Zoster

[bryan999]

I'm a 36 year old male and am extremely concerned. About seven days ago I noticed a single small red bump on my upper right thigh.  It was somewhat itchy.  Then about three days later the area developed into a rash with several red bumps.  The bumps aren't really really clustered together nor are they in a row, they are spread out within the area of the rash about 1/2 to  1/4 of an inch apart.  The area was itchy and somewhat painful if rubbing up against my pants.  

I went to my doctor, he said it was shingles.  He prescribed Valacyclovir.  I had actually put Cortisone on it starting a couple nights ago and this seemed to help a little.  

I have been in a monogamous relationship for several months.  Both my girlfriend and I were tested for STD's about 3 months ago - including HSV IGG test - and were clear.  I did have a sexual encounter outside the relationship about 5 1/2 weeks ago that was protected vaginal for about one minute and unprotected vaginal sex for about one minute or less.  I got tested again right after this and was clear (including IGG).

I am certain my girlfriend was faithful, and as we were both tested 3 months ago, I assume there is no risk of HSV transmission there?  Also, the exposure five weeks ago seems low risk given that it was one-time, extremely brief, and also I was extremely vigilant as to any changes in my genital region after the exposure and did not see anything.  Given the lesions appeared almost five weeks after the exposure, I assume I can rule out this as possible HSV transmission?

After a few days on the medication some of the red bumps have formed very small whiteheads (they are small) and one seems to have a blackhead which I assume is a scab.

So, is there any risk that the rash/lesions were misdiagnosed as Shingles but it is really HSV?  I have spoken with the doctor who seems assured it is shingles not HSV.

[Terri Warren, RN, Adult Nurse Practitioner]

Most outbreaks (if people are going to have them with first infection) occur within 2-10 days, with the average being 5.5 days after the encounter.  It sounds like it might be too late for a PCR, yes.  

Yes, most recognized first infections in males and females are specifically in the genital area, but there are exceptions to this.

Terri

[bryan999]

Is assume it's to late to pcr?
It's my understanding that hsv would present itself in the vast majority of cases with 2-3 weeks.  Also that an initial outbreak would most likely involve the genitals in males.  Doesn't this make hsv very unlikely in my case?

[Terri Warren, RN, Adult Nurse Practitioner]

No clinician, including me, can look at a rash and sort out shingles from herpes in the situation that you describe.  If someone presents to my clinic with a rash on their chest that circles around their body and stops at the midline front and back, I can likely say that is shingles, yes.  But not in your situation.  He definitely should have swab tested the area for both zoster and herpes simplex.  

Herpes seems unlikely in your situation, with the testing that you have, but I can't completely reassure you of that because of the other contact.  Condoms reduce the risk of herpes acquisition by 30-50%.  They are not perfect.  

You could test again 4 months from the contact or if you get more symptoms, have a PCR swab test done to gain more information about the nature of the rash.

Terri