[Question #5426] lymp node question

21 months ago

My apologies if this is duplicate, computer reset. Brief update on my question last year. In summation, a specialist agreed with you guys and your answers where helpful. Good news, no STI. Bad news, elusive none consequential issue.

My current embarrassing situation is I acted on a desire to be a bottom. Chose a guy that had been tested for HIV, Gonn, Clymida in past and was negative. Only one partner since tests. Used condom. Events area as follows (a) performed bare oral on him and used condom for 5 min. of penetrative anal sex. (b) 24 hours later felt a slight stinging after I urination, even though he did not touch my penis. Also when sitting down my groin was sore on one side. (c) 48 hrs later no problems urinating but one lymp node in the groin sore to the touch (d) fast forward to day four post exposure, no problems with urination, no fever, no soreness in anal region but very sore lymp node remains. My questions

1. Does this sound like I might have gotten herpes from this event? I assume one lymp node with no other symptoms would be unusual?

2. I assume an STI he might have would not show up as one lymp node within 24 hours either?

3. Is it possible due to my chronic but unknown prostate issue that the sex may have massaged the prostate and released infection, although I have no other symptoms

4. Any other ideas?

My plan is to keep watch on myself, see if he will test for HSV 2 (I have had HSV 1 for years and told him that) and see if the lymp nodes will go down. No doc can see me anyway until the end of the week .

thank you!

H. Hunter Handsfield, MD

21 months ago

Welcome back to the forum. Thanks for your continued confidence in our services. FYI, I reviewed your thread 5 months ago and have nothing to add to that discussion.

As for this exposure, no STD can start to cause symptoms only 24 hours after exposure. Whatever the cause of the "slight stinging" with urination, it's not from the exposure you have described. And certainly no lymph node inflammation can start within 48 hours -- for that, a minimum of 1-2 weeks would be expected. In addition, everybody has small lymph nodes that can be detected on careful examination of the inguinal area (groin). Inguinal area pain is not itself evidence of lymph node inflammation. To your specific questions:

1) These symptoms are not at all suggestive of herpes. In addition, initial herpes occurs exactly at the site(s) of inoculation. You cannot have penile or inguinal herpes symptoms without direct genital contact

2) Correct, wee above.

3) Conceivably receptive anal sex (bottoming) could irritate the prostate, but not likely. Your symptoms don't sound prostatic.

4) My best guess is that anxiety over the event has heightened your awareness of trivial symptoms or even entirely normal body sensations that you otherwise would ignore or not even notice.

I suggest sitting tight for a while and seek medical care (e.g. your local NHS GUM clinic?) if something more definite shows up. For sure you should not be tested for herpes based on your symptoms so far. In the meantime, avoid the possible temptations of self examination. Repeated manipulation of hte penis (e.g. to look for discharge or sores) and of the groin are excellent ways to exacerbate symptoms like yours or even cause actual inflammation -- totally screwing things up for later evaluation. Hands off -- if you develop anything important, you'll know it without looking carefully.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

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20 months ago

Thank you for your prompt response. Understand completely. Also reviewed past posts and see where one protective event is unlikely transmission of hsv. I guess I was concerned because of the ingrional node, that is definately protruding and sore but i am not touching it. Your comments on my past event where helpful for my provider to, so thank you. I have read posts where general poor feeling, including lymp swelling happen prior to a first out break and ingrional swelling can happen from anal hsv. I assume I just need to stay off the internet.

So to my follow up...

1. I assume if this node was from hsv, assuming that's even possible, it would not have gone on for 4 days without blisters?

2. When am I out of the woods as far as other symptoms. I have seen 8, 10, 12 14 and 21 days? Would appreciate your thoughts.

3. Out of curiosity, if someone did have anal hsv, do they shed from their penis that would infect other sexual partners.

Thank you again. Great service that sorts out all the information on the internet

H. Hunter Handsfield, MD

20 months ago

1) Herpes never causes lymph node inflammation/enlargement without overt, visible herpetic skin lesions, which also alwaye precede lymph node inflammation. You cannot look at lists of symptoms associated with HSV and conclude you might have herpes just because you have one of two of them. It's the pattern of symptoms -- timing, location, sequence, combinations of symptoms -- that can give good clues. Single symptoms almost never do.

2) 90% of new herpes episodes cause symptoms withinb 5 days. It can take up to 3 weeks, but only on rare occastions.

3) If acquired anally, HSV is unlikely to also involve the penis. And vice versa. (The virus doesn't travel through the body to unexpoased sites.)

Thanks for the thanks!

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20 months ago

Thank you for the detailed information. I am worried about using my last response in case this turns out to be herpes. So here are the events and what is happening now.

Ingrional lympnode tinderness within 48 hours of the event, closer to 30. This continued and only got more tinder (I was not checking, heading your advice). No other symptoms.

Day 5, ingrunial tinderness continues but I developed a fever of 101 and 100.00, depending on when I take it. Head ache and generally feels like I have the flu.

Day 6 ingrunial tinderness continues but is much lessor and fever is still present. Same flue like symptoms. Some tingling on my lip but no soreness and it may be my imagination. I have HSV 1 and it doesn't feel anything like HSV 1. No tingling and no strange symptoms in the anal area.

So my questions:

1. While my risk is real and flu symptoms concerning, as I re-read your email post about symptoms and timing giving the best picture, it would seem that this is some other viral issue given all of the flu/node symptoms started and it has been almost 6 days post the node symptoms with no outbreak and 24 hours since the high fever with no outbreak. Would that be your experience or am I just wishful thinking? I have had a flu shot for what it is worth.

2. I am comforted knowing that anal herpes doesn't shed at the penis. However, Terri Warren in perivious post did not come out that strong can you elaborate on that?

3. how frequent would oral HSV 2 shed? I have had oral HSV 1 forever.

Thank you for your response and work with me on this. I could probably dealt with the ingrional node but the flew like systems have thrown me. I keep waiting for the outbreak but I keep reminding myself this should have already happened. I am debating on going to see my PCP but I am sure they will tell me it is viral and this will not be helpful.

thank you

20 months ago

Just writing to give an update...please still respond to previous questions but I wanted to add new information. No lesions, no out break no itching but lymp node still sore and fevers for 3 days. Tonight it was 103.4. The fever is easily treated by fever reducer. I am not sure if I should go to my PC and ask for an antibiotic, valtrex (for soon to be outbreak) or just tough it out. If this event had not happened I would probably have no concern and tough it out. If I'm reading your symptoms time line this should happen after the lesions. It's now day 7, 3 days of fever, 6 of swollen nodes and no outbreak. Thank you for considering this information in the context of my last quests to be answered

H. Hunter Handsfield, MD

20 months ago

Correct -- herpes is a very unlikely cause of fever or other "flu like" symptoms without prior appearance of oubreak lesions. Something else is responsible for your symptoms.

With these symptoms, and especially a fever this high, you need to see a doctor. Do it today. Having had receptive anal sex, you need testing to check out the possibility of acute retroviral syndrome (ARS), i.e. initial HIV infection. The symptoms started much too soon for that -- ARS rarely if ever starts your sooner than a week after exposure, but it's conceivable your early and later symptoms are unrelated. And although I still believe HSV2 is unlikely for the reasons described, it would now be reasonable to be tested. Even if no lesions are present, you could have an initial blood test -- expected to be negative, but as a baseline for a later test to check for seroconversion, i.e. for a later positive result. Make sure the provider you see is entirely aware of your sexual exposure. If your PCP isn't an expert in sexual health and HIV, consider asking for a referral, or a nearby NHS GUM clinic, where expert care is pretty much guaranteed.

Normally threads are closed after two follow-up comments and replies, but I'm leaving this open for another round after you have been further evaluated. Good luck.

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20 months ago

Thank you for extra questions. I will joy abuse and most grateful. I took ur advice and here are events of today......pcp said not likely HIV for lymp nodes would not happen that fast and even if fear was seperate it was to soon. He also added the sex was protected. I showed him your response and he got serious. I got an RNA test. He said he normally doesnt order for 10 days post exposure but given my symptoms it would catch it at 7 days. I got a lecture on false positives too. Said visual inspection of anus and throat looked fine but he swabbed for gon,clymid anyway. Said I had rbc in urine but no infection. He did not send off for other testing. I did get a baseline hsv igg 2 test. He tried to sell me on igm and to his disapproval I said no. I did get an antibiotic to try in the even it's my prostate. He took a lot of other blood wek too. So, now I wait. I never though abt HIV given the timing of nodes (24hrs) and fever (5 days) and that is was protected. Now I am worried. I hope he is correct regarding the accuracy of RNA at 7 days with symptoms.

Thank u again and I will let u know as test come back

20 months ago

I will not abuse and most grateful I meant to say. Sorry for typos

H. Hunter Handsfield, MD

20 months ago

I'm glad you are in apparently expert care. But I do agree that HSV IgM testing is not useful. It's commonly falsely positive and, contrary to common beliefs -- and what some laboratory test sources say -- it does not reliably distinguish early from longstanding HSV infections. However, we agree entirely about HIV and I expect your RNA test to be negative. My suggestion of its possibility is a long shot, but even at long odds, you don't want to take the chance of missing it.

Another (slim) possibility is lymphogranuloma venereum (LGV), a severe type of chlamydia that is causing a lot of rectal infections these days in MSM. Absence of rectal pain, discharge, etc is evidence against it -- but in any case, if the rectal chlamydia test is negative, that will exclude LGV. If positive, speak with the doctor about having the specimen tested to see if it's an LGV type.

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