Shingles

[bryan999]

I'm a 36 year old male. About five days ago I noticed a single small red bump on my upper right thigh.  It was somewhat itchy.  Then about three days later the area developed into a rash with several red bumps.  The bumps aren't really clustered together nor are they in a row, they are spread out within the area of the rash about 1/2 to  1/4 of an inch apart.  The area was itchy and somewhat painful if rubbing up against my pants.  Currently, it looks like only one of the bumps has a barely noticeable blister head - its very hard to see this- the others are just red.

I went to my doctor, he said it was shingles - he actually seemed not 100 percent convinced that it was shingles given it was looked mild.  He prescribed Valacyclovir.  I had actually put Cortisone on it starting a couple nights ago and this seemed to help a little.  

I have been in a monogamous relationship for several months.  Both my girlfriend and I were tested for STD's about 3 months ago - including HSV IGG test - and were clear.  I did have a sexual encounter outside the relationship about 5 weeks ago that was unprotected vaginal sex and was very brief, about one minute.  I got tested right after this and was clear.

I am certain my girlfriend was faithful, and as we were both tested 3 months ago, I assume there is no risk of HSV transmission there?  Also, the exposure five weeks ago seems low risk given that it was one-time, extremely brief, and also I was extremely vigilant as to any changes in my genital region after the exposure and did not see anything.  Given the lesions appeared almost five weeks after the exposure, I assume I can rule out this as possible HSV transmission? Overall, at this point it seems very mild, whatever it is - there is not that much pain or itching and the lesions haven't presented themselves as blisters -except for a very minuscule white head on one.  

So, is there any risk that the rash/lesions were misdiagnosed as Shingles but it is really HSV?

[Edward W Hook, MD]

This will be my final answer.  You seem to be unwilling to address the root cause of your issues which is your guilt.  It does sound like follicultis. that's why I told you this.  See you doctor and get a grip on yourself regarding you guilt.

this concluses this thread.  EWH

[bryan999]

To be clear, the bumps themselves aren't necessarily small but the whiteheads (or blackheads) where those have formed are quiet small.  I can see that some of the bumps/whiteheads are forming our of a hair follicle, but not all.  Does this sound like folliculitis?  I have to be honest that I had to wear the same pair of underwear for a few days as I ran out.  I noticed the first bump wearing that pair and then the rash formed a couple days later wearing the same pair.  Is there any connection here?

[Edward W Hook, MD]

Actually the progression on therapy and the description you provide is more consistent with folliculitis than any sort of herpes infection.  I suggest that you have your doctor take another look.

The blood tests are unlikely to be any help at all unless they are negative and in your situation, you are more likely to have a false positve blood test or even discover that you have HSV that you did not know about which is not the cause of the lesions than anything else.  I recommend against the blood test for you.

EWH

[bryan999]

Doctor - some of the bumps have developed small whiteheads/blisters.  They look very small.  One looks to have a small blackhead which i assume is a scab.  I guess this would be consistent with both Zoster and HSV?  Does this change your view at all this this isn't likely HSV?

Also, given that I'm on medication at this point a PCR is not very useful correct?  At what point might a blood test be useful?  Its been 5 1/2 weeks since exposure.  

[Edward W Hook, MD]

Is it a possiblity- yes, just as it is possible you'll be struck by a meteor today.  Is it likely- no.  I've tried to indicate this repeatedly but you seem to be haiving trouble hearing it.  Time to suck it up and deal with your guilt .  I say this not to be unkind but in an effort to help. EWH

[bryan999]

I apologize Doctor, I am experiencing a high level of anxiety right now.  I am hoping to get some further assurance that this isn't likely HSV, given the timing of exposure, my testing, and my doctors diagnosis.  In your view, is there any reasonable possibility this could be HSV?  Thanks again.

[Edward W Hook, MD]

My comments are based on YOUR comments.  May I remind you that you said "....he actually seemed not 100 percent convinced that it was shingles given it was looked mild.".  Perhaps I should have ignored this statement.  You then asked for reassurance that this was atypical for HSV- I indicated that this was the case and told you why.  

The virus that causes shingles and the viruses that cause herpes (HSV-1 and HSV-2) are related and, as a result, on occasion HSV lesions are mistaken as shingles.  That is a fact.  The only way to prove or disprove this is by testing with a culture or PCR test from the lesion (not a blood test). Further, now that you have taken the medication (which you said you had not done 8 hours ago), it makes it less likely that a culture or PCR test would be positive.  A positive test would tell you what it is, a negative test would be interpretable in that you would not know whether this is the effect of the drug or the absence of infection.

What you and I know now is that you have a rash and that your doctor said it is most likely to be shingles and has provided appropriate treatment.  He did not test so you cannot be sure.  Rashes of this sort can be caused by a variety of things, including the zoster virus, HSV and by other dermatological conditions.  

My sense is that what is really going on here is you are wrestling with concerns and guilt over your infidelity 5 weeks ago.  I cannot help that.  EWH

[bryan999]

Doctor - I'm sorry Im very confused by your statements.  My doctor has diagnosed this as shingles.  Are you saying you think it might not be shingles?  And also that it isn't likely HSV?  Neither?  If not these two then what could it be?

Also could I get tested at this point via swab or is it too late now that I've take 2 pills?

[Edward W Hook, MD]

Testing for the shingles virus may be helpful.  As I already said, this is unlikely to be shingles.  EWH

[bryan999]

Ok.  To clarify I just saw the doctor today and haven't yet taken the medicine so it hasn't influenced the progression yet.

Would you suggest any further testing at this point?

[Edward W Hook, MD]

No, I see no reason for disclosure- there is no evidence that you have HSV.

As for your"what if" questions
It is hard to assess the course of this outbreak since you have been taking therapy.

Normally, there is not a high rate of misdiagnosis but your doctor said this was an atypical in his expereince.  EWH

[bryan999]

Thank you.  In your view am I obliged to tell anyone I might have sex with about this or am can I be reasonably assured that this isn't HSV?

Also, if this were a first time HSV outbreak, wouldn't a typical initial outbreak present itself in a more harsh manner?  I.E. more painful, weeping sores, which I currently don't have?  

Finally, do you believe there is a high rate of misdiagnosis when it comes to shingles vs. HSV?

[Edward W Hook, MD]

Welcome to our Forum.  I'll try to help but without the ability to examine you and perhaps test, obviously I cannot be sure.  I do agree with your analysis however.  It would be unusual for an episode of HSV to occur on the anterior thigh and five weeks is long after it would be expected for a first episode of HSV to occur.  Further, as you point out, the risk of acquiring HSV from any single exposure is quite low.   At this time, there is not much else you can do.  If this were zoster, the valacyclovir could very well make your culture or PCR results negative at this time.  

My advice would be not to worry unless the lesions recurs.  Should it recur however, it would be to your advantage to have material from the rash cultured or tested by PCR.  I hope this comment is helpful.  EWH