[Question #442] Please help.

34 months ago
I suffer from hard bowel movements and have been working with a proctologist to cure my bleeding. Every time i go to the bathroom, there is blood on the tissue and my tears bleed. My proctologist stated that I had a fissure on tuesday of this week, but i went to my primary doctor today to see how things were healing. My primary doctor said it looked like i could have anal herpes. She did do a swab and typed it. I immediately freaked out. I have not been sexually active in two years and tested negative for hsv 2 after this. In october I was laying in bed naked with a man, but no intercourse took place of either oral or vaginal. i tested negative for hsv 2 at 3 and 6 weeks with levels below <.2 after this. I do have hsv 1, which i've had for years with values greater than 8.0 and rarely get oral outbreaks. My primary doctor stated that i could of passed my own oral infection to myself genitally, but i've seen Terri state that she's never seen a patient get genital herpes this way. I immediately went to urgent care to get a second opinion and the dr. said she agreed with my proctologist. She said it looked like a fissure and she saw nothing that suggested herpes. She said she's seen plenty of herpes outbreaks and this doesn't look like it. She said my rectum has straight line cuts, and herpes are more circular. The tear or fissure has been there for 11-12 days.

I am scared to death, please someone help me. Any advice would be extremely helpful. 
Any thoughts on what this is?
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
34 months ago
Hi Cassidy,
So when was your last sexual contact with anyone and how long ago was your last antibody test? 
This does indeed sounds like fissures to me not herpes and your negative HSV 2 antibody test at 6 weeks suggest that this is not HSV 2, though I like a 12 week IgG test and a 16 week out western blot..  And no, I don't think you have transferred virus from one place on your body to another.  The clinicians you are seeing are in a far better place than we are to sort out what is going on with you.

Terri
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34 months ago
Hi Terri.

My last sexual encounter was 2 years ago and my last test was in November of 2015. However, on Sept 30th I fooled around with a man. Now I do not mean sexual wise, but we were both naked in bed together. We didn't have vaginal or oral intercourse. For the longest time i was so concerned that his penis might of touched my genitals, which i was i got tested twice after him. The last test was at 6 weeks and was negative at a value below <.2. My last oral outbreak was three years and before I knew i had hsv 1 i accidentally picked at it and touched my vagina, but by this time my index value was well above 8.0, which is when i discovered the outbreaks were cold sores. I trust your advice when you say that I did not pass this to myself. I believe my first oral outbreak was when I was 12, i got a cluster of blisters under my nose and then it returned again 3 years ago. My proctologist and the urgent care doctor states that it is a fissure. They also said I have multiple ones from hard bowel movements, but saw nothing herpetic. When i saw my regular doctor today she said she saw a red irritated area with possible vesicles. When i went to the urgent care doctor, she said she saw no redness or vesicles other than on the fissure, but she said that's to be expected. My primary doctor is making no sense.. at first she said she saw redness and bumps, then when i had her look again she said she didn't see what she first thought she saw. I asked her about the tears and she said she saw none. She said it looked like i had dermatitis or a rash. Now, its obvious i'm a hypochondriac and i have not seen any red rash otherwise i would of been at the doctor a long time ago. i do have redness around my anus, but it's been this ways for years. thats never changed. But my proctologist and the urgent care doctor both saw multiple fissures and tears. I'm just so confused how i could have herpes. 

the tears bleed any time i look in the mirror or have a bowel movement and have been there for 12 days now. I'm just so lost. I'm going insane. What do i believe Terri?

I'm so fearful that i contracted hsv 1 oral and genitally at the same time, but it wouldn't make sense because i do get oral outbreaks but have never had a genital one. When i got my first cold sore, i was a virgin- never had oral or vaginal intercourse. Im just so concerned and confused :((
34 months ago
Sorry, let me clarify.. the urgent care doctor only saw redness on the fissure but NO vesicles. She said she saw nothing herpetic. 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
34 months ago
I do not believe that you should be concerned about having genital HSV 1.  And if your test in November was negative for HSV 2, then you can rely on that with 98% certainty, compared to western blot, the gold standard.  Fooling around naked in bed, even if his penis just touched you, is not a method of transmission.
I understand that you are worried about the fissure, but it sounds like just that - a fissure.  If your last sexual contact was 2 years ago (except for the naked in bed scenario), I think you can put your worries to rest.

Terri
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34 months ago
Thank you so much for your helpful words Terri.

Why do you believe I should not worry about having hsv 1 genitally?

But yes, my last antibody test for hsv 2 was in November, right before thanksgiving and it came back negative with an index value of <.2. This was a year & a half after my last sexual intercourse exposure and 6 weeks after the naked bed situation. 

When the doctor did my swab yesterday, I just started my period and thought I saw blood on the swab. Will this have any affect on my results? Because obviously I know i'm positive for hsv 1- have been for several years, and don't know if the blood will cause a positive result. 
34 months ago
sorry, if i could just add something real quick. My fissure is a tear and between the tear is blue/purple skin popping through. The urgent care doctor said this could be a vein coming through the tear. I don't know if this sounds typical of an anal fissure to you.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
34 months ago
I don't think you have genital HSV 1 because you have an established history of oral HSV 1 and the chances that you would get the same type you already have at a new location it very very tiny.

Terri
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