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Unusual, recurrent symptoms.
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Unusual, recurrent symptoms.

I am a 25 year old male who recently had a sexual encounter w/ a 23 year old woman at the end of September.  There was no intercourse, but we both rubbed against each other genitals vigorously, naked and without protection.  A week and a half later, I noticed some strange symptoms.

I came down with severe headache, sensitivity to light, and extreme fatigue.  My lower back was sore, as were my joints throughout my legs.  Genitals seemed itchy, and slightly sensitive, though no noticeable lesions, etc..  This lasted for about 3-4 days.  I have been diagnosed w/ 'prostatitis' (urethritis) in the past, and have had recurrences.  I took a 2 week dose of Levaquin (which my doc instructed me to do should I have flare-ups of urethritis), and the symptoms subsided.

However, I noticed I had extreme sensitivity to light at the beginning of last week, and by Wednesday, had the same symptoms I had felt just a month prior.  My head hurt, I was very fatigued, urethritis returned, and I had the familiar feeling of joint and back pain.  However, I noticed on my penis that there was a very red area on the left side, which was scaly and dry looking.  I noticed this while masturbating, and had obviously irritated the area due to friction.  (Was painful afterwards.)  I put coritzone on the area, which has healed as of yesterday.  I did not notice any blisters or lesions, just a rough area of red skin that seemed shiny, irritated and slightly sensitive to touch.  But as this area healed, the symptoms I mentioned went away, too.  

Could this be an atypical presentation of herpes symptoms?  Confused about the recurrence of these flu-like symptoms; accompanied with the red, sore area on my penis that came along with it.  Any thoughts what these symptoms as a whole might be?
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There was no significant risk of STD from the encounter you describe, and certainly no STD causes the symptoms you describe.  The recurrence of urethritis/prostatitis was not due to the sexual event, and the systemic symptoms don't fit with any STD.  Herpes lesions can be atypical, but not likely to be the cause of a dry, scaly rash or red area.  Of course, any time you are close enough to another person to have sex (or semi-sex, as in your case), you are plenty close to catch a garden variety respiratory or other virus--so it is conceivable you caught some sort of non-STD problem from your partner.  However, a respiratory virus doesn't really explain your symptoms either.

My bet is that there is no connection at all with the late September event, except for the possibility that some of your symptoms might be partly due to could anxiety over it.  Of course return to your health care provider for further assessment if your symptoms continue to concern you.

Best wishes--  HHH, MD
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Dr. H,
  Thank you for your help with my question...you provide a great service with your expertise.  Out of curiousity and education-wise for myself, what sort of characteristics would an atypical presentation of HSV-2 genital herpes have?  Have read conflicting information, and am not sure what to believe.  (All sources seem to say something different.)
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Mostly it's just that the symptoms are mild, not really atypical.  For example, instead of having overt genital blisters or sores, a person might have a localized itch that went away in a few days.  Had s/he looked, s/he would have seen one or more typical lesions.  Other people have transient burning on urination, or women may just have vaginal discharge.  Other infected persons (the majority, actually) are entirely asymptomatic.  What herpes does NOT cause is prolonged symptoms of any kind.  The symptoms always last only a few days, with no symptoms at all between outbreaks; and those outbreaks always are at least a month apart.  Herpes doesn't cause diffuse genital itching; flaky or widespread rash; or genital tingling, or leg or back pains, or any symptoms of the sort your describe.  Once in a while there are indeed highly atypical findings, such as viral meningitis, or the serious skin rash called erythema multiforme, and eczema herpeticum, when herpes lesions are superimposed on an allergic skin rash; and sometimes fatal systemic infections, with death often due to liver failure.

The problem with looking on the web for herpes symptoms is that most sites will just say "genital itching", without describing the sort of context I just gave, i.e. they say just "genital itching", not "localized itching that accompanies sores (if you look) and lasts only a few of days".

The other problem in all this is that people often don't know what their own symptoms are.  If someone is asymptomatic for herpes but also has back pain or tingling/burning in a leg, then after that person has a positive blood test s/he might say "Aha!  That explains my back or leg pain", which in fact it does not.  And whenever a disease is naturally accompanied by fear, anxiety, and uncertainty, wild ideas have a fertile field.

Bottom line:  Most "atypical" herpes either is entirely asymptomatic, or the symptoms are quite typical but mild.
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Dr. H,
   Wanted to follow-up with you about my prior symptoms.  All was well, had literally forgotten about the prior episode...until 2 days ago, I had a recurrence of the exact same symptoms I had detailed to you above.  (Photophobia, headache, joint/muscle pain, mild urethritis, fatigue/malaise.)  As of today, the same area on my penis that was previously affected by the 'red, scaly rash' I described is now noticeably red, slightly swollen, and sensitive/painful to the touch.  (Noticeable tingling at the specific sight, as well.)

I am so confused as to why these symptoms have occured again.  I am in good health, eat right, and exercise regularly.  However, these symptoms have occurred like clockwork...(First noticed end of Sept., cleared by end of first week of Oct...then recurred end of Oct., cleared by end of first week of Nov...and here we are, again.)

Do you think this is possibly HSV-2 related?  I was hoping that with my encounter not being full-fledged sex, coupled with the relatively quick recurrence time between each episode, would rule out that possibility, but I guess it is almost a month in between each symptomatic occurence.  I am just concerned that these noticeable symptoms keep recurring, and now the same spot on my penis that was affected just a month prior is now showing signs of being affected again.  Thoughts?
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239123_tn?1267651214
Herpes remains a very unlikely cause of your symptoms.  The genital symptom doesn't sound like herpes, and recurrent herpes rarely includes systemic symptoms.  However, if you truly have headache and photophobia--classical symptoms of meningeal irritation--HSV-2 could be responsible.  There is rare syndrome of recurrent viral meningitis that is due HSV-2 of the meninges (the tissues surrounding the brain and spinal cord).  So I cannot guarantee you don't have it, but if you do, it isn't necessarily from the sexual exposure you describe above.

What you should have done is see a health care provider immediately (same day) when your symptoms started, not posted another question here.  If the symptoms are still there tomorrow, see a provider.  Or of course if the penile red spot turns into blisters or open sores in the next day or two.  If the symptoms clear up before you get examined, see a provider right away if/when they reappear.  
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Avatar_n_tn
Did some research on it...certainly could be a cause.  No migraine history for me, and as of today, symptoms have basically subsided.  Do you suspect this disorder is quite rare, or just underdiagnosed?  I remember some neck pain during my first occurence, but this discontinued...never had a fever or vomiting.  Prior to each occurence, I have felt very panicky and anxious (lasting for about a day or so), which seems to come out of the blue...followed by a few days of overall mental 'cloudiness'.  Weird, I know.  Do these symptoms ring any sort of bell w/ you?  

Since it appears that these spontaneous symptoms can have a root in HSV-2, I am going to meet w/ my provider and have the appropriate sexual health blood work done next week...do you think that is the appropriate way to go about this?  
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239123_tn?1267651214
The recurrent aseptic meningitis with HSV-2 is also known by the names benign recurrent lymphocytic meningitis and Mollaret's meningitis, going back to the days before herpes was know to be the cause.  It usually does not occur in conjunction with genital outbreaks, and I have never heard of it occurring as often as once a month.  The other atypical aspect of your case is its apparent mild nature.  Although aseptic meningitis is not dangerous, most cases cause more severe symptoms than you describe.  However, atypical cases undoubtedly occur, perhaps including mild ones.  The condition is rare and probably underdiagnosed.

From a diagnostic standpoint, all you need is a blood test for HSV-2.  If negative, it will rule out that possibility--then you can deal with your provider about other expalanations.  If positive, suppressive treatment with valacyclovir or acyclovir probably will be effective in prevention.

Putting it all together, I retract my statement above aboutherpes being  "very unlikely".  Instead I would say the situation is unclear and herpes a possibility.  But it's by no means definite.  If that's the explanation, you still didn't necessarily acquire the initial infection during the sexual event last September, which was a low risk exposure in regard to herpes. But if you want, you could help to nail that down by contacting your partner and encouraging her to have a blood test for HSV-2.  If that's negative, she will be exonerated as the source.

I would be interested in knowing the result of your HSV-2 test and the ultimate diagnosis, if one is established.  Keep us posted.
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