Lyme or Herpes?

[nervous dave]

Hey there,
Hopefully one of the Doctors here can but my mind at ease.

Last saturday night I came down with a low grade fever after a long hot day of mountain biking. My first concern was Lyme disease since I had been treated for it last year with the same symptoms. In the hope it was just a bug I took some advil to keep the fever down. Monday I should have seen the doctor but was still hoping it would pass. Then Monday night I felt like I had been bitten or something on my right testicle, pretty much on the underside of my scrotum. I looked and saw nothing except what might be described as an insect bite. I figure that's where the damn tick got me. By the next morning, July 4th, a ring of brownish skin had formed around this bite. There was no itching what so ever and there was only a tiny spot that was a bit raw and tender. The next day I so the doc and was put on antibiotics. He said it was probably Lyme although the bite didn't look typical and that it sorta looked like herpes. Well as you can imagine I kinda freaked. He didn't swab it but did take blood. It's now almost a week later and a feel quite a bit better, antibiotics maybe? My blood work came back negative for pretty much everything including Lyme. Hopefully I'm not mixing these up but IGM came back negative and IGG almost but not completely undetectable. He wants me to come back in 6 weeks. The spot on my testicles is now almost gone, a little tender skin but thats it.  I never saw anything that resembled blisters or sores.

I'm a 32 year old male. In addition I've not had any sexual contact since breaking up with my girlfriend 13 months ago and we always used condom. She does not have herpes that I'm aware of.

I seem like an awful low risk, but could it really be herpes? The doc still leans towards Lyme but I'm still nervous.

[H. Hunter Handsfield, M.D.]

I do not think you have herpes.  I'm only saying that you don't provide enough information about your herpes blood test and therefore I don't know how to interpret it.   This also is the first time you have said anything about your sexual risks.  What you say makes me even more certain it isn't herpes.

HHH, MD

[H. Hunter Handsfield, M.D.]

Of course I cannot comment on what the lesion looks like to your doc.  But your description is unlike herpes, both in location (scrotum) and the description of a brownish ring around it--which sounds to me like a classical description of erythema chronicum migrans (ECM), a hallmark of early Lyme disease.  (But I'm definitely not a Lyme expert; I live in the wrong part of the country and have never seen ECM myself.)

Part of the answer may lie with the HSV blood test.  I don't know what to make of your description of IgG antibody "almost but not completely undetectable".  If that means the ELISA ratio was below 1.0 (but not zero), it is the same as zero and absolutely is a negative result.  But if your doc is trying to soften the blow, perhaps what he really means is that your HSV-2 result is positive but not strongly so (i.e., ELISA ratio above 1.0).  In that case, you may well be positive for HSV-2 infection--in which case, you might have a lesion of recurrent genital herpes (even though the scrotal location is atypical).

HHH, MD

[yoy]

Does not sound like it, but the doctor here will tell you that your own doc's examination will beat anything he could do on line.  13 months after your last sexual contact would be a long time for your first symptoms- usually the first outbreak is the worst.  Alos, usually herpes will appear on the shaft and not the scrotum.  Usually.  I'm betting that the doc will tell you that it does not sound like herpes, to relax, and rely on your own doc's advice.

[nervous dave]

i forgot to mention that I believe the Doc is leaning towards Lyme despite the negative result is due to my lack of recent sexual exposure. He really seemed to think my skin conditioned looked herpes like. He saw it when this ring of brownish skin was flaking away. Also I live in Connecticut and i spent a lot of time in the woods so i'm at much higher risk of a tick bite then an std at the moment.

[nervous dave]

If it's recurrent genital herpes then why the fever? I'm not exactly sure what he meant when he was trying to explain the blood test results. I was at work at the time of his call and had limited privacy and didn't really know what questions to ask anyway.

Just as I was becoming relieved I've now become concerned again. I've never had unprotected sex in my life and have ony had 2 partners. So of course I felt as if I was at very low risk for an std.

[nervous dave]

If it's recurrent genital herpes then why the fever? I'm not exactly sure what he meant when he was trying to explain the blood test results. I was at work at the time of his call and had limited privacy and didn't really know what questions to ask anyway.

Just as I was becoming relieved I've now become concerned again. I've never had unprotected sex in my life and have ony had 2 partners. So of course I felt as if I was at very low risk for an std.

[H. Hunter Handsfield, M.D.]

If you haven't had sex for more than a year, there is no way you can have an initial genital herpes infection.  I don't know what you (or your doctor) mean by the IgG blood test result, but it sound to me like it is negative, in which case it rules out any chance of a longstanding HSV infection.  In any case, genital herpes does not often involve the scrotum and recurrent herpes does not cause fever.  All in all, the chance you have herpes is zero or close to it.  As to whether it is Lyme disease or whatever else it might be, I leave to your primary care provider.

Best wishes-- HHH, MD