[Question #7548] 7482 Follow Up

4 months ago
Hi Dr H, I am following up to 7482  from a few weeks ago.

You eased my mind in Syphilis, but I have had and continue to have what may be Herpes around the anus.

My initial issue was a small ulcer type split on the inner foreskin.  I since recall having a shite solid spot on the shaft and a roundish blood blister on the scrotum, around the time of the oral.

My anus has had varying issues for five weeks, it has changed appearance almost daily, some days its looked like there were small scabs that covered maybe 3 spots, almost looking linear in appearance.  The inner skin to the hole looks grey ish, and around the centre line towards my anus is a pink colour in the skin, its quite isolated to one side although around the hole the marks are all around.

I will be getting teated at 12 weeks with IgG, the questions I have Dr are

1. Do Herpes symptoms around the anus last for five weeks without healing before another outbreak, or can new lesions keep appearing over this period?

2. If this is Herpes, it could be from on old infection but I am sceptical due to the timing, as Oral sex is only what took place, would it be a reasonable assumption that this is HSV1  (if at all), rather than HSV2?

3. Almost all sources say HSV2 from Oral to Genital is almost unheard of...... have you ever seen this take place in your 40 years experience?

4. As I had masturbated the lady before the oral, is there a chance I self infected myself by accidentally touching my penis?

I have been checking myself many times per day for weeks and the stress is getting to me, I even have a small white patch on my shaft which routinely is not something I would ever notice,  everything is telling me its Herpes....

Any help and context you can provide would be welcomed.

Thanks Dr.

Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
4 months ago
1. Do Herpes symptoms around the anus last for five weeks without healing before another outbreak, or can new lesions keep appearing over this period?
No, herpes symptoms don't continue for five weeks, unchanged.  That would be extremely unusual indeed.

2. If this is Herpes, it could be from on old infection but I am sceptical due to the timing, as Oral sex is only what took place, would it be a reasonable assumption that this is HSV1  (if at all), rather than HSV2?
If you were given oral sex, yes, the thing you should be concerned about is HSV 1.  So I would not expect all these concerns be due to new or recurrent HSV 2.  But if you received oral sex, I would believe that the first symptoms would be on the shaft of the penis, NOT around the anus.

3. Almost all sources say HSV2 from Oral to Genital is almost unheard of...... have you ever seen this take place in your 40 years experience?
Never, and I don't believe Dr. Hook or Handsfield has either. 

4. As I had masturbated the lady before the oral, is there a chance I self infected myself by accidentally touching my penis?
No, I don't believe that either.  NO.

I believe that I have answered your questions on westoverheights.com, is that correct?  Dr. Handsfield requested that I answered this question as I answer the herpes questions on this site as well.  it's possible there was a similar question and not yours but this sounds very familiar.

Terri Warren
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4 months ago
Hi 

The first issues were on the shaft / foreskin, but around five weeks after exposure the anus symptoms started, which has me worried as HSV1 is less likely to recur than HSV2, assuming the anal issues are a 2nd BO, would this still be feasible to be HSV1?

1. Is it possible for HSV1 to recur for a couple of times in the first year?

2. Does the fact the symptoms are Anal indicate its more likely HSV2? 

3. The anus symptoms have been present for over five weeks, would a BO evolve over this period? ie - the could the spots or whatever they are come and go and develop in new places during one OB?

Please don’t think that my me asking Dr H to comment it was a reflection on your knowledge, I am just seeking reassurance that if this is GH, that it is likely HSV1 not HSV2 from the oral sex.

I cannot understand how the pink area changes colour and the look of the texture each day.  

4. Have you ever seen someone have a mild first outbreak followed by a more sever 2nd one?

5. I have had  2 courses of AB in this time so this could be fungal, does what I have  described sound anything like fungal?

6.I have had mild discomfort at best, I have shaved the area and clean it very well. If one had Anal Herpes the way I have described, would you expect it to be painful?

7. The photos are hard to judge but would Herpes lesions appear linear on the centre line?  

Thanks Terri, I am immensely grateful for your assistance. 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
4 months ago
1. Is it possible for HSV1 to recur for a couple of times in the first year?

Yes, that is possible.  The first year is very often different in recurrence rate than subsequent years.

2. Does the fact the symptoms are Anal indicate its more likely HSV2?

No, the location has nothing to do with the type, HSV 1 or 2

3. The anus symptoms have been present for over five weeks, would a BO evolve over this period? ie - the could the spots or whatever they are come and go and develop in new places during one OB?

Herpes outbreaks would NOT last 5 weeks.  An outbreak would more typically come, and then leave.  And if this is genital HSV 1, then that is particularly true

Please don’t think that my me asking Dr H to comment it was a reflection on your knowledge, I am just seeking reassurance that if this is GH, that it is likely HSV1 not HSV2 from the oral sex.

Thank you, but I don't think that at all. 
I cannot understand how the pink area changes colour and the look of the texture each day.  

4. Have you ever seen someone have a mild first outbreak followed by a more sever 2nd one?

Well, I have seen people who have an outbreak that is remarkable, do an antibody test on them and they are strongly positive so we know it isn't a new infection, and they report never having had symptoms before, so I guess the answer would be yes to that question

5. I have had  2 courses of AB in this time so this could be fungal, does what I have  described sound anything like fungal?

Yes, I think that is an excellent possibility, indeed.

6.I have had mild discomfort at best, I have shaved the area and clean it very well. If one had Anal Herpes the way I have described, would you expect it to be painful?
Yes, probably, but not ever time.  I would advise that you stop shaving the area.   You could be irritating the area and causing problems for yourself.  If you are concerned about cleaning the area well, do you have access to a bidet or you could try using a squirt bottle with warm water to get the area extra clean -kind of a home grown bidet.

7. The photos are hard to judge but would Herpes lesions appear linear on the centre line? 

Not usually, no.
I think you are likely dealing with something else, but the best way to try to sort this out is to see perhaps a dermatologist and have swab testing done.  what professionals have looked at this so far?

Terri
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4 months ago
Thanks Terri, your answers are very helpful.

I have been to scared to see anyone about it as yet, I hope to get an IgG test next week but much of Scotland is on lockdown.

It could be I am piecing all together and coming up with the wrong answer... but the timescales etc are a concern as they do align somewhat following the oral.

The centre line looks pink both into the anus from the penis and also away out the other end too.  When I look at the centre line by the fleshy fold, this is where say five spots appeared to be, linear in fashion which makes me believe they could be hair follicles, I have had folliculitis in the past. 

1. Is is a fair summary to say that the area and look of lesions / scabs etc, is the same for HSV1 as it is for HSV2?

2.Given the fact that almost universally, no one with years of experience, such as yourself and Dr H and Dr Hook,  have seen Oral to Genital HSV2, would you confidently say that if this is Herpes, it would be HSV1 from the Oral encounter, NOT HSV2?

3. As we don’t have a WB test in the GB, how much faith can I place in a 12 week igG test?

4. Where would my next step be if it was indeterminate?  Ie - a weak positive that could be false?

5. Have you seen anyone have a 5 week+ Anal occurrence? 

6. Is the centre line sensitive, ie, the fact I am separating by butt cheeks to take photos, could this cause inflammation?

7. Do OB’s normally just come and go, reducing all inflammation back yo normal until the next flare? Ie - this ongoing inflammation in my anus region would have calmed before the next flare up?

Thanks for your advice on the cleaning, that is a really good idea.

Finally, any other thoughts / context you have would be appreciated.

Thank you Terri
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
4 months ago

1. Is is a fair summary to say that the area and look of lesions / scabs etc, is the same for HSV1 as it is for HSV2?
Lesions of HSV 1 and 2 look the same, correct.

2.Given the fact that almost universally, no one with years of experience, such as yourself and Dr H and Dr Hook,  have seen Oral to Genital HSV2, would you confidently say that if this is Herpes, it would be HSV1 from the Oral encounter, NOT HSV2?

IF it is herpes, yes, i think HSV 1 is far more likely

3. As we don’t have a WB test in the GB, how much faith can I place in a 12 week igG test?

it picked up 70% of HSV 1 and 92% of HSV 2.

4. Where would my next step be if it was indeterminate?  Ie - a weak positive that could be false?

You mean equivocal?  A low positive could definitely be a false positive yes.  You can always send a western blot to the US

5. Have you seen anyone have a 5 week+ Anal occurrence?
Never

6. Is the centre line sensitive, ie, the fact I am separating by butt cheeks to take photos, could this cause inflammation?

I suppose if you do it enough, yes!

7. Do OB’s normally just come and go, reducing all inflammation back yo normal until the next flare? Ie - this ongoing inflammation in my anus region would have calmed before the next flare up?

Yes, there is normally a much longer period of no symptoms with herpes than you are currently experiencing.
You are out of posts.  If you want to pursue the blot, you can reach me at westoverheights.com

Terri


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