Now What?

[okwhatnow]

About 8 weeks ago I met a girl and kissing, the touching of breasts, and boxer on boxer grinding occured.  No blow jobs or direct skin contact of any kind on my genitals. (At least that I could tell)  I didn't think much of it, but 4 days later I began to burn a bit down there and then had a small pimple show up and went into the doc.  He confirmed genital herpes via visual inspection and symptoms about 15 days after the night.

I really felt like **** for about 3 weeks (headache, sick, etc.) and then the symptoms started to subside and this combined with my usage of Valtrex at the end of the cycle led to the elimination of the bumps and two small red skin spots where the pimples were (although I'm not sure if the pimples disappeared completely.  At this point everything is fairly typical.

About 5 months before this I was tested for syphillis, Gohnorrea, and HIV all negative, and this was my only sexual encounter since then.  I spoke to the girl and she "says" she got tested and everything was negative on her front.

The concern i have is that while the bumps went away I still had a wierd feeling down there and a week after my first OB subsided I got another one.  This one has lasted almost 4 weeks now and I am a little afraid that something else might be wrong.  Some days the bumps almost go away, but then can come back like a new OB.  I do drink and drink coffee; maybe I need to give these up.  I am using Valtrex and it really doesn't seem to help all that much.  The "wierd feeling" down there never really leaves tingling, burning in the innner thigh, etc.  It's pretty much day to day as far as symptoms go.  
Is there anything else I should be concerned about or that my symptoms may suggest?

[H. Hunter Handsfield, M.D.]

They call them STDs because you have to have sex to catch them. What you did doesn't count.  Herpes and other STDs generally are not transmitted by kissing, hand-skin contact (with breasts or genitals), or through clothing.  

However, herpes can be an exception through hand-genital contact, and if the provider who diagnosed you is experienced with herpes, his or her opinion means a lot.  However, visual diagnosis alone is often inaccurate, even by experts such as herpes researchers with many years experience.  Also, you say you had only a single genital lesion, whereas first-episode herpes usually has multiple lesions.  However, the occurrence of systemic symptoms is consistent with a new HSV infection.  But I stress that it is never appropriate for a provider to diagnose herpes without laboratory confirmation.  Even if s/he is convinced based on visual appearance, it is necessary to know the virus type, which can only be determined by a lab test.

Whether or not the initial diagnosis was correct, genital herpes generally does not behave the way you describe after the initial outbreak cleared up.  Recurrent genital herpes outbreaks don't last 4 weeks; outbreaks do not recur only a week after a previous outbreak subsides; and herpes lesions don't "almost go away then come back like a new OB".

All in all, I'm not sure you have genital herpes at all.  If that is what you had to start, I am not convinced it explains your more recent symptoms.  And if you have herpes, you might have acquired it sometime before the heavy petting incident 8 weeks ago.

At this point you need to return to a health care provider who is knowledgeable about herpes.  If you are sure the original doc is highly familiar with herpes, return to him or her.  Otherwise, either your local health department STD clinic or a dermatologist would be good choices.  You need both visual assessment of your current genital condition, which probably is not herpes; and a blood test to determine whether you are infected with HSV-1, HSV-2, or both.

Finally, to maximize the certainty about what is (or is not) going on, talk again to your heavy petting partner and ask again to be sure she actually was tested for HSV.  Most routine STD testing does not include an HSV blood test.  If that hasn't been done, she could be tested now to help sort things out.  

I hope this helps.  Best wishes--- HHH, MD

[H. Hunter Handsfield, M.D.]

I meant to also say that although initial genital herpes lesions can last as long as 4 weeks, it is unusual.  And with valcyclovir treatment, symptoms almost always clear up entirely within 10 days.  That your initial symptoms lasted so long, while taking valacyclovir, also makes me suspect you had something other than herpes.

[okwhatnow]

Hey doc,

I really do appreciate your quick response.  A few things, I do have 2 pimples not one, it started as one.  My doctor told me that he would "rather not' do a culture swab so I said ok.  I don't really know why he didn't want to run one, but at the time I thought he must have his reasons.  I don't really have all that much faith in him.  He did say he had a few other herpes patients, but he's young and he has made a few basic mistakes with me in the past.

I am fairly certain that at least I do have herpes; the symptoms are just too typical, but I didn't get screened for other STD's based on my recent previsous negative test results and the lack of real intimate contact I had with the girl.  I asked the girl specifically to get tested for HSV and she "thought she had", but she seemed very uncertain when I pinned her down on it.

I don't know where to go at this point; I have to go to the same hospital for insurance reasons, do I just call in and request an appointment with a dermatologist?

Thanks again doc

[H. Hunter Handsfield, M.D.]

As I already said, there are several aspects to your symptoms that in fact are not typical for herpes.  But only further examination and testing can sort it out.

I can't tell you how to make an appointment in your health care system.  I'm sure there's a way to call your hospital or HMO and ask how to get to a dermatologist.  If specialty care requires a referral by a primary care provider, call your original doc and ask for it.

[H. Hunter Handsfield, M.D.]

Your frequent questoins for clarification from the moderators or the questioners (e.g., more details about their symptoms) are not helpful.  When a questioner has uncertainties about Dr. Hook's or my responses, s/he can ask; and if Dr. Hook or I want more clinical information from the questioner, we'll ask for it ourselves.