Could all this be caused by herpes?

[Joe239]

Dr. HHH congratulations on your recent award. Received unprotected oral sex from a female, we kissed and I touched her genitals with my hand back in Oct 2009. a few days later experienced some burning and tingling in the groin area specifically in the urethral opening. Self medicated with doxy. Contracted conjuctivitis 2 weeks later. Had some discomfort(stinging) before and after urinating. Also underside of shaft was sore/rash as was the tip. No signs of blisters or obvious lesions Tested 4 weeks post exp (HIV, HSV1&2, Gon, Chlam, Hep b &c ) all neg. Started to get pain in lower back, burning/tingling sensation started in thighs buttocks and legs early in November. Frequent urination and discomfort started again in Dec along with cloudy urine. Neg urine test no WBC, bacteria or blood. Was put on doxy for 2 weeks. More than anything the burning/tingling in my thighs, continued along with calves, buttock, lower back/tailbone even felt it in my face, arms and shoulders. I had some small cuts on my tounge in Nov and above my lip. Derm said I have had folliculitis which I have had it seems forever. I continue to have the burning (icy/hot/menthol feeling) in all those locations. I get electric shocks that itch but they don't stay long enough for me to even itch them and my rectum feels like it is raw/burning. I have tested at 12 weeks IgG, 13 weeks WB, 15  weeks immunoblot and 17 weeks IgG all type specific and all negative.  The person I was with went and got tested and she fouund out in January she is HSV1 1.35+, & HSV 2 >5+. What are the chances this is post herpetic neuralgia? usually with herpes zoster (shingles)) What are the chances I have not seroconverted? Could I have herpes in both locations since this would be my primary outbreak?  How accurate are the combination of these test? What else could be causing this neurothopy? Should I tested again at 6 months, 1 year?  Have you ever seen a person serroconvert after 17 weeks negative?

[Edward W Hook, MD]

Dr. Handsfield and I share the forum.  You got me.  FYI, the reason we share the forum is because we have worked together for nearly 30 years and while our verbiage styles vary, we have never disagreed on management strategies or advice to clients.  (And thanks on his behalf for your kind words regarding the Thomas Parran award. he is certainly deserving).  Now, on to your questions.

The exposure of concern that you describe involved your receipt of oral sex and your masturbation of a partner whose blood tests indicate that she has HSV-2 and may have HSV-1 although her value is in an area where false positive HSV-1 tests are not uncommon.  Subsequently, although there was not typical genital outbreak, you have had a continuous (I think, it this correct?) tingling involving your thoughts, buttocks and calves.  Such symptoms are suggestive of neuropathic pain but do not tell you what the cause.  We receive many questions about neuropathic pain on this forum and Dr. Handsfield and I are in agreement that if this ever occurs due to HSV infection, it is extremely rare.  There are numerous causes of neuropathic pain, including vitamin deficiencies, structural (back) problems, other infections and much, much more.  Given your multiple negative tests for HSV, it is unlikely that you got HSV from the exposure that you describe or that HSV is the explanation for your symptoms.  The similar discomfort in your arms and shoulders would not be due to HSV.

My advice is to have this evaluated by a neurologist,  I don't doubt that you have neuropathic discomfort but I am quite skeptical that it is due to HSV.  EWH

[Edward W Hook, MD]

No, I have shared my thoughts. It is time for you to put the iea of herpes away.  As the problem sounds neuropathic, perhaps a neurologist can help.  

It is now time for this thread to end.  Take care. EWH

[Joe239]

Thank you for your advice through out this thread. I am still having issues since this sexual encounter. That noone seems to know what is causing my discomfort. I have had an EMG done with no signs of nerve or muscle damage. The symptoms are still constant with a burning like pain in the boxer short area. I also get it on my arms as well this is what is the thing that worried me. I actually got two blisters that were about an inch apart on my arm which happened over a weekend. I could not get seen. It was like a clear fluid in them which burst and healed in about 14 days. How likely could this be herpes on my arm. The boxer short area every day has a strange feeling like tingling but almost like a wet burning sensation. I get this around my waist,pubic/genital area, buttock, thighs and even on the sides of my stomach. Does this sound like anything that could be herpes. This has now been going on for 6 months. Any thoughts?

[Edward W Hook, MD]

I understand your concnern and frustration.  Again, and as mentioned earlier, that you had contact with a partner who has HSV-2 by no means indicates that you have the infection.  Estimates are that only 1 in 10,000 exposures to infected partners who do not have active lesions lead infection and in your case, there is no evidence that you have become infected.  Negative tests and no clinical findings of infection.  My advice is to keep working with the doctor.  My impression (admittedly from a distance) is that he/she is in the process of thoroughly evaluating you and will work with you to address your concnerns.  Stick with them.  I really would not worry about HSV as a contributor to your symptoms however  EWH

[Joe239]

Will ask you to comment. Today after ejaculating my semen was a funny color brownish/red. What would cause blood (?).... to be in my semen?

[Joe239]

So I went through some extensive testing. I do not have the hard or soft copy of all the tests that were run but should be getting them soon.  all the test that were done came back negative. They did some x-rays and found my back to be in great shape for a 40 year old. Some slight degeneration but as the radiologist said that is to be expected. He did not feel that this was the cause of the burning in the lower extremities or in the shoulder area. Sugar was fine, no allergies, test for indicator of Siacs (sp?) disease was in range, ran another herepeselect test IgG at 149 days post exposure - for HSV1 and - for HSV2, I don't have all the other test; they took a lot of blood to run some16 or so test. Also had an EMG done nothing at the inital testing stood out. I still continue to have this burning in my lower extremities thighs, buttocks, back/tailbone, calves  and waistband area. It just feels like anything that touches my skin when it feel like the sunburn feeling just hurts enough to make me feel off and to lose my focus. Also feel it in my lips shoulders and arms. I continue to get a metallic taste in my mouth at times and the tingling on the tongue and lips with no sores on the exterior sometime on the inside of my mouth never in the genital area that I have seen. I am at a loss. I just know something is not quite right but so far all my test say I am fine,  Would a chronic yeast (fungal) infection cause any of these symptoms? The only antibiotic I have taken was doxy for 2 weeks. I have a few more test that I will report on as well as the final results of an EMG. I know there have been others who have had similar symptoms who may benefit from reading the thread.

Any further thoughts on this? I only ask this because all this stuff started  to happen after a sexual encounter with a person of + HSV status and so I I believe in my mind that somehow all this is related to that exposure. Whether it is HSV or something else. How about all the information that says HSV! is missed 10 % of the time. I have tested 7X with every known blood test.

Last thought ...If I do post again it will only be with results. I realize online medical help has its limitations but can be very useful. Like I said before I am at a loss and very frustrated. I would just like to know what is going on with my body.  

[Edward W Hook, MD]

Sorry, not much to add.  I understand your frustration.  Please understand however that when you are dealing with such a common problem, it is not suprising that many people with unexplained neuropathies are found to have HSV. In your case, there is no evidence of HSV either (you were expsoed to a partner who had HSV-2.  This does not by any means mean that you have HSV-2.  Most persons exposed to partners with HSV do not get HSV).  I worry that your focus on HSV would keep you from finding out what the real culprit is here.  EWH

[Joe239]

Dear Dr Hook,

This week I am goingto another doctor who is familar with herpes. I looked at an old thread from "Apachedriver" and here is a person who has is not the exact same symptoms they are very close. He did not test + on an IgG for about 1 year but did test on a WB not sure how long after exposure. But the burning pain and tingling pain that he writes about is exactly what I am feeling. I was monogoumous for 23 priror to this one sexual encounter how can these symptoms be so identical to other and he is not the only one. The strange this for me is my test have all been negative so far... which would logically conclude that I do not have this... In this other poster case he kept testing positive on the IgM. I realize the IgM is considered a bad test becasue other antigens interfere with this teat. But what explains this nuerological pain,. I can guarantee it is real... why it is there I can only see one root cause.... I have been on anti depressants which have not help I have sought counciling which does help the mental aspect of couping but it does not take away the pain.

I am not sure where to go with this but I think there is more nuerolical pain with HSV 1 & 2 than has been documented in medical journals. I realize it is hard to conclude that HSV woudl account for all this pain because so many people have HSV but in a peson like myself who has tested negative prior to this exposure what else could it be. I realize I am still testign negative but something  is happening here and I just think it has to do with HSV since it is all ove rmy body.....Any advice when I see the doctor other than my history.  

[Joe239]

I have an appointment with the neurologist in a couple weeks and I plan on getting tested again for HSV plus some other blood test to check vitamin levels, and to explore other causes. I will check back in in two or three weeks with reults.

[Edward W Hook, MD]

Experience with post-herpetic neuritis following herpes zoster infection (chicken pox) suggests that antiviral treatment has no role in management,  The pain associated with neuropathies is treated with other sorts of medications.  

Yes, as I said, the combination of negative tests makes HSV unlikely.  EWH|

[Joe239]

Thanks for the quick reply. I know that sometime a false postive is in the low range under 3.5 but I thought that was strickly for HSV2 when a person was HSV1 +. I did not think HSV2 would affect the titers for HSV1. I also understand that the neuopathic pain is thought to be rare with HSV, but I have seen on this forum where it seems to exist more so than it is probably documented. I am/was a very healthy person with no medical issues until this iccident. I can trace back to the exact date when this started to happen. I have an appointment to see a neurologist coming up. Is there any treatment for neurological pain associated with herpes or even in general? And given the multiple negative test and the combination of IgG, immunoblot and WB does that give a higher degree of assurance than just one test alone?