STDs Expert Forum
herpes, systemic symptoms
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The STD Forum is intended only for questions and support pertaining to sexually transmitted diseases other than HIV/AIDS, including chlamydia, gonorrhea, syphilis, human papillomavirus, genital warts, trichomonas, other vaginal infections, nongonoccal urethritis (NGU), cervicitis, molluscum contagiosum, chancroid, and pelvic inflammatory disease (PID). All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.

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herpes, systemic symptoms

Doctor,
I was exposed to a woman who has had herpes for 12 years, her last outbreak was 2 years ago. We engaged in genital-to-genital rubbing with her underwear as the only barrier. I recall having some friction burns that subsided within a day.

2 days later, I became extremely exhausted and light-headed and started to notice some swelling on the left side of my penis. The following day I made an appointment with a urologist and was diagnosed with penile thrombosis.

3 weeks post exposure (body still achy), my groin felt like it was burning, alarmed, I made an immediate visit to a dermatologist. The doctor said there was no signs of herpes and commented that the likelihood of transmission from my exposure was low since there was no intercourse. However, the doctor did prescribe valtrex (500mg 2x day/5 days). A few days later after engaging in some fully clothed genital-to-genital stimulation, I noticed what looked like 3 small friction burns around the crown of my penis. These 'burns' disappeared within the next 24-36 hours, not sure if this was due to the valtrex (which i stopped taking after 5 days).

It's been 35 days since exposure; My legs and buttocks are still achy and weak, my groin (inguinial lymph nodes?) have become tender, hip joints sensitive and occasional twitching in my right leg muscle. To top it off, I have on occasion felt time to time a pinch on my penis and a small sensitive red spot on my penis will appear but only for a few hours.

This has caused me a lot of anxiety, I can barely sleep, and since exposure have examined my groin area at least 20x day. I have not had the typical water blisters/scabbing but all these other systemic symptoms often attributed to herpes seems more than coincidental since they only started occurring after being exposed to the virus.

I am aware i can take a blood test in 3 months, but am I being over-reactive, thoughts?


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239123_tn?1267651214
Welcome to the STD forum.

As you were told on the community forum, it doesn't sound like you acquried genital herpes.  You have misinterpreted the information you found online or elsewhere about herpes symptoms.  It is true that initial herpes is often accompanied by systemic symptoms, like fever, headache, muscle aches, and so on.  But almost never are these the only symptoms.  The systemic manifestations only occur in combination with overt herpes lesions.  And herpes also doesn't cause groin pain without lesions.  Also, you had a no-risk exposure; herpes is rarely transmitted without actual intercourse, and it certainly cannot be acquired by genital rubbing through clothing, including skimpy underwear.  Finally, continued symptoms despite valacyclovir (Valtrex) is additonal strong evidence against herpes as the cause.  (My guess is that you talked the dermatologist into prescribing valacyclovir as a trial, because you were convinced you had herpes despite his professional opinion.  Had you made that request in my clinic, we would not have agreed to treatment.)

In other words, the evidence is overwhelming that you did not acquire herpes.  Something else is the cause of all your symptoms.  If you insist on a blood test for HSV, feel free.  However, be very clear:  if it turns up positive for HSV (either HSV-1 or 2), it will not explain your symptoms.  That outcome would mean you have an asymptomatic HSV infection plus another cause of your symptoms.

If your symptoms are related to the sexual exposure, it is probably through anxiety about it.  Certainly most of the symptoms sound consistent with the physical manifestations of anxiety or stress.  I'm not making such a diagnosis, just suggesting a possibility.  But if the symptoms continue, I suggest you discuss that possibility with your physician.  I suggest it out of compassion, not criticism.

Regards--  HHH, MD
7 Comments
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Avatar_m_tn
Doctor HHH,
Thank you for your response. I am not disagreeing with your initial assessment, but these are just some lingering questions.

You mentioned that my exposure was no-risk, however isn't herpes transmitted primarily through skin-to-skin contact? Though I did mention she was wearing underwear, the fabric was very porous. The physical contact/rubbing was enough to cause trauma to my penis (thrombosis).

This is the only time in my life I've been exposed to someone with genital herpes; As you said, systemic symptoms can only appear with lesions, but aren't some primary outbreaks mild enough (almost unnoticeable to some) where the lesions only appear as fissures, small bumps, or rashes?. In addition, I've noticed time-to-time some irregularities on the skin of my penis, like rashes or bumps that appear intermittently for a day or so. The most recent being yesterday where a small pimple like bump appeared but seems to be subsiding now. As of yet, I haven't developed any water-blister type lesions, but I've read through this forum that not all men experience that during their primary outbreak.

Thanks again, your time and expertise is very much appreciated.
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239123_tn?1267651214
How the virus CAN be transmitted and how it IS transmitted almost all the time are two different things.  In 30+ years in a busy STD clinic, I have never seen a person with genital herpes who had not had insertive genital, anal or oral sex.  Even with insertive sex, the average HSV-2 transmission risk, if one partner is infected, is in the range of once for every 1,000 exposures.  (In monogamous couples with one infected partner, having unprotected sex 2-3 times per week, transmission occurs in only 1 in 20 couples each year.  You can do the math yourself.)

Assuming you have had a relatively normal sex life, it is improbable that this is your first exposure to someone with genital herpes.  About 20% of sexually active people in the US have genital HSV-2 and 90% of them don't know it, so it's a good bet you have in fact been exposed.

Herpes does not cause penile skin "irregularities".  Most persons with new herpes has typical symptoms, if symptoms occur at all.  Sometimes they are mild and therefore missed -- but if anything at all is felt, almost always there are recognizable blisters, pimple-like lesions, and/or ulcers, lasting at least 7-10 days and healing with scabs.  Herpes lesions simply cannot appear and heal in a day or two.  And recurrent symptoms cannot occur more often than once a month; and between those outbreaks, there are no symptoms at all, nothing different than normal skin.

My judgment that you did not catch herpes is based on all these issues, not only the exposure history.  Taking the totality of the available information, herpes is simply not a realistic possibility for you.  Please accept the reassurance and stop worrying about it.
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Avatar_m_tn
Doctor,
Your recent analysis was comforting and relieving, however a new symptom showed up today. The area around my left inguinal node has become noticeably red and feels like a bruise when I touch it. You have mentioned in various posts that swollen inguinal nodes can be caused by a variety of things and that it is hard for people to self-diagnose. I have not had any recent trauma to my lower body. Is this something I should be concerned with; Should I follow up with either the urologist or dermatologist who previously examined me?, I don't currently have a GP.  

The only noticeable symptoms I have now are lower back pain, weakness and twitching (especially when i'm sitting down) in my leg muscles, lower abdominal pain, and occasional pinching sensations in my penis.
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239123_tn?1267651214
The additional symptoms also do not suggest herpes, and this information does not change my opinion or advice.

It is always reasonable for someone with symptoms that concern them to visit a health care provider for diagnosis.  On that basis, you probably should return to your own doctor, since my reassurance apparently isn't having the desired effect.  You can expect that they will continue to agree that you don't have herpes.

In any case, that will end this thread.  Take care.
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Avatar_m_tn
Without your reassurance, I would have been 100% convinced I was infected, and most likely would have told the woman I was exposed to that I had contracted it from her - which would have been disastrous.

This week i received my 6 week test results and was negative for both HSV 1 & 2. I'm hoping those results combined with your previous answers will help finally bury this 1.5 month ordeal I've been going through.

I never realized how much fear, anxiety, and stress could affect one so much physically. I hope anyone who is going through a similar situation like I did can learn from this thread so they can make a more rational and sensible approach than I did.

I wish I had found this site first when initially doing research on Herpes, my judgment and mental state would not have been so clouded.

Thanks again, your service is invaluable.
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239123_tn?1267651214
Glad to have helped.
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