Herpetic Rash On Inner Thigh?

[MedHelpMail]

I’m a 30y male, 6 weeks ago, I had protected oral/vaginal sex with French kissing while wearing short-length boxers with an Iranian-American escort who says she’s a grad student but who’s STD/HIV status I did not know. Our legs did mingle together when we were lying on the bed cuddling. Before this, I was tested HSV-1+ but HSV-2 neg. I have not had any genital lesions/sores at all. However, around the 2nd week or so, I started to have intermittent right inner thigh and groin achiness. Also, I started to develop sudden/random itchiness around and above my right knee accompanied by a red spot or two but which would quickly resolve through the day or night. This also occurred on my left leg in the same area but just not at the same frequency. I’ve had random infrequent itchiness on my forearm accompanied by similar red spots as well. This past weekend though, I had sudden tingling/itchiness on my inner mid-way right thigh with three bug bite like spots/dots. I tried not to scratch and it got better but the next day the area itched again, I scratched and my skin became raised, but after a day it quickly resolved and the redness pretty much went away and it didn’t itch and now it’s almost unnoticeable. The location of this is what bothers me since that’s where the achiness and tingling have been. And for the past two weeks I’ve had intermittent achiness around my armpits which causes nausea. It seems as though atypical herpes symptoms w/o genital sores are not uncommon since HSV-2 is such a variable disease. So….

1. Could this be a herpetic rash on my inner thigh from our legs mingling? Why or why not?
2. Am I at risk at all for HIV or Hepatitis C?
3. I want to get tested for HSV-2 but I can’t wait the 12-16 weeks, but wanted to know if I should wait 2 weeks if there’s a big difference between testing at 6 weeks and 8 weeks. What’s the percentage of people who test positive at 6 and 8 weeks? And if I test negative at 6 or 8 weeks can I be confident in that result?

[MedHelpMail]

Dr. Hook,
I said my last post would be the last, but I just want to end this thread with a thank you for your concern. I appreciate your patience with me. You've been more than generous with your time. I don't know why I can't get herpes out of my head despite your expert opinion and the 6 week negative test. I just fear that I may be some exceptional/atypical case who hasn't seroconverted yet, but I will try my very best to move on and stop attributing all my symptoms to genital herpes.

Regards

[Edward W Hook, MD]

You are grasping at straws.  Are  you hoping to have herpes?  

Since I recommended against any need for testing to start with, that your test is negative is not really a surprise to me and should be taken as validation that you do not have herpes and that your symptoms are not due to HSV.   Your symptoms, which might be due in part to anxiety, are not consistent with infection due to HSV.  As to what else might be causing them, I cannot say.  Your statement that HSV "fits the bill"  is incorrect and your reference to anecdotes about unexplained neuropathic discomfort on this site fails to acknowledge that neither Dr. Handsfield nor I have endorsed any of those anecdotes as being due to HSV.

You don't have herpes, really.  If you cannot accept this after receiving professional opinion and negative tests, I urge you to see counseling and professional help to assist you in sorting out why you cannot put the possibility of HSV aside.  I say this out of concern, nothing more.

This will end this thread.  EWH

[MedHelpMail]

Dr. Hook, this is my last post. I took a HSV-2 IGG antibody test on Thursday which would be 6 weeks and 2 days since the time of exposure I'm worried about and it came out negative. Can I be confident that I am truly negative with that result?

I've had varying degrees of burning/soreness intensity only in the back of my right leg that extends from the upper thigh to lower calf with some intermittent stinging and numbness sensations. It seems like something to do with a nerve. Would that change your assessment that this is not HSV-2? Sorry if it seems like I'm grasping for straws. I just don't know what else it could be since all my symptoms started after my escort encounter and HSV-2 seems like it's the only thing that fits the bill since there are personal anecdotes on this site saying that HSV-2 causes the type of neuropathy i'm experiencing. I thought my negative result would put me at ease and that my symptoms were related to focused-anxiety but my symptoms persist which makes me wonder if my negative test came out negative because i took the test too early.

[Edward W Hook, MD]

Sorry, I cannot guess what this might be.  It is not herpes.  Tingling of the fingers and other body parts can certainly accompany anxiety.  If it bothers or continues to bother  you, ask your own doctor.  This will be the last answer.  EWH

[MedHelpMail]

Thank you again for such a prompt reply and your response was comforting and helpful. However, I have one interesting observation that doesn't seem normal that I hope I can share with you. I just had a tingling stinging sensation 30 minutes ago at the end/tip of my left ring finger. And then subsequently redness developed there like a red spot. The red spot like this in other areas usually lessen and go away in a day or two, but it occurring on my finger is a weird location. Do you have any guesses what could be causing this and other similar occurrences in other parts of my body since at least for this finger instance it doesn't seem to be a normal skin variation nor a normal location? Should I see my GP for this or do you anticipate that all this will resolve once at a normal stress/anxiety state? This is my final comment for today. I apologize for the length of this thread and I appreciate your patience with me.

[Edward W Hook, MD]

The stinging sensation, along with the location which includes you arms does not suggest herpes in the least.  Sometimes after an exposure that, in retrospect, one wishes they had not had, persons tend to examine themselves and be far more attuned to genital skin findings and sensations than in periods when they are not concerned.  This in turns leads to noticing what turn out to be normal skin variation and sensations that might have been not noticed or ignored at other times.  Perhaps this was a contributor to your situation.  

That's really all I have to offer.  This is not HSV.  Hope that is comforting and helpful.  EWH

[MedHelpMail]

Dr. Hook,
     Thank you for your time. I will try and make this my only reply unless you or I need clarification or if I test positive for HSV-2. I failed to mention that I do get random quick stinging sensations in my legs and arms but most of the time my upper-mid legs. Also get some stinging/tingling in my toes or bottom of my feet and at times get aches/soreness in those areas where the stinging occurs or even in the muscles or wrist of my forearm. When the stinging happens sometimes there's a red dot/spot slightly elevated, other times it can be red rash and other times nothing and everything looks normal. I sometimes experience fatigue and nausea when this happens. Seems like some kind of neuralgia, but is it a herpetic neuralgia I don't know. I'm so confused on what could cause this and the only thing I can boil it down to is stress/anxiety or herpes or some other std.

Does this remotely sound like anything HSV-2 related even in atypical cases? Or can stress/anxiety cause this stinging sensation and perhaps elevate histamine causing random redness/bumps?

.... Just confused, uncomfortable and concerned....

[Edward W Hook, MD]

The rash you describe is more consistent with a mild case of folliculitis than anything else other than some sort of mild dermatological problem.  The migratory nature, the absence of lesions and its episodic nature all make it unlikely that this is HSV.   It certainly does not suggest herpes in any way.  In addition, the nature of your exposure is such that you are not at risk for HSV, either.

As for your other aches and pains, no reason at all to think this represent HSV or any other STD.

As for your specific questions:
1.  No - see above.  In addition, if she has HSV, having it on her legs would be a most unusual location for a herpes infection.
2.  No, no risk for hepatitis C or HIV from the exposure you describe.
3.  Over half of persons who have acquired HSV following sexual exposure will develop a positive blood test within two weeks of the onset of symptoms.  The remaining 45% of persons who will develop positive blood tests do so over the next 2-4 months.  The further out in time you are from exposure, the more likely a blood test will be positive if you got herpes.  In your case, I really don't even see any reason for testing for the problems you describe, other than to seek peace of mind. There is no medical reason for you to be tested at all.  

Hope this helps.  I really would not bother to get tested for this.  EWH

[MedHelpMail]

And I failed to mention that when our legs were mingling there was skin to skin contact even though I was wearing boxers since the boxers aren't that long