Anal Herpes

On March 6 I had a rare anon encounter with a male. He rubbed his unprotected penis on and around my anus and poked it into the area an inch or two away from the opening itself as we simulated intercourse for a minute or two. He also rimmed me first for a minute without entry there either. There was a significant amount of his saliva on my anus the whole time from this. There was no penetration though. I didn't engage in oral and he only went down on me for a minute or two. He ejaculated under my scrotum (just above the anus). There was no penetration from either of us. When I got back home a half hour later, after going to the toilet, I wiped and noticed a small pink dot on the paper which I guess meant a slight abrasion, but I could have did that at that instant.

Then on March 17 (12 days later) I notice a small red area (like a scratch) on the very top of my anal area about .5 inch long and the area seemed dry. On March 19 the whole area around the anus was unbearably itchy with noticeable redness, but there were no blisters, sores, bumps, papules, etc, just bad itchiness and some dry red looking skin. The red skin isn't flaking, chafing or anything. Also, on March 19 I noticed significant swelling of the lymph nodes on either side of my groin and also a dull persistent ache in the area around the nodes. But no blisters or sores etc.

March 23 (5 days with itch and sw groin nodes) and I still have the same symptoms: redness and persistent, significant itching (bad at night) around the anal area (without bumps, rash, blisters, sores, nodules, papules discharge, wetness). I still have swollen lymph nodes on either side of the groin too. I have and have had no fever or flu-like symptoms, no fatigue, urinary symptoms, pain, diarrhea,  etc.

March 24, there was a stinging in the shower near the anus that felt like paper cuts but no apparent lesions. I hear sometimes this happens with herpes. But would I have swollen glands and itching all week long before the lesion stage starts? Could this be atypical?

[H. Hunter Handsfield, M.D.]

First, if you have not seen a health care provider, you need to do that; it is a far more reliable way than any guess I can make about whether you have herpes.  If nothing else, you need professional assessment to know for sure whether you have lymphadenopathy (lymph node inflammation) in the groin or anywhere else.  Self-assesssment by a non-health professional is extremely unreliable in judging lymphadenopathy, so I'm not sure you have it.

But if you do have lymphadenopathy, there are too many potential causes for me to reliably guess at the cause.  You are right that herpes normally would cause lesions before (or simultaneously) with lymph node inflammation, but there probably are plenty of exceptions. The scratch-like mark is atypical for herpes, but probably it was a possibility; and the subsequent stinging/paper cut symptoms also are compatible with that diagnosis.  Syphilis also is a concern for your symptoms.  On the whole, though, the most common causes of groin lymphadenopathy have nothing to do with any STD, especially minor infections or inflammation of the legs or feet, such as folliculitis.

Bottom line (pun not intended but sort of accepted):  See an STD-knowledgeable health care provider to for diagnosis, probably to include testing for both syphilis and herpes.  And while you're at it, have an HIV test; not because that particular exposure was especially high risk, just because you're a man who (sometimes) has sex with men.

Good luck--  HHH, MD

[willy55]

Thanks HHH,

When you said the paper cut feeling I got a week later was "compatible with that diagnosis"... did you mean compatible with the diagnosis of it being not normally typical for herpes, or compatible with the diagnosis of herpes?

Something else I should have mentioned. I have a white ring around the anal area, that looks like flour residue. I am going to clinic tmmmrw.