explanation

[garymdmd]

Doctor,

I am a 25 year old male. After a sexual encounter involving receiving oral sex and vaginal sex 3 days later I noticed a slight pain in my groin area and my scrotum seemed slightly red.  After about 2 weeks there was more pain and my lymph nodes were swollen, although they did not hurt.  At this point I was tested to reveal positive for the unspecific Igm antibodies but negative for HSV1 and HSV2.  A few days later I started to feel a strange numbness on one side of my face especially around my eye.  I also had a spot under my lower lip that puffed up but wasnt painful and didn't form a sore.  Both of these symptoms have not progressed in to anything for 2 weeks yet still remain present.  In my groin region I have been having strange shooting pains in the inner thigh of my leg and there has been red rashes coming and going on my scrotum.  I have had no sores whatsoever.  I was tested again at 4 weeks to reveal the same result of Igm but no Igg for HSV1 and 2.

At this point I feel like because of my symptoms (that all seem nerve related) I must have HSV because the doctor and my own research is unable to give me any other possible explanation for the symptoms.  I guess I am looking for your honest opinion on the situation.  Does my situation sound likely to be herpes ?  I want to have some faith in my 4 week test but realize that 4 weeks is far too early to be even slightly accurate.

Thanks so much

[H. Hunter Handsfield, M.D.]

The additional information does not change my opinion or advice.  You still describe nothing that suggests herpes.

You came here for reassurance.  I gave it.  Please move on.

That's all for this thread.

[garymdmd]

Ok, one last post.  I sincerely thank you for your time and opinion.

My concern is mainly that what seems to be going on with my body us not the typical unexplained pain of daily life.  My shooting leg pain has been consistent for about 2 weeks and I have also had, as I earlier mentioned, a obvious swelling under my lower lip and a white discharge on the side of the eyes.  Is it possible that the rash I mentioned on my testicles is indeed the "mild painless sores" that you mentioned?  I have closely examined my testicles and the rash that has been reappearing looks like a dry redness (similiar to chafing) with more pronounced veins in the area.  However upon close inspection I do not see the white sores that I viewed in many of the pictures of herpes.   Could I be missing the sores because they are that tiny?  I realize only a primary care provider inspecting the site could really tell me but I would be interested in one last opinion.

Thanks again

[H. Hunter Handsfield, M.D.]

That is an excellent question and indeed the available information can be confusing.  There are several reasons why such atypical symptoms usually do not indicate herpes.  

First, some initial HSV infections are entirely without symptoms.  When a person who had no symptoms turns up with a positive blood test, sometimes s/he in retrospect recalls such things as "tingling", a backache, or an itch of the genital area, a buttock, etc.  In retrospect, s/he comes to believe that was a herpes symptom, when in fact it was just a random body feeling that had nothing to do with herpes.  But some such people become convinced, and then post strongly stated opinions on websites.

Second, many websites correctly state that many people with herpes have such symptoms, but often don't make clear that they usually occur in combination with more typical symptoms (blisters/sores) and not all by themselves.  So you see numbness, tingling, backache, etc in lists of herpes symptoms, but without the additional information that those symptoms generally occur along with (or preceding) typical skin lesions -- and that by themselves do not necessarily indicate a herpes outbreak.

Finally, these are symptoms that occur commonly in entirely healthy people from time to time, often without explanation. (Why does anybody's elbow, or knee, or penis suddenly itch?).  They also occur as a result of other common ailments (a pimple, a pulled muscle, etc, etc). All these events are much more common than herpes.  So even though herpes can cause such symptoms, in the vast majority of cases, herpes is not the explanation.

Bottom line:  Most cases of "atypical" herpes are in fact typical, but mild.  That is, usually there are genital blisters/sores -- but they may be painless, small, or otherwise just missed entirely.  But in the absence of genital area blisters/sores, few people with symptoms like you describe have new cases of genital herpes.

[garymdmd]

Thanks for your response.  It was nice to hear that perhaps I misdiagnosed my problem.    I was tested by a primary care provider who deals with infectious disease.  

What concerns me is that I have read that people can experience a wide range of symptoms from severe to very mild and sometimes a person will indeed have herpes without sores but have other minor symptoms such as a genital rash, leg pain and lymph node inflamation (all things I have been experiencing without explanation).  What is your opinion on this?

[H. Hunter Handsfield, M.D.]

I disagree with your conclusion "I must have HSV". I am quite certain your symptoms are not due to HSV and you are not infected with HSV of either type.  Genital herpes simply does not cause the symptoms you describe.  (Some of the individual symptoms can occur, such as "shooting pains" and enlarged lymph nodes in the groin.  But never by themselves, only in combination with more typical herpes symptoms, like blisters and sores.)  The HSV IgM tests are notoriously unreliable and often falsely positive.

I believe your symptoms are not at all related to the sexual encounter you describe, except for the possibility that they are manifestations of anxiety over the event.

You don't say whether you have a primary care provider, or might have sought HSV testing from an online service or other anonmyous source.  If you don't have a herpes-knowledgeable provider, find one.  If nothing else, have another round of tests (IgG only, please -- definitely do not have another useless IgM test) 3 months after onset of symptoms.  You can expect those results also will remain negative.

Good luck---  HHH, MD