[Question #6626] STI Concern

66 months ago

Hello

I’ve posted on here previously and had discussions with Terri about herpes. She did not think my symptoms were herpes related so I’m hoping someone can offer an alternate theory to what may be occcurring. All of these symptoms began post unprotected sex with a female on NYE.

I had a fungal infection on my inner thigh. I then had stinging/tingling/itching in my lower back/buttocks/thighs/ for a week and even sometimes my arms and head. That butt pain went away for two weeks but now is back and has now been mostly consistent (only when I sit down however) for the last two weeks.

Some slight nerve pain in my butt thighs and genitals. I currently have a pimple on my life hip near my butt and right butt cheek but those developed over a month post exposure so that would be too late to be related? No real lesions in my genital area other than the fungal infection on my inner thigh. Shaft has been clear. The hair area above the shaft has the occasional red spot or bump and a white bump that was diagnosed as a sebaceous cyst but I attribute those to razor burn.

The nerve pain is incredibly uncomfortable I cannot sit comfortably. I find it difficult to accept that it isn’t STI related or somehow related to my exposure. Any ideas on what could cause that kinda of pain in the thighs and buttocks that isn’t herpes? Please any help or advice would be appreciated.

Edward W. Hook M.D.

66 months ago

Welcome back to the Forum. Thanks for your question. In preparing to comment, I have read your two past interactions with Terri several times and agree with her entirely- what you describe in no way suggested herpes. That rash started too soon and was atypically in both its appearance (as judged by multiple health care providers) and its time course. It sounds to me as though what you are currently most troubled by is the Nerve pain". Could you please describe it more fully? I find myself wondering is it is tingling or burning in nature, if its there all the time, whether it is worse at night, what makes it better or worse (you mention that sitting makes the pain in your rear end worse- it is it the pressure or the position?), You mention of "razor burn" also makes me wonder if you shave your genital regions or not.

It is clear to me that you are quite concerned about this. I must tell you that what you describe does not sound like any STI that I have encountered in my nearly 40 years of STI-focused practice. There are many other causes of the sort of neuropathic discomfort that you appear to be describing. Do you have a reason to be worried about your partner who you indicated is a close friend? Are you in other relationships?

EWH

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66 months ago

I'm not in any other relationships but am pretty sexually active (usually safe though hence why I'm so concerned about this specific encounter) but have not been active since this encounter just out of fear of exposing someone else to whatever I am dealing with. Especially since there is still some redness where my fungul infection was, all bumps and irritation is gone but theres still a slight red spot/discoloration of my skin. This fact makes me worry about herpes less since any herpes related rash or sore certainly would be completely gone six weeks later correct?

1. I would describe the nerve pain mostly as a tingling sensation, but it sometimes burns as well (mostly in the waistband area) and sometimes the muscles in my butt becomes sore. Another sensation I experience in the region is a sharp stinging that lasts no more than a second at a time, almost as though I got pricked with a pin. These stinging sensations are mostly in my butt/thigh and are not constant but maybe occur a couple of times a day. I have felt it once or twice in my genitals as well. The nerve pain in general does not really increase or decrease in severity based on time of day, but I know any pressure on the area is when I become uncomfortable. Whether it be sitting in the car driving, sitting in class, or laying in bed. But when I sleep on my side or lie on my stomach to sleep it is pretty much completely absent. And when I stand and am walking it all feels relatively normal.

2. I do shave my genital region. I have done so twice since the encounter. The second time I did so it resulted in two cuts in the area that bled a little bit but once I showered the bleeding stopped and thats where the redness showed up so thats why I assume its irritation from shaving. The area was examined by my doctor recently and nothing about the area alerted their attention.

Edward W. Hook M.D.

66 months ago

Thanks for the additional information. Reading your current and past posts carefully, as well as the description of the discomfort you are experiencing suggests that you MAY be noticing sensations that are normal but with heightened attention become more obvious and distracting. We see this relatively commonly among clients who have recent, suspect encounters. The description you provide is not suggestive of any STI including herpes. OTOH, you may have a neuropathy which is a term for a specific type of neurologic disorder which occurs commonly and has many, many non-STI causes. The diagnosis of neuropathy is best made by a neurologist although many trained clinicians such as internists are also able to care for the problem. Once diagnosed, if present treatment of neuropathy may involve both therapy for the underlying cause, as well as symptomatic treatment.

Shaving can heighten cutaneous sensations and predisposed persons to rashes and other irritations. My advice would be to shave further.

I hope this pe4rspective is helpful. I am confident that the symptoms you describe do not represent any STI acquired though the interaction you describe. EWH

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66 months ago

I really appreciate the input Dr. Hook and the timely responses. I just have a few short follow up questions I hope that's alright.

1. I also am currently experiencing muscle soreness in my thighs. Any relation do you think? May be good to note maybe that I'm currently on an antibiotic and steroid for a severe cough I'm experiencing. Doxy plus Prednisone.

2. Just for some more reassurance concerning my fungul infection, an initial herpes outbreak would likely be on the penis correct not the thigh or butt? And with the tingling around my butt, without any sort of anal sexual exposure (which did not occur), it would be surprising to have an initial outbreak there as well? Because like I said I did find a pimple or two in that region as well but they seemed like regular pimples to me.

3. Also throughout this whole process I did get a cold sore on my lip (not the first and certainly not the last, I've had them my whole life), that doesn't suggest anything genitally correct it was probably just a coincidence that they occurred simultaneously?

4. Would you say I am safe to resume condom protected sex without any further testing/evaluation even with these neuropathy symptoms and the discoloration from the initial fungul infection?

5. Would you advise a blood test? I have an aversion to needles so I avoid them when possible, so if you tell me it's unnecessary it would save me a tremendous amount of anxiety/anguish.

Thank you so much again, this service has been a god send these past six weeks as I try to grapple with whatever has been going on.

Edward W. Hook M.D.

66 months ago

I'll be glad to provide final responses (as you know, we provide up to three questions to each clients questions, this is my 3rd reply). Shortly following the reply the thread will be closed without further responses:

Neither the doxycycline nor the prednisone would be anticipated to impact your muscle soreness. If anything they would be expected to help.

Your fungal infection had its onset the day after your encounter. There are NO STIs, including herpes which would become symptomatic that quickly. As you point out, initial herpes outbreaks typ8ically occur at a site of direct contact. This is further evidence that, as Terri has indicated and that I agree with, this is NOT herpes.

I agree, this was coincidence although sometimes stress and anxiety may be associated with cold sore recurrences.

4. Would you say I am safe to resume condom protected sex without any further testing/evaluation even with these neuropathy symptoms and the discoloration from the initial fungul infection?

I see no reason to abstain from condom protected sex with new partners and unprotected sex with trusted regular partners. While Terri indicated that fungal infections are sometimes transmitted through sex, this is rare and most of the time such infections are not transmitted.

5. Would you advise a blood test? I have an aversion to needles so I avoid them when possible, so if you tell me it's unnecessary it would save me a tremendous amount of anxiety/anguish.

I see no medical reason whatsoever for STI testing of any sort, including blood tests. With regard to your concerns about herpes, I would specifically advise AGAINST a herpes blood test as falsely positive tests are relatively common, particularly among persons who already get cold sores (HSV-1)

I hope that this information is helpful. Take care. Please don't worry. EWH

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