2 week follow up/possible prodromal/blood in stool

[worried333]

Hello, I posted about a week and a half ago:

"I am 26, male, and I recently (june 22/06) had unprotected oral sex, both giving and receiving, with another man who later (same night) informed me that his boyfriend of 13 years has genital (hpv2) herpes. He also swore they are VERY careful, and never have sex during or leading up to outbreaks. He's never had an antibody test. I realized afterwards I had a canker sore too."

And I would just like your opinion as to my current status. As of tonight it will have been 14 days since possible contraction. I've had no lesions. I have had a lot of fatigue that involved wanted to fall asleep during the day. I was taking lots of mid-day naps due to the tiredness. It's a strange kind of tired. Watching a movie I might totally forget about it, but sometimes reading was very difficult/hard to focus. That fatigue started 36 hours after possible infection. I've also had a lot of achey (achy) pain in my groin/waist/butt/lower back area. That pain started about 4 days after possible infection, and it comes, goes, and moves around. Sometimes I try to alleviate the fatigue and the aching with Tylenol. About 3 days after possible infection I felt hot like I had a temperature. I bought a thermometer and it kept putting me around 97.5-98.6, so maybe I was inventing it? My fatigue seems to be getting better, and yesterday I was almost convinced it was gone, but noticed it again late at night (it feels different than normal tiredness). I do feel almost normal again.

Also, for the last two days I've had bright red blood in my stool, also on the paper when I wipe. It doesn't fill the toilet with blood, but it does create about an inch-wide stream that runs down the bowl. The blood is not mixed with the stool. The stools have also been rather small and very hard. I've had blood in my stool before (few months ago), and recently (June 20) had a doctor jam a camera up there, and they reported nothing except a benign polyp that they removed.  The blood from those incidents was in larger amounts though.  I'm paranoid about blood in stool meaning that I may have had no visible lesions but it's secretly been existing inside my rectum. When I deficate (in the last two days) it is painful at the moment the stool exits as a kind of quick sharp exit-pain and then it goes away immediately. I have no pain in that area otherwise, no itching/etc, except for the dull groin aching in general. My stools have been rather light brown. I think I've been deficating less than usual, and the stools tend to be small and compressed, like they had a hard time getting out. A few times during this period I had diarrhea, but no more.

I saw another doctor 4 days after possible contraction. He said that if I had no lesions in 14 days, to relax and move on. Having reached that 14th day, I'd like to know if I should follow his advice, or be continually stressed about these symptoms as a possible prodromal, or if the blood indicates some kind of internal herpes.

[H. Hunter Handsfield, M.D.]

Basically, you have 2 symptoms:  fatigue and rectal bleeding.  Neither suggests herpes.  And if you didn't have anal sex, there is no way to acquire herpes or any other anorectal STD.  I really cannot comment on the possible causes of fatigue; there are too many possibilities (mostly not sexually acquired), both physical and emotional.  As far as rectal bleeding is concerned, the most common causes are hemorrhoids and anal fissure.  Had you had receptive anal sex, I would be concerned about sexual and about various STDs (but not herpes, becausee rectal herpes typically is very painful.

So follow through with your provider if either symptom persists.  But I see no reason to be concerned about STD, based on both your symptoms and the low risk nature of your exposure.

HHH, MD

[monkeyflower]

Wow, that's a really detailed list of symptoms. I think you're dwelling WAY too much on this. First of all, all of this sounds like anxiety (except for the rectal bleeding, which since you've recently been checked is probably a hemmorhoid or fissure, caused by the hard stools you mention). And I'm not sure why you're so freaked about herpes anyway, or why you'd think you'd contract HSV2 genitally from oral sex. The chances of that are nil.

I think you might do two things. First, seek counseling for your anxiety, and talk to your doctor as well. The lethargy could be a symptom of depression, and you may need medication for both anxiety and depression. Second, try to stop focusing on perfectly normal bodily functions. Instead, invite friends for dinner; do something that gets you out of the house and gets you involved in something. Take in a yoga class, learn to paint, whatever. And eat more fiber and drink more water, and your hemmorhoid or fissure and the rectal bleeding will no doubt clear up.

Okay, I know I'm oversimplifying and it sounds way perkier and more obnoxious than I intended, but you get the idea. What I'm trying to say is that when you're actively involved in something, in "flow", you tend to forget your symptoms and just LIVE. That's the key to a healthy, happy life :-)