[Question #775] Herpes Outbreak

53 months ago
Hello, on March 11th I had unprotected oral sex and brief (2-3 minutes) of unprotected vaginal intercourse. I was tested for HIV (4th generation), syphillis, hepatitis B and C, and herpes 1/2 at 6 weeks post exposure. All negative. I was also tested for chlamydia and gonorhea at 1 week and 3 weeks post exposure which were negative. Lastly, I was tested for trich 8 weeks post exposure which was also negative.  Now fast forward to 9 weeks post exposure and on May 12 I had tightness and minor pain in both calf muscles. It lasted a full day and then when I checked on the evening of May 13th I had rashes on both legs that started at the Achilles' tendon and went slightly up my calf but nothing at all above the knee or anywhere else on my body. The rashes are a few (10-20) red bumps that are scattered between mid calf and my Achilles. After the rash appeared the tightness and pain in my calf subsided but still a bit tight. I have no other bumps anywhere else and the rash doesn't go onto my feet very much. My other symptom is I've had a white patchy tongue for about 5 weeks now. Does the calf pain/tightness and subsequent rash sound like any std to you as I am still worried about my exposure in March. Thank you for your help. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
53 months ago
Welcome back, Jim. Although herpes questions generally are answered by Terri Warren, I'm picking this up because of our previous discussion.

I'm afraid you are making the mistake of assuming that sequential events must be causal. In fact, there is no reason at all to assume that every new symptom you experience is somehow related to a sexual exposure a few weeks earlier. No STD causes symptoms like you describe, and herpes certainly does not do so. If you acquired genital herpes, the ONLY site at which you would have any kind of skin problem would be where the virus entered your body, i.e. the sites of friction during sex, i.e. your penis or immediate genital area. Herpes simply does not cause a widespread rash of the sort you describe. And no STD causes "white patchy tongue".

As we discussed last time, your test results are valid and you can be sure you don't have any STD from that event. If you want 100% assurance about herpes, you will need a final blood test 4 months after the event. But based on all you have said in this thread and your previous one, you can be confident that result would also be negative.

As implied above, you can't go through life assuming every little twinge and tingle has something to do with a sexual exposure and decision that you regret. These things are unrelated, except for a likelihood that your anxiety about it is making you notice trivial body feelings or minor sensations that you would otherwise not notice or would ignore. It is time for you to move on. If you cannot, you might need to consider professional counseling. I suggest it from compassion, not criticism.

I hope this has helped a bit. Best wishes--

HHH, MD

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53 months ago
Dr. Thank you for your honest answer. I did see a doctor this morning at the local med-express and showed him the rashes on my calves/ankles and he thought it was some sort of viral infection and my immune system reacted with the rashes. He gave me a weeks worth of antiviral medication and a candida pill for the white tongue. He didn't think it was sexual either but the fact I had a slight fever along with the rash and sore calves that it was a viral infection. I am happy that you are very certain of no sexual diseases occurring from my exposure.  I haven't had any health problems ever before so any rash I automatically rush back to what could have caused it. I am guilty of "googling" and seeing folks who say they have herpes but only outbreaks on there leg. Obviously I trust your expertise more than what I am googling and am confident I don't have an std. Since I am obviously anxious, how accurate would a 12 week herpes test be? Thanks for all your help. 


H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
53 months ago
You cannot read lists of symptoms, whether for STDs or anything else, and conclude "aha I have that one, I must have that problem". This is especially the case for herpes. A recurrent genital herpes outbreak once in a very great while presents as a small cluster of blisters/sores that can occur on the leg, ankle, etc. But that's for a recurrent outbreak only, neverotinfection, which just about always shows up where the virus enters the body. And certain herpes does not cause wide spread red bumps etc. And so many people with herpes suffer serious psychological effects, which leads to more hyperbolic and irrational claims about symptoms than for most medical conditions.

Largely for those reasons, I agree with your own understanding that it is often a mistake for anxious people to search the web in too much detail. Like many such persons, you are being drawn to information that inflames your worries while missing the reassuring bits that also are there. As the famous statistician Nate Silver (fivethirtyeight.com) put it in his book "The Signal and the Noise", "Give an anxious person a commputer with an internet connection in a dark room, and soon he'll be mistaking his common cold for the bubonic plague."

There's a bit of controversy about 12 vs 16 weeks for conclusive HSV2 testing. Given your low risk of having it, 3 months (with at least 90-95% test performance) is fine; I would recommend waiting 4 months only in much higher risk and higher probability settings than yours. (The lower the risk, the less precise testing needs to be, believe it or not. For exmple, if we say your risk of having caught HSV2 were 1 chance in a million, a negative test with "only" 90% certainty drops the odds to 1 in 10 million. It really shouldn't be necessary to wait for a 99% reliable test, because the difference between one in 10 vs 100 million is meaningless. Both are zero for all practical purposes.) As I think I said in the other thread, if somehow I had been in your situation, I wouldn't feel a need for any HSV testing at all and I would have resumed unprotected sex with my wife a few weeks ago.

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53 months ago
Thank you, I was worried that my case could have been one of the "first outbreaks so mild a person may not notice it" and the rash on my leg as a second breakout. I realize that is a small chance of that. My last question would be even if the rash sores are herpes related, would I still test negative on a blood test even though symptoms are present? And how does the antiviral medication my Dr. placed me on effect any std testing that is done and how does the medication play a role. Once again thanks for all of your re-assurance from my two posts it has made me feel MUCH better about my situation. Hopefully this is my last post! Thx again.

Jim 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
53 months ago
A recurrent outbreak would never occur in presence of a negative blood test. And as discussed above, your description simply doesn't sound at all like herpes.

I can't imagine what "antiviral medication" anyone would prescribe in this situation. By far the most common antivirals are acyclovir and valacyclovir, but they are not used for any conditions except herpes (simplex or zoster). They could in fact delay development of a positive HSV test, but usually do not -- especially at 12+ weeks after exposure. Your final test, if you still go ahead with one, will still be reliable. It would have absolutely no effect on any other STD tests.

That ends this thread. Please refrain from any more questions on this exposure and the same issues discussed. Repetative questions are not permitted.

Best wishes, stop worrying so much, and do your best to move on. 

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