stinging the next morning? Someone in the world has seen this exact scenario.  Where do I find that person?  I need relief.  This is not anxiety.  I didn't think anything about my encounter until issues started.  PLEASE HELP! Thank you!
Edward W. Hook M.D.
Edward W. Hook M.D.
33 months ago
Welcome to the Forum. I'll try to help.  What you describe sounds like some sort of direct irritant or a superficial, not STI skin infection which may have originated from contamination of the nick you describe.  your testing has ruled out typical STIs and the scenario you describe in no way resembles herpes infection, either in terms of its onset, in terms of discomfort without visible abnormalities, and in terms of duration. 

As for your specific questions:
1) Many of your replies indicate HSV cannot present this fast.  Some sites say it can present in hours.  Can you clarify? 
I can't explain other sites.  When people acquire HSV, the virus must be present, then divide many times before it causes symptoms.  Initial HSV does not start to be symptomatic in hours or even a couple of days after exposure.  Rapid onset of symptoms of the sort you describe requireds DIRECT irriation whether than is friction, chemical irrigation or something else. 

2) I completed STD panel 5 days after- all neg.  My ID doc told me to apply anti-fungal cream - no help. He dismissed prostate issues. What else should I test?
I'm not sure more testing is in order.  I have two suggestions,  You might first see what application of 1% hydrocortisone cream 2-3 times daily to the effected area might do.  If that does not resolve the problem, I would se a dermatologist.

3) This feels like nerve pain. it tingles at times, burns/stingsat time.  What is proability of HSV1?
See my comment above.  This is not HSV-1

I hope these comments are helpful.  EWH
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33 months ago
1) Here the website - https://justherpes.com/facts/the-first-herpes-outbreak-symptoms/.  Misinformation is frustrating.  
2) Thank you for the explanation on onset - If I have HSV1 in my system already, is possible the symptoms would show up sooner? FYI - I read one of your other post where you said the HSV needed to be massaged into the skin.  The defintely happened as she stroked my penis and we had protected sex after the oral
3) I tried the oitment you suggested and well as  many others.  There is no exact place on my penis. Some days it stings, sometimes the head seems to tingles.  Some days is burns. If this was a chemcial irritant shouldn't it have resolved after 30 days?
4) New unrelated question - many people indicate that you can have HSV without lesions?  Is this correct?  My understanding is HSV impacts everyone different depending on one's immune system.  Please explain
5) Last unrelated question - I am borderline anemic. I tested for HSV many years ago.  Borderline Pos - followed by WB neg.  
I promise no more endless questions - this really seems somehow related my nerves.  Your service is greatly appreciated.  I will seek support from my ID doc.  I want to share your insights with him.  I need this constanst pain to stop- I am scared to death - 
33 months ago
Sorry to clarify my anemic question.  If someone anemic does it impact test results.
Edward W. Hook M.D.
Edward W. Hook M.D.
33 months ago
1.  This web site provides considerable mis-information.  The internet typically provides considerable information which is taken out of contect, out of date, or just plain wrong.
2.  Recurrent herpes could appear quickly but as I said above NONE of the symptoms you describe in ANY way suggest herpes. Nor would HSV symptoms persist as yours have.
3.  Yes, if it was a chemical irritant it would have dissipated by this time (or progressed enough to declare itself).   Having tried the hydrocortisone, I would now suggest a dermatologist.   I remain confident that this is not an STI.
4.  You seem convinced you have herpes.  I disagree that your symptoms are due to HSV.  Persons with HSV can asymptomatically shed the virus.  That however has nothing to do with the sorts of symptoms you describe. 
5.  Anemia should not in any way impact blood tests for STIs.

As I said above, you seem quite focused on HSV.  Nothing you describe suggests any HSV syndrome that I have seen in nearly 40 years of STI-focused practice, doing research and attending medical meetings.  I think you need to look for a non-STI explanation for your discomfort.  eWH

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33 months ago
I did not share with you my exact situation seven years ago I had an unprotected incident two days after I felt a subtle Stinging sensation on my genitals. It went away really quick. The sensation is similar.  30 days after this episode I started to see macerated skin in the  navel cleft. Six months after that nerve pain in the dorsal nerve, sacrum,  and ankle started.  My s1 nerve and  pudendal nerve were  inflamed.   I’m on a pretty significant cocktail of drugs to  manage nerve pain.  The consensus is some viral element caused this damage. I drew a few low positives for hsv and then a negative by Western blot. I have always believed that HSV is the root cause.  This new Issue stings my Genitals In more pronounced manner.  I know I sound like a lunatic. Is it possible this exposure reactivated something in my foreskin? What else could possibly cause such a strong reaction? I’m going to sort this out with my ID doc. I welcome your expert opinion of my case thank you take care.
Edward W. Hook M.D.
Edward W. Hook M.D.
33 months ago
Thanks for the additional information.  I think you and I are going to disagree regarding the role of HSV in yor problems you have had "gold standard" testing for HSV and it is negative and as I've already said, neither your signs and symptoms, nor the time course of your illness fit.  The additional history you provide however does suggest that this problem is neuropathic in origin.  I think a good neurologist might be more helpful to you than an ID consultation.

I'm sorry I don't have more to offer.  As you know, Forum guidelines limit us to no more than 3 replies to clients.  Consequently I will have no further replies as part of this thread and the thread will be closed later today.  Take care.  I wish you the best.  EWH
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