[Question #6732] Possible HSV/Other Possibilities?

11 months ago
Hello

Im a male and had unprotected sex a few months ago at the end of December. It was a Saturday. The following Wednesday I woke up with a small red rash on my thigh. No itch/burn. It was just a slightly bumpy red rash. Over the next few days it became inflamed and by Sunday had a little puss filled bump or two within it. I became concerned about a possible STI so I went to have it looked at. The original nurse diagnosed a fungus infection and prescribed a topical ointment. This immediately reduced the inflammation but the rash didn’t completely go away really ever (months later there is still some slight discoloration in the area) 

About two weeks post exposure and ten days after the rash developed I began to experience some muscle fatigue, tingling on my butt, and some chills. I don’t think I had a fever. Those symptoms lasted for a week then went away. I don’t think I had any lesions on the butt at this time other than one pimple. 

I never developed any lesions or bumps on my actual penis. But still I’ve been concerned about Herpes. I would say the tingling symptoms on my butt are on for a week or two then on for a week or two. Between the intervals I’m experiencing nerve sensations in my feet and legs. But still, no lesions on my penis. Just the original rash on my thigh and possible few pimples on my buttocks. 

I eventually took a blood test (7 or so weeks post exposure) which came back negative for anything. I’m having trouble accepting this negative result because the tingling in my Butt is intermittent and comes and goes the way Herpes supposedly does. I think maybe I’m developing lesions on my rectum and just can’t see them? 

I plan on retesting at 3 months but i believe even a negative result here isn’t 100% conclusive? Should I have any concern for herpes or any other STI that are causing these burning/tingling sensation? Do any of my symptoms concern you?  I apologize for the abundance of detail but if you could take the full story and provide your analysis 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
11 months ago
So many people report tingling as their only symptoms that trigger herpes worries, but the vast majority of the time, when they test, they are not infected.  Your negative IgG at 7 weeks post-exposure should be reassuring - by 6 weeks out, 70% of those who are going to test positive will have done so.  So you're a little better than that.  If you had lesions at the rectum, I think you would most certainly feel them when having a bowel movement.  And they wouldn't just be itching, they would be quite tender. 
The risk of acquiring herpes from a single unprotected sexual encounter is really quite low.  First, you don't know that this person was infected.  Second, the rash of new herpes would be on the shaft of the penis the first time, not the thigh and three, herpes lesions generally are not pus-filled,  and finally, a negative test at 7 weeks out is a very good sign.  Yes, you can retest at 12 weeks with the IgG or you can go for the best possible test, the herpes western blot from the University of Washington.  You can work with your own provider to get this or I can help you with that at westoverheights.com

Terri
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11 months ago
Thank you very much for the reply. A few follow ups if you don’t mind

1. Would it be abnormal to develop lesions and then have the fever/chills/headache associated with an initial OB 10 days later? Are those symptoms usually relatively close together in proximity of time? 

2. I felt some pain irritation in my rectum this week but it only lasted 24 hours, nothing herpes related could last for that short a period of time correct? 

3. Is there a large difference between testing at 11 vs. 12 weeks. I only ask because the sooner I can achieve peace of mind the better so if the one week difference is a small one I may test sooner. Do you know of many cases of people testing negative at 11 weeks then changing to positive? 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
11 months ago
1.  That is possible, but normally, with new herpes, lesions and flu symptoms such as chills and fever come together at the same time
2.  correct
3.  No, there is very little difference between 11 and 12 weeks results.  I know of no one in my experience who tests negative at 11 weeks and then positive at 12.  However, you should be careful if you are taking daily antiviral medicine as that can impact test results in a new infection, if taken for longer than 2 weeks or so.

Terri

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11 months ago
Thanks for the help Terri. I just have one more follow up. I currently have two bumps at the top of my butt. They look like pimples to me and they don’t particularly hurt or itch at all except if I touch them. How does one distinguish regular pimples from a herpes lesion? I wouldn’t normally be concerned about them except they’re in a similar location to where I felt the tingling previously described. Would it be normal for herpes to present two pimple like bumps that don’t hurt? Also they haven’t changed at all over the past few days I believe I read herpes sores develop and change appearance over time? But I’ve also read herpes sores can be mistaken for pimples and insect bites which is what these look like 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
11 months ago
Herpes lesions are often tender or painful, they are water blisters usually vs. the pus that would be found in a pimple.  They are often found in groups and on a red base.  And you are correct that with herpes lesions, they do change over time, moving from blisters to ulcers to scabs or crusts.  If you are worried about these, you might consider a professional evaluation and/or swab testing.

Terri
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