Is it genital herpes....

Hello, Dr's.

I have been reading a lot and am a bit perplexed.  Last Friday night I had unprotected sex with a female.

I awoke Monday morning and noticed 2 red bumps on my upper left thigh (1 larger than the other), 3 small bumps in my pubic region (2 of which looked like zits with white heads), some reddish/flesh colored bumps beginning to arise on the shaft of my penis.

The female later told me that she was HSV-2 positive, hadn't had an outbreak for over a year, is on Valtrex, and just got over a yeast infection.

Tuesday I felt pain in my groin lymph nodes, stomach and tired.  My PCP thought it might be or might not be herpes.  He referred me to a dermatologist and prescribed Valtrex.

The dermatologist did not think it to be herpes because there was no blistering and could not culture.  The spots on my thighs were still there, the spots in my pubic region no longer had white tips but were just red.  The spots on my shaft were barely visible.  No pain, very light itching (possibly mental), no blistering or scabbing.
The dermatologist prescribed a cream for scabies and tested me for STDs.

On Wednesday morning (after 1 Valtrex pill), the bumps were still there, still no blistering, scabbing, pain, or real itching.  The shaft now had flaky, dry skin forming a ring where I thought there was something coming up.

On Thursday, I woke up feeling fine (no more aches or tiredness), but still with peculiar looking things down there.

By Sunday the red spots have all but faded....just a slight pink color...fading bumps with no blistering or scabbing or pain and dry skin on my shaft.

So it has now been exactly 1 week since I noticed symptoms 2.5 days after exposure.  I went back to my dermatologist and he did not think it to be herpes.  But gave me a prescription for Valtrex as suppressive therapy until I can take a reliable blood test in 2 and 3 months.

I know that everyone has different symptoms for genital herpes and I feel like I have some.  

Thoughts?

[Edward W Hook, MD]

Welcome to the Forum.  I wish that neither your regular doctor nor your dermatologist had given you valacyclovir when they did not think you had HSV-- you must have seemed very anxious to them.  The lesions you describe really do not sound even like an "atypical" episode of initial herpes. The lesions were atypical and sound much more like folliculitis (clogged pores) than anything else. furthermore, the lesions did not evolve in a way to suggest herpes and you did not have any of the systemic symptoms which are typical of an initial episode of HSV.

At this point, my advice is to not take the valacyclovir.  If you have HSV (which I think is most unlikely) taking the valacyclovir can hinder development of the antibodies which would be detected by the blood test he plans to use.  Furthermore, should the lesions recur, you can ask either your regular doctor or the dermatologist to perform a culture or, even better yet, a PCR test which would give you a more definitive result.  (don’t take valacyclovir if the reappear, get the lesions tested, then you can take the valacyclovir)

Hope these comments are helpful to you.  EWH

[googler08]

Thank you, Dr.

I find your comments very helpful.

I think they prescribed me the Valtrex because I had unprotected sex with a known carrier of genital herpes and then had some red spots show up in my groin.

Also, I was feeling run down starting Tuesday with muscle aches in my stomach and genital lymph node area on both sides...as if my body was fighting off a virus or flu.

What I found strange were the actual lesions.  No pussing, no scabbing, no pain, and barely any itching.  Just a few red bumps....2 on my left thigh (1 more pronounced than the other)  and 3 or 4 in my pubic hair region.  They lingered for the week and have just about disappeared.

Then the dry, flaking skin on the shaft of my penis...which I still have.  I can't explain it.

This does not sound like a primary genital herpes infection?  Is it unusual to have one 2.5 days after exposure?  Would the outbreak already have passed after 1 week?

So it would not be in my best interests to take the Valtrex?

Thank you.

[Edward W Hook, MD]

Did you think I didn't read this the first time you described your exposure?  As I've said, this in no way sounds like a hepres infection. that is in fact what you say the doctors indicated to you as well.  No change in my assessment of advice.  Why take medicine for something that it is unlikely you have?  EWH

[googler08]

Thank you, Dr.  I have stopped taking the Valtrex.  

I'm curious as to what you think this could possibly be.

[Edward W Hook, MD]

Glad to hear you have stopped the valacyclovir.

See my original comment.  Warts, molluscum contagiousum and follicultis are all candiates.  If the lesions are still present, having a clinician take a look should help.  eWH

[googler08]

Hi Doctor,

I don't have any lesions, but have been a little itchy (may be psychosomatic).  I do have another question:

Is a reason that this does not seem like herpes because I have had spots in multiple locations:  thigh, pubic hair region, and penis shaft?

I have spoken with a few people who are hsv-2 positive, and they have told me that it doesn't appear in multiple locations, but rather in one specific spot.

Just wondering if that is true.

Thank you.

[Edward W Hook, MD]

There are multiple reasons that this is unlikely to be herpes including that they have occurred in different locations, that the locations you report are atypical for herpes and that the lesions desccribed are not characteristic of HSV.

This should conclude this thread.  If you ahve further questions please start with a new question.  EWH