Herpes Scare?

Thanks in advance for the service and time!

About a month ago I had unprotected vaginal sex for a couple of minutes with a women who I do not know her past sex life of. This is the only incident outside of marriage ever for 15 years. She also gave me oral sex, but also was short in duration. Just like everyone else here, I got extremely nervous and went to a clinic (4-5 days after incident). Tested for Gon, Clam, Syph, and also gave me Z pack and levoquin to make sure. Test came back negative, but they told me to finish them out just in case. I went about my business but was still concerned so I talked to a friend who takes Valtrex. I took 2 pills a day for 10 days starting from about 8 days after the incident. (I know I was not supposed to take my friends meds, but I have a GP in my neighborhood who told me the dosage he perscribes quite regulary for this type of thing).

Then at the 3 week mark (about 22-23 days) I experienced extreme itching in the upper part of my butt crack where the spine meets the crack. I itched it quite hard, and didn't try to examine it. I also had some tenderness and some very mild stinging in my urethra opening. However, I never had any burning while urinating nor do or did I have any redness or anything on my penis (i checked 20 times a day!). So this past wednesday (and still today) I was still having that itching in my crack, so I decided to have a look in the mirror, and now is why I am extremely scared of Herpes. I noticed that there were 2 red spots in that itching area. They are not connected, not bleeding, no scabs, but are like pimples that someone has scratched the top off of and are red. They are not raised, but flat and 1 of them is red and when I touch it I know that it is in the skin (why I am scared), and not just on top of the skin. In addition, there is a lot of white flaking skin around this area. My concern is that i never checked when it first started itching so i do not know if blisters were ever there or not.

Questions:
1) I noticed you said initial herpes symptoms usually show up 2-10 days after exposure. Since this itching showed up 22-23 days is that good news?
2) I also read you say that initial herpes almost ALWAYS shows up at the site where it was in contact with possibility of infection(penis). She never touched nor kissed anywhere on my backside. Is it likely initial herpes would be in this place in my butt crack?
3) Does this sound anything like herpes? The itching has been going on for a little over a week now? Could the antibiotics have caused the skin to be this dry perhaps?
4) Since I took the valtrex, would it be unusual that this showed up like 5-6 days after finishing it?
5) If I were to walk into your clinic today with these same symptoms, what would you inform me to do? I see you often say that any single encounter is very rare for someone to catch herpes, but you never know!

Thanks again for your time!!!!

[H. Hunter Handsfield, M.D.]

Of course you need to see a provider and show him/her the butt crack rash you are concerned about.  But the likelihood they are herpes is very low and your description doesn't sound at all like HSV infection.  A much more likely explanation is that the antibiotics (which you did not need) contributed to overgrowth of natural yeasts of other fungi on the skin; warm moist areas, like the buttocks crease, are where such problems typically occur.

To your questions:  1) Yes, a 3 week delay is atypical for herpes.  2) No, it is not likely this would be the site of initial herpes, unless there was genital contact with your anal area.  3) See above; doesn't sound like herpes. 4) Conceivably valtrex could have delayed onset of herpes.  But all the evidence is against it.  5) I can't say what I would advice without seeing the rash.  But I very much doubt I would recommend testing or treatment for herpes.

Bottom line (pun intended):  Take your sore butt back to the clinic that examined and treated you for proper diagnosis and treatment.

Best wishes--  HHH, MD

[sparkeler]

I don't think you have herpes and i doubt that your initial outbreak would show up on your butt if your not a gay or bi sexual male.  I do think that anxiety and guilt are causing your symptoms.  Try to relax and realize that you made a mistake like we all do and learn from this experience.  The chances of you getting infected after a one time sexual encounter even if the woman had herpes is minimal.

[nervous1helpneeded]

Thanks for your response and I LOVE your bottom Humor and Pun!!! :-)  It makes me feel much better! I know you do not have to respond again, and you sometimes go WAY above and beyond by doing so so I appreciate it in advance if you can. This is now my rational (which I know medical situations don't always follow). I have to travel the next 2 weeks and will not be in the country to see a clinic here. so...

1)Seems like my brief encounter was a VERY low risk, even if this stranger did have HSV, the statistics are low against 1 encounter this brief catching anything. (How many of your patients caught herpes the ONLY 1 time they had an encounter?)
2)The time from encounter to onset was atypical. (have you seen many initial infections take this long?)
3)the location is atypical sense her genitals nor lips even came CLOSE to this area. (How many initial infections in 30 yrs have you seen in this location?)
4)The sores still itch over 1 week after they started, I never read anything itching this long in the herpes discussions.
5)You, the expert of experts, say the discription does not sound anything like hsv, and my discription is dead on.(I know you have not seen them and can't make a diagnosis online)
6) I will do the blood test in 6 weeks just to make sure? Or do you think I should just chill and move on?

All in all the stats are PRETTY low I caught herpes. I would guess 1 in 1000? even less?

Thanks again! I will now enjoy my weekend, especially if you have the time (and heart) to reply 1 last time :-).

[littleworried]

I also had very similar symptoms (itchy crack and anus) after a similar episode.  I have been on various anti-biotics for weeks.  Doxycline 2 weeks.  Cipro 5 weeks, and an anti-inflamitory for a month.  Did not realize that the medication could be compounding the symptoms.

[nervous1helpneeded]

Dr. H,

Sorry, but could you lastly please determine if my last response sounds like a logical way to procede? I apologize that many others have "piled on" (pun intended) to my other comments. Just looking for a little professional judgement on the way I will proceed. Does it seem responsible?

Thanks again for taking the extra time to reply!

Brian

[nervous1helpneeded]

Dr. H,
Hoping to catch u one last time before I leave the country! Thanks again for checking this thread out! I just noticed that there are now 4 red raised bumps in the itching area. They too are itchy and look like red bug bites or pimples. not sore, but itchy. Does this make herpes seem more likely? When would the bumps turn to blisters if they are? Over and out! I will not do any buts, or 1 more etc....thanks

[intrest]

I see people comment on different cases here and very few actually seem to be genuine. How does one determine if something is a herpes sore ? I have heard that you can not scratch off a herpes sore if it is one and it can resemble a pimple. It doesn't have to be painful, but it very often is. would anyone care to clarify with their own personal experience.

[H. Hunter Handsfield, M.D.]

You reasoning is sound. (Easy for me to say; you have basically repeated the same reasoning I used in my initial respone.)  But see the first line of my response:  instead of relying on the probilities and my advice, see a health care provider.

HHH, MD

[nervous1helpneeded]

OK will do in a week and I am guessing the addition of those 4 bumps, 1 red don't make you all of a sudden make things catistrophic? I was all fine until these raised bumps appeared. Which I am now wondering if Candida or that yeast overgrowth and my scratching could cause these bumps to appear? Doubt you will answer this thread so low, but wanted to give it a shot. Thanks again,
Brian