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Herpes, Strep and Uncertainty
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Herpes, Strep and Uncertainty

I am an 18 year-old male who, 2 weeks ago, had an unprotected sexual encounter with someone whom I've never known nor will likely ever see again.

The next morning, I noticed some redness, and immediately thought chafing, but was guardedly skeptical and concerned.

I went in for a doctor's opinion on the 3rd day after the encounter, and at this stage I was seeing more of a cluster of tiny bumps across the penile shaft.  They did not look superficial (they were reddened follicles), but the doctor wisely asserted that herpes cannot be ruled out.

Over the next week, a few of the bumps disappeared, and two of them enlarged to about 3-5 mm.  They would consistently go through a cycle of scab, swell, burst (revealing puss-like contents) and sit open (and very painful).  I had to make several bandages, and each removal was similarly very painful.  I would ritualistically clean the area in the shower with antibacterial soap, doing the same with my hands.  I would pat the area dry and rebandage, though just recently I'm trying to wear loose fitting clothes only and see what transpires.

During this time (3rd day-8th day), too, I was on a cycle of acyclovir.  I took three pills a day as directed for five days.  No noticeable suppression of the lesions (ulcers, perhaps) occurred.

I visited a new doctor on the 10th day with open sores present.  She was puzzled by the lack of suppression in the lesions, and noted that herpes may not be the culprit (though she did not explicitly diagnose "no herpes," just so I don't misrepresent her) if no healing had occurred.  She took a bacterial culture of the area.  On Friday I was called and told it came back negative, but just today (Monday), I was called and told that strep had grown.  I received a prescription for penicillin (2 tablets 2 times a day for 10 days), and have just now taken the first day's dose.

After the 10th day visit, by the way, my gland swelling and groin pain had more or less subsided, but the cycle of the ulcers "opening" and "closing" continues on a 12-hour basis.  Here I am on Monday (the 15th day, I believe), and am still in significant pain, with the ulcers showing no decrease in redness or irritation (I'm trying to detect the itch/burn characteristic of herpes, as I've experienced outbreaks of HSV-1 on my face, but rarely feel anything but a sting from chafing/soaping/etc., or an itch from bandaging).  

Sorry for the gratuitous parentheses.  More to the point:  I'm posting this information to get a second opinion, though I know no diagnosis can be made via text/internet.  I'm wondering if strep could have infected an incubating herpes, but I still think back to when I first saw the symptoms appear non-superficially.  Conversely, I also know that the first herpes infection can be very steadfast and very intense compared to later infections.  Could strep be capable of such ulcers if left untreated (at least until now)?  My intuition says no, but I'm not as medically literate as, say, a doctor.

Oh, and I have had one prior sexual partner, which was over two years ago with no symptomatic sexual health problems.  This new instance was a frivolous, intoxicated "one night stand."  I'm shamed, but just generally concerned about my health.

Thank you for your extensive efforts on this website and these forums.  I would really appreciate some words.

Would be glad to provide any additional information, but that's quite the helping right there.

Cheers
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10 Comments Post a Comment
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101028_tn?1348750963
At this point just to cover the bases - I'd get a baseline type specific herpes igg blood test for hsv1 and hsv2.  I'd then repeat it in 3 or 4 months.

Meanwhile - yes strep can cause issues in the genital area. You can also develop fungal infections too from the treatment. Continue to follow up with the dermatologist as needed if this doesn't clear up with your current treatment.

I agree that skipping the bandages is the best idea. Change your underwear several times a day if needed instead ( if that's a feasible option  of course ).  

grace
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Avatar_m_tn
This is a very interesting scenario.  As someone who is unsure of their HSV status, I think you should post this to the Doc's on the expert board and see their opinion.

Very interested to see how this turns out, please keep us posted.
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Avatar_m_tn
Further follow-up remarks:

I went to the doctor today, and she noted that the sores had not quite begun to heal, even after early antibiotic treatment.  She gave me an antibiotic ointment to be applied three times a day, so I'm going to continue with bandaging as long as I have this ointment.

In conjunction with the penicillin, the doctor is pretty confident in the sores completely healing, at which point I'd seek out some STD tests.  The herpes blood test, by the way, is apparently not very effective until 3 or 4 months, so I wouldn't seek one out just yet.  Same goes for an HIV test.  I could have gotten a viral culture, but that would have cost $150, and I'm a college student.

I'll be in touch, and will likely post on the doctor forum, though I originally thought that's what I was doing.
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101028_tn?1348750963
Not sure ewh/hhh's advice will differ from mine at all.  I'm also guessing you'll get the - you've seen your provider we can't do much better for you reply too ;)  I'm saving you $15 or whatever it costs to post to them.  You had a + bacterial culture for strep  - not really any reason to suspect anything else though certainly you can have more than 1 thing going on at a time down yonder.  

The reason I suggested a herpes test now is so that you have a baseline. Useful for determining if this is just your first obvious reactivation of a prior herpes infection or not.  Just because it's the first time you've been noticing symptoms down yonder doesn't mean it's a brand spankin' new infection for you.  Also since a viral culture wasn't done from the sounds of things - getting a baseline might help you if this actually is hsv1 genitally though even if your blood test comes back as hsv1 negative now and hsv1+ in a few months that doesn't tell you if it's an oral or genital infection ( or both ).

When you are at home and can do so - skip any bandaging and go bottomless when you can. Cool, dry air is best to retard the growth of bacterial/fungal/viral infections in the genital area.  I can't understand trying to keep ointment from going thru your clothing and showing up during the day though certainly.  

grace
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101028_tn?1348750963
also did they suggest testing for syphillis (syphilis) at all?

grace
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Avatar_m_tn
They offered me all of the tests, but didn't make any suggestions.  I don't think the doctors were particularly inclined towards syphilis.  They were thinking herpes because of my description of scabbing, opening, etc. that might be characteristic of herpes (though we now know strep is the chief culprit of the ongoing infection, regardless of any other infections).

I'm only less concerned about syphilis because I couldn't really compare my two sores to the ulcer/chancre characteristic of early syphilis.  While I could have an asymptomatic infection (hence future plans for testing), the chancre is typically described as larger and (somehow) relatively painless.

I'll likely be back in the doctor's office for a "where to go from here" discussion once this infection clears up (I'm so glad I'm a student; the health center is very helpful and free for simple visits, and prescriptions have been relatively cheap).   By the way, after just a few applications of ointment/rebandaging (prescribed for every 8 hours), I'm noticing one of the sores decreasing in size noticeably (the other, not so noticeably just yet), and I'm still on penicillin.

I might just avoid posting on the doctor's forum.  I guess it is just posting for an opinion and certainly not a diagnosis.  Thanks for the suggestion.

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101028_tn?1348750963
btw I meant I CAN understand covering it so ointment doesn't get on your clothes. Teach me to post at 3am ;)

Follow up testing for peace of mind can be invaluable so don't hesitate to do so in a few months. If you end up testing positive though for hsv1 or hsv2 - you won't have any idea if it's a newly acquired infection from this encounter or not. Just keep that in mind.

grace
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Avatar_m_tn
Well, unless I acquired herpes from my 2 years past sexual encounter (and it was extremely asymptomatic), I can pretty much deduct the source of my positive results, should they come back that way.

Quite worried about it, actually.  Herpes is pretty atypical in an 18 year-old.  It would be unfortunate.

Infections are noticeably better and less painful from ointment/bandaging and taking antibiotics.  I don't see how any infection could survive that, anyway.
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101028_tn?1348750963
Actually herpes is not the least bit atypical in a 18 year old.  It's pretty darn common. Hsv2 is in 20% of your peers and hsv1 is in 30% of your peers orally and 60% of your peers genitally.

I've had hsv2 since I was 19 years old. Trust me - it's not the end of the world by no means.  It's barely a blip on the radar screen of life once you get past the IDEA of having it.

grace
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101028_tn?1348750963
correction - it's not 60% of your peers have hsv1 genitally. It's about 15-20% or so.  It's 60% of all newly diagnosed herpes infection in your age group are due to hsv1 genitally.  Still tired.

grace
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