Dr. Rockoff - Your comments on Herpes

[Nevervana]

You commented here regarding a hearpes outbreak: http://www.medhelp.org/forums/dermatology/messages/31242a.html



"those who are infected but have no previous exposure get very high fever, terrible erosions, and severe swollen glands."



This contradicts everything I've ever read about Herpes.  Statistics show that 60% of people infected never have *any* symptoms and don't even know they carry the virus.  



This is so true that they've labeled the "typical" herpes infection to be no symptoms whatsoever.  The "Classic" herpes infection *might* include the things you've listed, but saying that they're ALL included, and saying they're all SEVERE is completely contradictory to everything I've read.



Mind you, I hope your assessment is the right one.  I've had a recent encounter and 7 days later my entire scrotum felt like it was on fire.  This spread up the urethra internally.  I developed bad headaches and felt very very tired for about 3 days.  Ive had *no* fever and *no* swollen glands and *no* sores have appeared.  



I am now 11 days from exposure and even as I write this I can feel the burning in my testicles, the skin around them, and at the base of the urethra internally.  I am negative on Gonnorhea and Chlamydia tests.  Herpes urethral culture and blood test pending.



I only received unprotected oral from someone who did not have any noticeable sores on their mouth.  Everything else was protected.



Maybe you were speaking from your own experience.  In your experience have almost 100% of people who tested positive for herpes gone through a severe outbreak that included swollen glands, high fever, and multiple sores?



The CDC leads us to believe that this is actually less common than asymptomatic infections.  Please advise.

[Alan Rockoff, MD]

Let me expalin the apparent contradiction:



It is certainly true that the majority of hepres patients have no recollection of a primary attack--they just get recurring "cold-sore" type of lesions.  They never had fever, glands, and many open sores.



The people I was referring to who do get a primary attack have high fever, swollen glands, etc.



The point is this: if someone is in the former group and just get a small cluster of blisters, there's no way to tell how long ago or from whom they got the infection.  But presumably it was a long time ago.



Therefore, if someone has a suspect contact and is waiting a few days to see if he or she contracted it, what they're wating to see is the severe primary outbreak (fever, glands, etc.), not the cold-sore type.



Your symptoms (burning of testicles and base of urethra) don't match either kind of herpes.



I hope this helps clarify your question.



Please see a doctor for proper diagnosis.

[Nevervana]

The only thing I do have, aside from my perpetual burning urethra and burning scrotum skin, is this little dot at the tip.  There are no other dots near or around it.  



http://hometown.aol.com/bipbopbump/example.jpg



Doctor saw it and said it looked more like a trauma related mark than a herpes sore.



The burning in my urethra right now is near the base of the penis on the inside... and its driving me insane.  It does not get worse with urination.  It has remained persistent for 5 days now.



Help.

[Nevervana]

Thanks for your response.  So this doesn't sound like a potential *PRE* herpes outbreak scenario?



1.  Received unprotected oral from 2 sex workers 8 days ago

2.  Painful sensitive burning genital skin on shaft and scrotum.

3.  Development of painful headaches lasting 3 days

4.  Development of strong fatigue lasting just as long

5.  Followed by urethral burning and pain with a peculiar red sore at tip of urethra.



?



60% of people get NO symptoms with this virus.  Aside from a blood test you have to diagnose this based on typical symptoms. Typical Herpes symptoms include irritation & burning genital skin, headaches, fatigue, and many times urethral sores that you can't see.  I could be having a full-on outbreak inside there right now, and not know it.



Why do you feel my situation isnt indicative of genital herpes?

Its good news, but I'm interested in knowing why you feel that way.

[Nevervana]

Hi - Normally Id end this thread but I did pay $20 just to ask a question, so could you reply to my last post, and also tell me what you feel this is, that Im experiencing, and what I should do about it?



The Herpes Culture they're telling me takes TWELVE DAYS to come back (they did one on my urethra), and if this is a recent infection, the Herpes Antibody will be useless....



But you feel its not herpes, so what is it? and what should I do?  I cant deal with this burning all over much longer.  8 days is enufffffffffff.......

[Alan Rockoff, MD]

I don't know where you get your information from.  In particular:



Typical Herpes symptoms include irritation & burning genital skin, headaches, fatigue, and many times urethral sores that you can't see. I could be having a full-on outbreak inside there right now, and not know it.



Where I live, typical herpes symptoms are blisters, crusts, and painful swollen glands.  The incubation period for a first attack is 2-5 days.  Herpes cultures grow within a week, not 12 days.



I don't know what you have.  If your doctor thinks it might be herpes, why not start anti-herpes therapy at once?  It's simple and safe.



Dr. Rockoff

[Nevervana]

<< I dont know where you get your information from >>



Since we're talking about a potential "intial outbreak" ...



(Famvir official website) http://www.famvir.com/hcp/about/gh/symptoms.jsp

"Typical Herpes Manifestation: usually the least severe of all manifestations. Symptoms include itching, burning, or soreness in or around the genital area; ulcers that are usually not recognized as genital herpes because of their small size and number and their location (internal rectal, anal, *URETHRAL*, cervical, or vulvar ulcers)."



<< Where I live, typical herpes symptoms are blisters, crusts, and painful swollen glands. >>



If sores develop, yes.  The issue here is that the majority of people with herpes never develop sores, and can have symptoms that are anywhere from nonexistent, to mild, to a full on outbreak.  From the CDC Website: http://www.cdc.gov/nchstp/dstd/Fact_Sheets/facts_Genital_Herpes.htm



"Most individuals have *NO* or only minimal signs or symptoms from HSV-1 or HSV-2 infection."



"HSV-2 usually produces only mild symptoms or signs or no symptoms at all."



"Most people infected with HSV-2 are not aware of their infection."



"Most individuals with HSV-2 infection may never have sores, or they may have very mild signs that they don't even notice or that they mistake for insect bites or a rash."



Therefore couldn't someone have an ongoing 2 week redness, inflammation, burning all around, and never actually develop sores, and it still be herpes?  According to the CDC and Famvir, yes.  



From the Valtrex Official Website:



"Initial infection...You may or may not see blisters and inflammation associated with the herpes infection."



From the American Social Health Association (ASHA):



"First symptoms can be uncomfortable and usually happen within 2-14 days after the virus is transmitted. However, some people have a first episode so mild they don’t notice it. Some people have no symptoms."



From the Famvir Official Website:



"Patients may present with a variety of manifestations of genital herpes. The different manifestations vary according to the signs and symptoms and their severity and may be divided into typical and classic."



"Typical: usually the least severe of all manifestations. Symptoms include itching, burning, or soreness in or around the genital area; ulcers that are usually not recognized as genital herpes because of their small size and number and their location (internal rectal, anal, urethral, cervical, or vulvar ulcers)."



"Classic: symptoms include clusters of small painful blisters that ulcerate, crust, and heal in nonmucosal areas, and/or ulcers with no blisters or crusting in mucosal areas. Primary First Episode*: most severe outbreak in terms of ulceration and pain. Symptoms include fever, headache, myalgias, and sometimes aseptic meningitis; inguinal lymphadenopathy; dysuria; vaginal or urethral discharge; itching; associated cervicitis (in about 80% of women); and new lesion formation for approximately 10 days. The time from the onset of symptoms to healing is usually 3 weeks."



Note that they call Typical just itching burning and soreness with ulcers that are not even noticeable or may even be found in the urethra.  They call "Classic" what you describe.  Full on outbreak.  Typical is more common.  Thats the paragraph that scared the hell out of me.  It describes exactly what I've experienced.  They list other "Typical" symptoms.  I have asterisked the ones I've experienced:



* Genitourinary itching, burning, or soreness with or without pain

* General fever, myalgia, and malaise

Dysuria and back pain

Genital discharge

Proctitis and rectal discharge

Vulvar, penile, and anal fissures

? Internal lesions

Perianal lesions

Nonspecific vulvar erythema

* Genitourinary pain without other symptoms

Redness on buttocks/thighs

* Aching lower limbs



<< The incubation period for a first attack is 2-5 days. >>



From the Valtrex, CDC, Famvir, ASHA Websites:



"Genital herpes symptoms usually develop within 2 to 20 days after contact with the virus, although it could take longer"



I had no symptoms until day 5/6.



<< Herpes cultures grow within a week, not 12 days. >>



Symptoms had persisted for only 6 days at the writing of my original post.



Thoughts?

[Nevervana]

By the way, last night I experienced some very very uncomfortable pain on my genital skin and called my doc.  He put me on Acyclovir.  I have been on it for 24 hours and the burning has all but gone away.



I don't suppose Acyclovir could be working this quickly?  Ive been told it takes at least 3 days to really kick in and start to curb an outbreak thats underway.

[Alan Rockoff, MD]

Acyclovir doesn't work that quick.  Pain that goes right away after taking a pill is psychological pain, not herpes pain.



I am going to send your comments to Novartis, makers of Famvir, as a classic example of the way internet information can make people like you anxious because of misinterpretation.



The "Typical" and "Classic" symptoms represent RECURRENT herpes, the outbreaks that happen long periods after exposure.  As for itching and burning, I see people who itch in the groin all day long.  They have anything from chafing to fungus to nothing.  Evem if herpes can sometimes burn, every burn doesn't mean herpes.



Sure most people have no symptoms of the first attack.  Then they get recurrences indefinite times later.  Would you describe your own symptoms as mild or nonexistent?



The kind of outbreak which would occur right after exposure would fall into the category, "Primary First Episode."  The incubation period is 2-5 days.  The symptoms are not burning or tiny ulcers but:



most severe outbreak in terms of ulceration and pain. Symptoms include fever, headache, myalgias, and sometimes aseptic meningitis; inguinal lymphadenopathy; dysuria; vaginal or urethral discharge; itching; associated cervicitis (in about 80% of women); and new lesion formation for approximately 10 days.



Is that what you have?  Hardly.



Enough.  Please direct further inquiries to specialists in infectious disease.



Dr. Rockoff

[Nevervana]

Let me know what Famvir says, because they, the CDC, and 4 doctors I've seen all agree that a primary *can* be unnoticeable.  I strongly believe you're misinformed on this issue.  



There isn't a single doctor or website including the CDC that says "If you get a primary it WILL be bad".  They all quite clearly state that a primary can be mild, severe, or nonexistent.



Make sure you email the CDC and tell them their information is misleading too.  I included several quotes from them above stating that a herpes outbreak can be unnoticeable or mild, and none of those quotes were pre-qualified as only for "secondary" outbreaks.



I hope you're right, and all those websites (all 6 of them) are wrong.

[yyyyy]

Listen man, you don't read very well or something.  Re-read what Dr. Rockoff has said and it makes perfect sense.  Some people never have a bad primary attack that they can remember and then only get the blisters of the recurrent attack.  Think about something else, those websites are there to sell their herpes drug.  They would love everyone to believe that any little thing is herpes so that they can sell more.  All they do is cause people to panic.  Yes, herpes can be asymptotic sometimes but it is just that - no signs.  If you have symptoms, you have blisters - that is what I was told from all the doctors I ever talked to.  They might be small but they are there where you can see them.  And apparently they hurt quite a bit. Hope you feel better soon.

[Nevervana]

From the Columbia Medical website regarding first infection:

http://www.columbia.edu/cu/sister/STDs.html



Symptoms:



* Appear about 2-20 days after infection

* Usually begins with a tingling or itching of the skin in the genital area (prodromal period)

* [Tingling or itching] may occur several hours to several days before the sores erupt or may not occur at all

* May also have burning sensations, pains in your legs, buttocks, or genitals and/or a feeling of pressure in the area



What part of this doesn't sound like my experience? Several days of burning, itching, tingling, discomfort.



And by the way, you are the one who misunderstood the doctors comments:



He said IF you have a primary outbreak you WILL have sores, blisters, and painful swollen glands.  That is the issue I am disagreeing with.  7 sites say a primary outbreak can be anywhere from nonexistent to mild, to uncomfortable, to severe, but USUALLY primary is severe.  Only 2 of those sites are selling something. The CDC and Columbia are not selling drugs.  They are government and institutional public health sites.

[Nevervana]

And by the way, I realize tingling, burning, itching can be many things but why is it that nobody has a clue what?  It doesn't help me very much when 4 doctors don't have a damn clue what it might be.  



If someone wants to actually offer up some information on what this might be, then be my guest.  



Unfortunately for the naysayers, the symptoms I've experienced only seem to match perfectly with herpes prodrome.  



I'll be sure to come back here if sores develop and inform the doctor of his extreme error in misinformation.... or .... apologize for my error if it turns out to be something else.

[harryhood]

I tested positive for HSV 2. My first outbreak was a small dot on the top of my penis. I never got a fever or got sick. I did experience a little fatigue. According to MY doctor,flu symptoms are more common with people who's immune systems are not up to par. Like you, (not saying you have herpes), I thought I was experiencing pain in my testicals. Your lymph nodes are REAL close to your balls. Thats what was hurting me.



I am a 23 year old male. Here is what happends to me during a supsected outbreak (which occur about every 4 months)



*Pain in my upper thights (it shifts from leg to leg for about 3 days.

*Fatique- probably cuased by me stressing my self out from stuff I read on the net

* Usually NO visiable sores, just tingiling in the area. It also cuases my urine spread side ways for about a week.

[Nevervana]

<< I tested positive for HSV 2. My first outbreak was a small dot on the top of my penis. I never got a fever or got sick. >>



This coincides with what the websites say.  It can be mild.



<< Like you, (not saying you have herpes), I thought I was experiencing pain in my testicals. Your lymph nodes are REAL close to your balls. Thats what was hurting me. >>



This coincides with what the doctor says above.  Im pretty sure im feeling this burning and inflammation in the testicle region, and that it's not the glands.  The glands in the groin, as far as I know, are on the inside/front of the leg, and I've had them swell up before.  This feeling is right at the base of the underside of my testicle right now, and migrates to the top of my testicle.  Also urethra.  



Im unable to determine if the hotness or inflammation feeling is inside, or on the skin-level.  It literally migrates and changes every 30 seconds. I have had chronic epidydimitis in this testicle in the past, but its an entirely different sensation.



Sometimes, usually later at night like right now, it just starts to ache really bad and then starts to sting.  And then goes away for a few minutes.  Then comes back a few mins later.  During the daytimes now I am for the most part symptom-free.



I really wish I knew what this was.  At night time when its really flared up, I feel like im waiting for the big outburst of sores... really sucks.

[shelbert6]

First, there is a difference between Primary Infection and first infection.  I never had a Primary Infection, but I did have a first infection.  I have had it for 15 years.  My break-outs are uncomfortable, but completely tolerable.  I have never had to take anti-viral therapy to control.  But, I'm a woman, and we can experience break-outs without symptoms more often then men.  My husband also has this.  He has had it for 20 years.  His out-breaks, typically, are much more severe then mine.  He knows when he is going to have a break-out days before he has blisters.  The typical indicator is hypersensitive skin on the buttocks and thighs.  Clothes rubbing on these areas can be very uncomfortable.  Your skin becomes very sensitive to even light touch.  Second, I've lived with the assumption that I have had this disease, since my first sexual encounter with my husband.  Never did get tested.  I was recently tested and in fact was positive for HSV.  This was included in a blood test that I was having done.  The results were given to me inside a week after testing.  Not 12 days.  All you can do at this juncture is to wait for your test results.  No one can tell you if you have it until then.  Until then, assume you have it.  This is the safest course for you and others you may come in contact with.  Herpes is not curable, but is very manageable.  By the way, when you say that your encounter was limited to oral sex, and you noticed no apparent blisters, I will tell you that you can still contract this disease.  You do not need to be in an active state of open, oozing blisters to pass this along.  Frankly, if an individual is in a state of open, oozing blisters, they will be less likely to be engaging in sex based on discomfort.  My husband didn't have open, oozing blisters when he gave it to me.  As a matter of fact, he wasn't having a break-out at the time, and was a little shocked to find out that I had contracted it.  He was under the same, misguided impression.

[Nevervana]

My doctor thinks maybe this is a urinary tract infection that has spread to cause general discomfort.  However a preliminary result of a urinary culture revealed "No growth overnight".



Is it possible to have a UTI and have no growth show on a culture?  Maybe a more elusive bacteria?  Or should i just simply rule out the chance that this is a UTI at this point.



He put me on 1000mg cipro last night, and i literally feel like a new man today.

[yoshi2me]

If you are looking for correct and factual information on herpes then you need to stick to these websites:



The National Herpes Resource Center:

http://www.ashastd.org/hrc/index.html



Genital Herpes: Ask Terri Warren, RN, ANP:

http://boards.webmd.com/topic.asp?topic_id=90



The Updated Herpes Handbook:

http://www.westoverheights.com/freebooktext.html

(You can read it online.)



Also ... herpes signs and symptoms vary from person to person. Not everybody gets those "classic" symptoms. The Herpes Resource Center put out an excellent news article about how herpes can and does go undetected all the time. You can read that one here:



http://www.ashastd.org/news/111201.html



Not everybody experiences a primary herpes outbreak. In fact, there are many people out there that have herpes and don't know it because they don't get any signs or symptoms ... or their symptoms are mistaken for something else. It's still possible to pass herpes to another person even if there is no outbreak. It's through what is called asymptomatic shedding. That means that the virus has traveled tot he surface of the skin and is active but with no signs or symptoms.



If you came to this forum to find out if you have herpes ~ nobody can tell you one way or the other. You have to go in and see your doctor and ask specifically to be tested for herpes. Since herpes is not included in the routine std testing process ~ you need to be specific and clear about what you want. If you get a flare up or outbreak you need to get in and have a culture done within 24 hours. If you wait too long then your results may come back false negative. So, don't wait! If you don't get any signs or symptoms that can be cultured within 24 hours ~ then you need to have a type specific blood test done to determine if you have herpes. Check out the testing section here:



http://members.cox.net/yoshi2me/Links/Links.htm



I know all this because I facilitate a herpes support group here in Omaha, Nebraska called Omaha HELP: http://members.cox.net/yoshi2me/Omaha-HELP/Omaha-HELP.htm



We are sponsored by the American Social Health Association which is also the National Herpes Resource Center.



I can be reached at: ***@****

Here is my bio: http://members.cox.net/yoshi2me/MyBio/MyBio.htm



Best Wishes,



Angela

[silverbeach]

Wow...





Hmmm..





if it is herpes....it really isn't the end of the world..



try this...



convince a doctor to do a intra urethral herpes culture when pain and discomfort is at worst.



Also convince doctor to do viral culture of penis glans when tingling is at worst..



Make himn scrape the skin and squeeze the area...forcing their to be any possible contaminant onto the swab..



the above tests may not be what a doctor would advise but if they are negative they will help to reinforce to you they are not herpes.  if positive....then well you got it.



perform tests twice each..if all test are negative....start anti depressants and try to chill for a few months and see what happens.





i understand what you have gone through as my problem and feelings mirror yours' but unless their is proof either way you still need to move on.  Yes herpes can be hard to diagnose and when ypou have symptoms that resemble what the web sites state then i see your points.



keep in mind..several negative tests and many atypical symptoms probably meens NO herpes!  if you get a positive herpes culture and only then will you be sure it is.. so what can you do. What will convince you it is not herpes??



Good luck

[helpme23]

I got so worked up over some irritated hair folicals in my pubic area that I thought were herpies (herpes) that I actually convenced myself the my scrotum was burning.  Then I realized that I really could not tell it it was burning or I felt an abnormal cooling feeling.  Either way when I forgot about it I did not have the feeling any more, only when I consentrated on it.  I went to the doctor and he looked at the spots I had and said it was irritated hair folicals.  I could have sworen that I had every symptom that I read about herpies (herpes) on the internet.  I even told my doctor that the last time I had sex was four months prior and I asked him if I was to get herpies (herpes), I should have had an outbreak already right?  He said, yes I should have. Since then I have had no burning or cooling.  I am hear to tell you that your mind can make a lot of weird things happen physically to you.  I know, trust me, because I am a worrier.  



Just like the other person said, some of these companies are out there to sell you their drugs and want you to believe that you have herpies (herpes) even if you have no symptoms.  Some like the CDC or other organizations are wanted to scare people to stop the spread or just cover themselves up from possible legal implications from misdiagnosis.  You could also say that people with cancer either have extreme symptoms, mild symptoms, or non at all.  That doesnt mean that if you fit into any one of these you have cancer does it?  You have to think, Dr. Rockoff does this for a living and he should know a thing or two about herpies (herpes).  There are a lot of other mild problems that can cause symptoms that people think are herpies (herpes).  I know, I had that problem.  Just go to your doctor and get checked.



The point is you cant let any thing like this rule your life.  Dont let your mind wonder.  Internet health site addiction doesnt help your problem, it only makes it worse.  See your doctor, he or she is probably very competant and if he or she can tell you no you dont have herpies (herpes) or yes you do have herpies (herpes) then you have to believe them.  They are the experts.



Thank you.

[helpme23]

I got so worked up over some irritated hair folicals in my pubic area that I thought were herpies (herpes) that I actually convenced myself the my scrotum was burning.  Then I realized that I really could not tell it it was burning or I felt an abnormal cooling feeling.  Either way when I forgot about it I did not have the feeling any more, only when I consentrated on it.  I went to the doctor and he looked at the spots I had and said it was irritated hair folicals.  I could have sworen that I had every symptom that I read about herpies (herpes) on the internet.  I even told my doctor that the last time I had sex was four months prior and I asked him if I was to get herpies (herpes), I should have had an outbreak already right?  He said, yes I should have. Since then I have had no burning or cooling.  I am hear to tell you that your mind can make a lot of weird things happen physically to you.  I know, trust me, because I am a worrier.  



Just like the other person said, some of these companies are out there to sell you their drugs and want you to believe that you have herpies (herpes) even if you have no symptoms.  Some like the CDC or other organizations are wanted to scare people to stop the spread or just cover themselves up from possible legal implications from misdiagnosis.  You could also say that people with cancer either have extreme symptoms, mild symptoms, or non at all.  That doesnt mean that if you fit into any one of these you have cancer does it?  You have to think, Dr. Rockoff does this for a living and he should know a thing or two about herpies (herpes).  There are a lot of other mild problems that can cause symptoms that people think are herpies (herpes).  I know, I had that problem.  Just go to your doctor and get checked.



The point is you cant let any thing like this rule your life.  Dont let your mind wonder.  Internet health site addiction doesnt help your problem, it only makes it worse.  See your doctor, he or she is probably very competant and if he or she can tell you no you dont have herpies (herpes) or yes you do have herpies (herpes) then you have to believe them.  They are the experts.



Thank you.