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STDs (Expert Forum)
4 mos. and still no diagnosis. HSV?
Answered by
Edward W Hook, MD - HIV Prevention, stds
Welcome to the STD Forum, which is intended only for questions and support pertaining to sexually transmitted diseases other than HIV/AIDS, including chlamydia, gonorrhea, syphilis, human papillomavirus, genital warts, trichomonas, other vaginal infections, nongonoccal urethritis (NGU), cervicitis, molluscum contagiosum, chancroid, and pelvic inflammatory disease (PID). All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.
4 mos. and still no diagnosis. HSV?
by JT_worried, Aug 16, 2009 08:00PM
Hi,
I’m a 22yo male. 4 months ago I had unprotected vaginal & oral sex with a symptom-free girl. A week later I developed folliculitis on my thighs and a single isolated blister on my penis shaft. My groin lymph nodes were painful, and my scrotum was red and tingled, which has continued to this day. The blister progressed from a swollen red bump to a painful weeping blister over 10 or so days. No itch. GP thought it wasn’t anything serious, saying that herpes "always" appeared as a cluster. No swab was taken. Tested clean for all STDs.
4 wks: Developed 2 tender, red bumps on edge of lip that didn't blister and disappeared within 4-5 days. I've never had a cold sore before. Pimples?
9 wks: Tingling continued. HerpeSelect neg. for 1&2. Given suppressive acyclovir just in case.
12 wks: Leg pain for 2 days, then a painless red bump appeared on penis shaft for 1 week. Almost looked like an inflammed Fordyce spot -- is that possible or common? Dr. said not swabbable.
14 wks. HerpeSelect again neg.
15 wks: Neck pain for 2 days, followed by a horrible sore throat and 2 painless lesions on palate for 1 wk. Negative for strep.
16 wks: Stopped taking acyclovir suppressively.
17 wks - now: Started feeling deep, aching pain in my testicles, lymph nodes, leg, buttocks, and lower back. It's been about a week now. Seem to be urinating a lot, and never feel "empty." Noticed a slightly swollen dime-sized red patch near the area of the original blister on my penis shaft, but it's connected to the scrotum's continued redness so I'm not sure if it's new or notable.
1. Is herpes likely? Or could these symptoms be caused by other problems? (Yeast? Bacteria? Prostatitis? Stress? Behcet's?) I've been treated for eczema, etc. to no avail.
2. Can I rely on my 14-wk neg.? Or could I have delayed seroconversion with the 6 weeks of acyclovir, as Dr. Hook mentioned in a post was a recently-researched possibility? (And is that study online somewhere?)
3. Any other advice?
Thanks, doctor.
I’m a 22yo male. 4 months ago I had unprotected vaginal & oral sex with a symptom-free girl. A week later I developed folliculitis on my thighs and a single isolated blister on my penis shaft. My groin lymph nodes were painful, and my scrotum was red and tingled, which has continued to this day. The blister progressed from a swollen red bump to a painful weeping blister over 10 or so days. No itch. GP thought it wasn’t anything serious, saying that herpes "always" appeared as a cluster. No swab was taken. Tested clean for all STDs.
4 wks: Developed 2 tender, red bumps on edge of lip that didn't blister and disappeared within 4-5 days. I've never had a cold sore before. Pimples?
9 wks: Tingling continued. HerpeSelect neg. for 1&2. Given suppressive acyclovir just in case.
12 wks: Leg pain for 2 days, then a painless red bump appeared on penis shaft for 1 week. Almost looked like an inflammed Fordyce spot -- is that possible or common? Dr. said not swabbable.
14 wks. HerpeSelect again neg.
15 wks: Neck pain for 2 days, followed by a horrible sore throat and 2 painless lesions on palate for 1 wk. Negative for strep.
16 wks: Stopped taking acyclovir suppressively.
17 wks - now: Started feeling deep, aching pain in my testicles, lymph nodes, leg, buttocks, and lower back. It's been about a week now. Seem to be urinating a lot, and never feel "empty." Noticed a slightly swollen dime-sized red patch near the area of the original blister on my penis shaft, but it's connected to the scrotum's continued redness so I'm not sure if it's new or notable.
1. Is herpes likely? Or could these symptoms be caused by other problems? (Yeast? Bacteria? Prostatitis? Stress? Behcet's?) I've been treated for eczema, etc. to no avail.
2. Can I rely on my 14-wk neg.? Or could I have delayed seroconversion with the 6 weeks of acyclovir, as Dr. Hook mentioned in a post was a recently-researched possibility? (And is that study online somewhere?)
3. Any other advice?
Thanks, doctor.
Doctor's Answer
by Edward W Hook, MD, Aug 17, 2009 01:57PM
, Aug 17, 2009 01:57PM
Sorry for the delay in answering your post. Missed it yesterday.
The first lesion you mention, on your penis which evolved and then went away over 10 days certainly raises concerns about HSV. For future reference, any lesion, blister-like or not can be tested by culture or PCR. (the PCR is both far more sensitive and more expensive). While negative tests do not rule out the possibility of HSV, a positive test would be most helpful for sorting things out. If any lesions should recur in about that location, please try to get it tested by culture or PCR ASAP.
The other lesions, occurring at different locations and times really do not particularly sound like HSV. It is remarkable how, once our awareness and concern has been raised, we start to notice many skin changes and lesions that may have been overlooked or discounted in the past. At this time however, the absence of a positive test at 4 months makes it very unlikely that you have HSV of any sort although, as you point out, several colleagues have recently mentioned that it was their impression that sometimes suppressive therapy can delay development of an antibody response which would be detected by the HerpeSelect. In your case, having not taken suppressive therapy during weeks 0-9 and for the past week make this somewhat more likely.
In answer to your specific questions:
1. I think HSV is quite unlikely although what this may be is tough to say. it may be a combination of things, including a flare of your eczema and stress. You don't mention what sort of interactions you've had with health care providers but this is really the sort of thing that dealing with a good internist can sometimes help. That is where I would go to sort this out. Given the test results you mention, I suspect that may be what you are doing. If so, keep it up- sometimes these sorts of things take a while to sort out.
2. As Ai said above, I think delayed seroconversion is very unlikely. If you wish to be sure, wait till around week 20. If you choose this course, I predict the tet will be negative.
3. Only as above. Also, if you can reach the woman who you partnered with, you might discuss things with her and even perhaps ask her to be tested to help both you and herself out. Just a thought.
Hope this helps. Unlikely to be an STD. EWH
The first lesion you mention, on your penis which evolved and then went away over 10 days certainly raises concerns about HSV. For future reference, any lesion, blister-like or not can be tested by culture or PCR. (the PCR is both far more sensitive and more expensive). While negative tests do not rule out the possibility of HSV, a positive test would be most helpful for sorting things out. If any lesions should recur in about that location, please try to get it tested by culture or PCR ASAP.
The other lesions, occurring at different locations and times really do not particularly sound like HSV. It is remarkable how, once our awareness and concern has been raised, we start to notice many skin changes and lesions that may have been overlooked or discounted in the past. At this time however, the absence of a positive test at 4 months makes it very unlikely that you have HSV of any sort although, as you point out, several colleagues have recently mentioned that it was their impression that sometimes suppressive therapy can delay development of an antibody response which would be detected by the HerpeSelect. In your case, having not taken suppressive therapy during weeks 0-9 and for the past week make this somewhat more likely.
In answer to your specific questions:
1. I think HSV is quite unlikely although what this may be is tough to say. it may be a combination of things, including a flare of your eczema and stress. You don't mention what sort of interactions you've had with health care providers but this is really the sort of thing that dealing with a good internist can sometimes help. That is where I would go to sort this out. Given the test results you mention, I suspect that may be what you are doing. If so, keep it up- sometimes these sorts of things take a while to sort out.
2. As Ai said above, I think delayed seroconversion is very unlikely. If you wish to be sure, wait till around week 20. If you choose this course, I predict the tet will be negative.
3. Only as above. Also, if you can reach the woman who you partnered with, you might discuss things with her and even perhaps ask her to be tested to help both you and herself out. Just a thought.
Hope this helps. Unlikely to be an STD. EWH
One more thing. I just realized I should also mention that I had a complete blood count + mono, thyroiditis, etc. tests done during an asymptomatic period in there, and the results all came back normal.
I had one last quick question, if you don't mind -- I can't seem to find a straight answer to this anywhere. Assuming for a moment this is HSV, and given that I had relatively mild symptoms and only a single, small blister, would it take longer for me to reach the requisite number of antibodies for a positive HerpeSelect than someone who had a more typical manifestation? And if so, should I consider taking a "better" test like the Western Blot?