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Lymphadenopathy from Herpes
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Lymphadenopathy from Herpes

Thx for the reply to my question about the indeterminate results of my HSV-2 test.  The western blot result is not back yet, but I know what you mean about noticing sensations when one is worried about infection.

Over the past week I've been feeling a dull ache in the area just below the hip bone in the front of my body.  The symptoms of inguinal lymphadenopathy of course can be from various causes, but how would it typically present if this was herpes infection brewing?   Would I be able to feel them easily?  I've been feeling around my groin (in the crease between my leg and pelvis lateral to the pubic area) for any tender areas and can't find anything.  The dull ache seems to be up a little higher and closer to my anterior hip.  When I just sit or lay down, the dull aching on both sides drives me crazy.   The western blot won't be back for another week or so they tell me.  
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Welcome back to the forum.  This question could have been asked as a follow-up comment in last week's discussion with Dr. Hook, without the posting fee.  Dr. Hook and I take questions more or less randomly; you got me this time.

Herpes rarely if ever causes lymphadenopathy or groin pain as the only symptom.  Further, lymph node inflammation typically occurs only with an initial infection, not during recurrent outbreaks.  Often a patient with enlarged or inflamed nodes will feel them as an obvious abnormality, but not always; and even when a lump is present, it may not be a node.  Any and all suspected lymph node enlargements need professional evaluation to determine whether things are abnormal.

My bet is that the pain is psychological more than anything.  Perhaps it will clear up if the WB is negative for HSV-2.  It not, discuss it with your health care provider.

I will let Dr. Hook know about this discussion; you can stick with the original thread, i.e. let Dr. Hook know the WB result when it returns.

Regards--  HHH, MD
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So my western blot came back positive for HSV-2.   I'm devastated.  I haven't had any sores develop, although I frequently have tingling around the head of my penis and feel like sometimes there's a mild urethritis but not really painful.  My tingling sensation has been on and off for the past year, more on than off....I thought herpes kinda came and went.....I would say I've felt the tingling and irriation more often than not and it comes and goes quickly.

My encounters over the past year have mostly been handjobs with 3-4 episodes of frottage with people....I guess once is enough hey?

Is there any utility of being tested again....I'm hoping that this is a false positive.....I won't know how to tell my partner....
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Unfortunately, positive WB results for HSV-2 are very reliable.  Your test is not false positive.  

As I said above, most likely herpes is not the cause of the gential (genital) symptoms you report.  Herpes indeed comes and goes; it definitely does not cause continuous tingling. Conceivably it could cause recurrent lymph node inflammation, but that's uncommon even with overt herpes skin lesions and very rare without them, if it occurs at all.

If you are on the lookout for actual herpes symptoms, you probably will notice them.  Research shows that when people without apparent symptoms have HSV-2 confirmed by blood test, about two thirds come to recognize mild but typical outbreaks (which doesn't include just tingling).  Outbreaks most likely would show up as a cluster of one or more superficial blisters or sores, most likely on the penis but possibly the scrotum, groin, buttock, anus, or pubic area -- anywhere covered by boxer shorts.  If you itch, for example, take close look at the spot.

If you have repeat outbreaks, which most people do, they probably will be in pretty much the same spot every time, give or take an inch.  Repeat episodes never occur more often than once a month, usually once every 2-4 months, and each outbreak will last 5-10 days, rarely as long as 2 weeks.  Between outbreaks there are no symptoms at all.

If real symptoms seem to appear, or if you have new episodes of groin pain or swelling, see a health care provider immediately -- within 2 days -- for examination and confirmation of herpes as the cause.  As for "mild urethritis" due to HSV:  conceivably yes but unlikely.  However, if uncomfortable urination and/or urethral discharge occur with this pattern -- every 1-4 months for a few days, with no symptoms between those episodes -- also see your health care provider for assessment and possible confirmation.

Finally, talk to your doc about a possible prescription for an anti-herpes drug like acyclovir or valacyclovir, which will help prevent outbreaks and also reduce the chance of transmission to sex partners.  But it would be best to delay any such treatment until you wait a few months to see whether proper herpes symptoms appear, how frequently you have outbreaks, etc.  But if you have an uninfected partner at current risk, perhaps the higher priority will be treatment to prevent transmission.  (Transmitting herpes doesn't require outbreaks with symptoms.  The virus can be present at any time, without symptoms.)

For further questions and advice, I highly recommend the MedHelp herpes community forum.  The moderators are very experienced herpes counselors.  They can help you cope with the diagnosis and go forward in good health and with a rewarding sexual and romantic future.  Good luck.
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I failed to notice my own advice in the original thread.  This follow-up comment should have been on the July 6 thread with Dr. Hook; my fault for referring you to the July 12 one.  What's done is done, however, and you shouldn't over-burden the forum by posting on that thread as well.  I'll ask Dr. Hook to glance at this reply and let us know if he has anything to add.
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My thanks to Dr. Handsfield.  As is typical, his advice is precisely the same as mine.  That you have HSV-2 does not mean thatt he sensations you have noticed are due to you infection and in fact, like him, I would anticipate that they are not.  EWH
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One other comment. I note that your Western Blot result appears to have come back quite quickly and sooner than we sometimes get results from the University of Washinton virology lab.  Please make sure that the test you had was a Western Blot performed at the University of Washington.  I believe the manufacturers of the HerpeSelect test also make a western blot assay using the same reagents as are used in the HerpeSelect EIA.  If this test was what you were tested with, your result may, in fact be false positve.  On the other hand the results from the UW are to be believed and the advise provided by Dr. Handsfield is right on target.  EWH
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