[Question #489] Are these signs pointing to Herpes or an STD?

38 months ago

Dr. Hook or Dr. Hunter, (I already asked Terri on her site)

14 Days ago I had sex with a woman at an Asian massage parlor (w/Condom).Our encounter was brief maybe 5 minutes.  Started with missionary and then she briefly got on top.

 Day 2 I noticed my left knee was achy and eventually other joints/muscles began to ache too.

Day 3 I took a Gonorrhea and Chlamydia test which came back negative

Day 8 I decided to go get a herpes igG test to rule out that I didn’t have herpes from any previous exposures. That test came back negative.

Day 9 I noticed a single red dot on the right side of my scrotum looked like a pimple,not common for me although I was obsessively checking my genitals. I also could feel a mild sore throat developing I took some vitamins and it seemed to go away w/in 24 hours. 

Day 10 I went and got an igM test to see if I had a recent exposure. It came back negative. I knew the igM is prone to false positives but I took it anyways to rule out recent exposure

Day 11 that red spot improved a lot (I did use tee tree oil on it). It was pretty small and didn't appear fluid filled I went to the doctor and had him check it out he said its probably a small pimple.

Day 13 the little pimple looking thing is pretty much gone. The sore throat is back.

Day 14 This a burning tingling sensation in my inner thighs has developed on both sides and it extends up to my groin. Sore throat still persists.  This has been going on all day today.

 

-During this entire time I have had a lot of anxiety this is all I can think about

-I have barely been eating and have almost no appetite

Between the igM and igG test and my symptoms (burning/tingling/muscle aches/sore throat) how likely is this to be herpes?  I'm really worried because the sore achy muscles and I read that herpes can cause that (specifically on the left side) and now the burning feeling in the "boxer short" region is really freaking me out.

 

Edward W. Hook M.D.
Edward W. Hook M.D.
38 months ago

Welcome to our Forum.  I will address your questions and, while Ms. Warren and I have not discussed the specifics of your concerns, I am confident that my answers will be quite similar to the ones you have already received from her.  Although each of our verbal styles may vary, Ms. Warren, Dr. Handsfield, and I all provide similar advice related to herpes infections.  Ms. Warren in nationally and internationally renown for her expertise in this field. 

I'm sorry to hear of the anxiety you are experiencing related to your recent exposure.  It was low risk and the information you have provided makes it unlikely that you acquired HSV from your exposure.  With regard to the specifics you mention:

1.  Even if your partner had herpes your risk for infection was quite low.  Most unprotected exposures to infected sex partners do not lead to transmission of infection and in your case, you used a condom which is highly effective for reducing risk for infection.

2.  You muscle and joint aches began sooner than would be typical for recently acquired HSV infection and, when these symptoms occur, they most typically occur in persons who have HSV lesions, something you did not have.

3.  The lesion you describe does not sound at all typical of HSV and if it were due to recently acquired HSV, it would not have resolved in a day or two.  There are many "stray" bumps and spots that appear on the scrotum from time to time.  This was unlikely to be an infection of any sort.

4.  It is now two weeks since your exposure and you have not developed lesions suggestive of infection.  The majority of persons who develop lesions following a recent sexual exposure do so by now.  There is little likelihood that you will have an initial outbreak related to this exposure in the future.  Time to stop you aggressive self examinations.

5.  You got lucky with your IgM test.  We, like the CDC recommend against IgM blood tests because false positive tests are very common with these tests.  It is quite early for an IgG test to be positive but given all of the other evidence that you did not get HSV, I would not worry about this.

Thus in summary, it is most doubtful that you did not get herpes from the encounter you described.  I would be a lot of money on this.  The symptoms you are experiencing are almost certainly due to something other than herpes and are also almost certainly being heightened by your anxiety.  Time to relax and move on.  I hope my comments will help you to do so.  EWH

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38 months ago

Doctor,

Thanks for the quick reply to my question your knowledge is truly helping to ease my mind. While I understand my risk was low sometimes anxiety can make you question yourself even when it is not logical to do so. Regardless I have truly learned my lesson and will never partake in such risky exposures again.

1.     1. I wanted to provide a link to a photo I took of the bump I described above to get your opinion on it even though I know now that initial outbreaks don’t typically show up on the scrotum. I figure it won’t hurt to get your opinion on it. (link at bottom of post)

2.     2. I also took a photo of my throat since I have a sore throat I read that sometimes doctors can tell if the throat is healthy, has a viral infection, or bacterial infection by how red the throat is. I did have my tonsils removed many years ago and do tend to breathe from my mouth if that makes a difference. (link at bottom of post)

3.     3. I forgot to mention in my initial post also that I have what feels like groin pain and sometimes my right testicle has a dull ache randomly sometimes throughout the day. Does this change anything?

4.     4. I know the IgM test is considered useless by many because of the high false positives and should not be used later on after infection but I was curious to find out if false negatives at 10 days are unlikely?

5.     5. Finally, I was reading some of Dr. Hunter’s old posts from MedHelp and in one of his posts he says “"atypical" genital herpes is something of a myth”.  I was curious about this because other sites say 80% of cases are often atypical. Do these people still get blisters?


Link to throat ---->  https://www.dropbox.com/s/j6qoulmhe9wvj5a/throat.png?dl=0 

Link to bump on scrotum----> https://www.dropbox.com/s/xtnl96iaz30mf57/Help.png?dl=0 


Thank you again this service that you offer is very valuable to me and many others.

 

38 months ago
I also wanted to clarify my comment on "the little pimple looking thing is pretty much gone" its not completely gone its just decreased significantly. So I noticed it on day 9 (photo in last comment) and today is day 14 so after 5 days it looks like this ---> https://www.dropbox.com/s/3vmdvblzq81wcja/bump%20day%205.png?dl=0

I took that photo through a magnifying glass so it looks bigger in the photo than real life. 
Edward W. Hook M.D.
Edward W. Hook M.D.
38 months ago

Straight to your continuing questions:

1 and 2.  As a matter of policy, Dr. Handsfield and I do not look at on-line photos of lesions.  Past experience has proved to us (repeatedly) that photos do not take the place of examination by a trained health care provider.  If you are concerned (and I believe you should not be), I suggest you seek evaluation by your own doctor or a dermatologist.

3.  Neither groin pain nor testicular discomfort are suggestive in any way of recently acquired HSV.  No change in my opinion or advice.

4.  You are asking me to comment on a test I recommend against using and for which there are not good data.  I am not going to guess about this.

5.  Genital herpes is quite varied on its presentations and for this reason we encourage persons with genital lesions to have a diagnostic PCR performed on genital lesions they are worried about.

Sorry I cannot provide more information.  None of your continuing questions make me concerned about your having acquired HSV from the exposure you described.   EWH

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38 months ago
Doctor, last question and sorry if I'm being repetitive or pushy I'm just really anxious. For my last follow up question the past two days I have had the burning/tingling sensation in my inner thighs. 

Based on research on other forums people posted that they experienced that same symptom. Before being diagnosed. What about my experience with the burning/tingling leads you to believe it is not related to herpes? 

Edward W. Hook M.D.
Edward W. Hook M.D.
38 months ago

By forum policy, this will be my final (i.e. third) reply.  The tingling you describe is not a sign of genital herpes despite what you may see on the internet.  My assessment is based on 30 years of practice, my own published research and reading the medical literature. 

This will end this thread.  EWH

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