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Inflammation and herpes?
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Inflammation and herpes?

Hi Doctor,
My girlfriend has hsv-2 confirmed by bloodtest. She has had a relationship with a former drugaddict 5 years ago, but she has tested negative for HIV and Hepatitis b and c.
1.In the end of sep we had unprotected sex. After that I  had some sort of inflammation on the head of penis, and the foreskin, with redness, but no spots or bumps. It lasted for two months with mild pain most of the time, and there were even soreness and itching on groin and thighs for a week or two, then it was on and off for a couple of weeks, mainly on the foreskin.
I took a yeast swab test and also hiv, hepatitis, chlamydia and gonorre on 2nd of november, all negative.
I also have felt soreness inside penis, and urinary passages or something else more inside.
Since february I have felt pain just before ejaculation, the pain goes out in a straight line to my thighs, it’s the same every time. 2 weeks ago I had negative urine test for mycoplasma genitalis and ureaplasma. They took a swab from the tip of penis and looked at in a microscope and said there was just enough organisms to diagnose it as urithritis. What do you think this could be?

2. In the beginning of nov, I think I got infected with herpes.
One week after that, I got flulike symptoms, muscleaches on thighs and buttock, soreness in the lower back, and after two weeks I got red spots/bumps on the skin beside (above) my penis, that lasted for just 3 days. That redness has come back (without bumps, just redness) several times, sometimes more, sometimes less, and sometimes its just itching w/o redness. The pain in the back of thighs has also come back.I’ve taken two bloodtests for hsv in the end of January and in april, both negative, but in January they said that an unspecific hsv test was slightly positive which could mean the beginning of an infection. I’ve also been taking a swabtest, which also was negative. How big chance is it that this is not herpes and what could it be then?

Thanks for your help
300980 tn?1194933000
Welcome to our forum.  I'll try to help.  The diagnosis of herpes can be quite challenging because the infection is both rather common and can be rather variable in the way that it presents. Thus, as a person who has specialized in STD diagnosis and care and who has published a number of papers on genital herpes diagnosis over the years, I must say that the most accurate means of making a diagnosis of herpes infection is with laboratory tests.  In your case, the repeated negative tests suggest that you have not acquired HSV.  I will address your two concerns in a case-by-case fashion and then comment a bit more.

Case 1 - September. A genital rash and inflammation that lasts more than two months is most unlikely to be herpes, particularly when it eventually goes away by increasing and decreasing in intensity over time.  Further the inflammation you describe really does not sound like HSV either.  It does not surprise me that there may have been a few inflammatory cells present on your urethral swab test- any sort of inflammation can cause this.  As to what this might have been, I cannot say.  It is the sort of thing that must be diagnosed through direct observation, and even then, many doctors may not come to the diagnosis immediately.  It sounds to be a dermatological problem of some sort.

2.  Case 2- November.  While initially herpes is accompanied by flu-like symptoms such as you report (muscle aches, etc) in about 50% of persons, these symptoms typically occur at the same time as the rash.  For the rash to follow such symptoms and all be part of HSV would be most unusual.  Is the rash that you mention in the area of the public hair?  If so, this may be folliculitis, a problem which certainly does have a tendency to recur.  

What else could this be?  As I said above, laboratory tests are the gold standard.  Culture or PCR tests taken from lesions provide the most definitive diagnosis of HSV (these tests do not require open sores or fluid to be positive- they can be taken from reddened, inflamed skin).  alternatively blood tests may be helpful.  The blood test is only about 92-95% sensitive (i.e. it misses a few infections) but the modern, type specific tests such as the HerpeSelect are quite good and reliable if they are strongly positive.  Tests that are positive at low levels are often falsely positive.  In your case, I doubt that the slightly positive non-specific test you mention represented a true infection. If it did, a specific test would be strongly positive just 2-3 weeks after the initial test.

Finally, I should point out that if your partner has HSV-2, it by no means assures that you will get it.  In clinical trials, partners of persons with proven HSV-2 become infected at the rate of about 5-7% per year and these rates can be substantially reduced with consistent condom use, avoidance of sex during outbreaks (if they occur) and taking preventative antiviral therapy.  

Bottom line, I suspect you do not have HSV.  If the rash recurs, my advice would be to seek PCR testing.  As far as the blood test, if a repeat is not strongly positive, then I would not take this as evidence that you have HSV.

I hope these comments are helpful. EWH
Avatar m tn
thanks for your long answer!
Its hard to believe its not hsv, but it gives some hope.

It doesnt seem to be follucolitis since its not on exactly the same spot. It varies within a 5 cm area.

What about this pain in the back of my thighs? Does that show up in other diseases?
Also I wonder about the pain when I ejaculate. Could that be prostatitis from bacteria or herpes?
My doctor suggest me to take doxycykline to see if that changes something, do you think that is a good idea? or some other antibiotic?

Thanks again!
300980 tn?1194933000
Pain in the back of your thigh is not suggesitve of herpes.  Niether is pain with ejaculation which might be prostatitis.  Protatitis is usually not an STD.

I do not treat patients when I do not know what is going on.  If your doctor has an idea of what is going  on,  he should tell you what he thinks is going on.  Doxycycline is not treatment for herpes or prostatis.  I think you may need a second opinion about the origin of your discomfort on ejaculation.  EWH
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H. Hunter Handsfield, M.D.Blank
University of Washington
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