Herpes confused/HPV

Dear Drs.

Happy New Year.

Recently asked a question in both the HIV expert's forum and the HC Forum. The facts are set out there already but summarise:

1. The 6-7 pimple like sores appeared 4 days after exposure in the pubic hair area on the left say an inch or 2 from the genitals. They were red at the base and round and filled with white 'puss' colour which when squeezed flowed with blood. I can't say for sure if there was hair coming out of them but they felt deep in the skin. On the right closer to the genitals (1/2 an inch may 1) there were 3 other sores although these were not pimple like and didn't hurt from what I recall. There was a small cut/abrasion/lesion (1-2mm) and the very top of my penis but it looked different from the other sores and I thought it was from rough masturbation the previous 1-2 days.  Following the anti-viral and anti-biotics the sores have cleared although redness and small 'dots' remain were the puss filled sores were. It's now 16+ days since they appeared (the cut on the penis totally disappeared a few days maybe a week ago).

2. The PCG diagnosed it as a skin condition and was going to proscribe me antibiotics but referred me to a dermatologist for separate HPV infection who then confirmed the HPV and clinically disagreed with the PCG on herpes - treatment summarised in HIV thread.

Questions:

1. Should I question the diagnosis?
2. I keep thinking the cut on the penis could be the site of inoculation considering the brief unprotected part of intercourse but sores should be in the area?
4. Could the antibiotics have helped if not HSV?
3. I don't want to transverse the other threat but the HSV2 diagnosis has me super worried about HIV infection (1-5 fold increase). My risk was detailed as 1-1000 but wondering if this summary changes.

[H. Hunter Handsfield, M.D.]

Welcome to the forum.  I agree with the replies you have already had form Dr. Hook and on the herpes community forum.

Your symptoms and your description of your genital lesions are not typical for a new HSV infection; both their nature and locations are wrong.  As for HPV, that's an impossible explanation for lesions as you have described.  Also, new HPV lesions (warts) typically don't show up until 6-9 months after exposure and never before 1-2 months.  To your specific questions:

1) I see no reason to question your doctor's diagnosis.

2) Cut or no cut, this isn't herpes.

3) Antibiotics have no effect on herpes, but often would help clear up folliculitis or other superficial bacterial infection.

4) You don't have herpes, so this isn't a realistic worry.  Even if you happen to have asymptomatic HSV-2 (which is not causing your symptoms), that would double your risk of HIV if your partner had HIV, but it is statisticlaly unlikely she did. And double risk doesn't really mean much anyway when the HIV risk is very low to start.  If we guess this exposure carried an HIV risk of 1 in a million (which probably is about right) doubling that risk means one chance in 500,000.  In other words, forget it.

Now looking at your comments below, I'm glad to see you understand about HPV; that wasn't clear from the title of your question.  Personally, if I were in your situation, I would continune unprotected sex with my wife without fear of giving her herpes or anything else.  But if you feel you would prefer to be abstinent for 3 months, that's your choice.

I hope this has helped.  Happy new year-- HHH, MD

[InAsia101]

Question the dermatologist's clinical diagnosis of herpes2 to be clear. I'm not concerned about the HPV having read your very useful information here.

Also - how should I proceed over the next 3 months while I wait for the test. I'm thinking total abstinence.

[H. Hunter Handsfield, M.D.]

See above.

[InAsia101]

Sorry Dr, my question perhaps wasn't clear. I attended my PCG in relation to the sores I thought may be herpes. He diagnosed them as non-herptic but diagnosed 3 entirely different nodules/warts on my penis as HPV (which I was totally unaware of). He then referred me to a dermatologist for treatment of the HPV. This is probably from an encounter 6 months ago.

I then attended the dermatologist that afternoon and he then treated the warts (3) with cryo treatment but then to my surprise proceeded to clinically diagnose me also with herpes in relation to the other sores in the pubic area (and the cut/abrasion) and proscribed me with antiviral medication and I have completed the course. So I have a standing herpes diagnosis from the dermatologist which I wonder if I should question. I think I'll have to wait 3 months unless new sores appear and hence my reluctance to engaged in any sex.

I returned to the PCG as I had a sore throat explained this and he said he was surprised as he hadn't seen it there before and he proscribed me antibiotics for the sore throat - I also completed the course. I thought perhaps it could be a non-primary out break from an earlier encounter that co-incidently turned up 4 days after this one but from what I have read it doesn't appear in multiple place across the mid line (which I understand runs down the middle of the body). It's now 2 and a half weeks since the infection and there is still redness where the pimples were and a small red dots where the pimples were.

Apologies for the confusion - does this clarification change any of the above?

Many thanks

[InAsia101]

Sorry I don't mean to test your patience Doctor but some further points:

1. there are remnants of 6 clustered sores (red spot with redness around it) on the right in the pubic area, there are around 4-5 on the left much closer to the shaft but not on the genitals in the pubic area. 1 further isolated 2 inches up on the right. There was the 'cut/abrasion/lesion' too noted above.

2. To be absolutely clear the General Practitioner/Primary Care Giver diagnosed it as a bacterial infection but referred me to a dermatologist for 3 entirely separate suspected HPV nodules on the penis. The dermatologist dealt with the HPV but then after a brief examination diagnosed herpes for the sores described (and cut) and proscribed antivirals (course completed). So I have a herpes diagnosis but no culture was taken. So I have 2 different clinical diagnosis for herpes2 albeit 1 is from a Dr who specialises in dermatology.

3. Note I have HSV-1 if relevant.

4. Perhaps this not a primary outbreak? It sounds like this thread: http://www.medhelp.org/posts/STDs/Herpes-in-Pubic-Area-in-24-hours/show/334425 and note I had eczema as a kid. I worry that perhaps this is eczema herpeticum? I have no idea and I can't expect you to answer that of course but I came across it.

5. The condom broke. Not sure if you noted this from the other thread but may affect your estimate re HIV but Dr Hook said probably 1-1000.

[InAsia101]

I'm not sure where the eczema I had as a child was located but I do use steroid cream from time to time on my face as the skin is dry around the nose on the face. I have no idea if this is eczema.

Anyway, I recognise I am getting carried away with myself here with real fear and self loathing. It's really impacting on my holiday time with my kids, sleep etc. I wish a culture had been taken. Anyway, sorry for this.

[H. Hunter Handsfield, M.D.]

Thanks for the clarification about your recently diagnosed genital warts.

I don't understand why you're tr'ying so hard to convince me you have herpes.  In regard to the other thread you found, that one atypical case turned out to have herpes is irrelevant to judging the likelihood that you do.  Rare things happen.

If you are insistent on a follow-up blood test for HSV, I would advise you to have an initial blood test now, as well as a second one at 3-4 months.  Comparing two results is often helpful in judging the likelihood of a new HSV infection.

In any case, I'll have no further comments or advice until and unless you return to let me know your test results.

[InAsia101]

Dear Dr, the reason I'm trying to convince you otherwise is because the dermatologist diagnosed me with herpes in contradiction to the GP. That's why I'm confused and want your view.

[H. Hunter Handsfield, M.D.]

And I've made it clear I agree with your GP, not the dermatologist.  Accept my reassurance or not, I don't care, but this isn't a debate and I'm not going to argue about it.

[InAsia101]

Thank you doctor. I'm not trying to argue - I was just confused by the different diagnosis and wasn't sure I had made that clear. I accept your reassurance and will follow your advice.