Why the persistent symptoms?

[scaredstraight76]

In Cambodia on March 6th, I had sex with a CSW which included kissing, receiving unprotected oral (8 seconds), and having two condoms break on me while having intercourse

timeline:

36 hours after the act I began to feel pain directly AFTER urination, not during.  I got tested negative for STDs and also for HIV in Sydney and about a day later the pain left
4 days after, I had an itch on the top of my upper lip which developed into a small bump.  12 hours later it was gone
Enlarged Thyroid with pain – Mar 22 to April 19th
Sporadic nerve ending pains since April 1st  (even on the shaft of penis)
April 2 noticed black pimple about an inch above my penis which hurt when I touched it but left in 2 days
April 2 tested negative for Syphilis, & HIV
Tired with head pressure from April 3rd to April 19th
Pain in left testicle from April 15th to April 17th
Intermittent groin pain since April 14h
April 20 Bump on lip reappeared after itching and scratching it but disappeared after three days
April 22-present – slight back pain on low part of middle back
April 25-28 pain in left testicle, little even in the right
April 29 tested negative for Herpes 1 & 2 and Hepatitis B (7 ¾  weeks after)
April 29 pain in my left top gum above my last tooth
April 30 symmetrical pain on top of my right gum above last tooth
Night of May 2 noticed painful blister on the inside cheek flesh that connects to the top left gum where I was experiencing pain
May 2 before sleeping felt nerves on face acting up and was sure to have an outbreak
Morning of May 3 saw bump about ½ an inch off the bottom of lip
May 3 Started back on the Valtrex and by May 5th pain in both gums dissipated as well as the blister
Pain on back is persisting

I understand that back pain can be a symptom of herpes, but I thought the pain only came during an outbreak.  If so then why am I continually having back pain. Also would taking Valtrex produce false negatives disrupt my body’s building antibodies and increase conversion time?

[Edward W Hook, MD]

It appears that you presume that you have herpes.  I do not.  Herpes is not transmissible unless the person with herpes has lesions at the time of sex (that is not to say transmission does not occur with asymptomatic persons but rather that while people are regularly exposed, most do not acquire infection from those exposures).  In addition, herpes does not cause migratory pains of the sort you describe, nor testicular pain.  As for back pain, if this occurs, it is rare.  

I do not argue that you do not have have lesions (bumps) in your mouth that come and go  but there is little evidence that they are herpes and in fact, your negative blood test, while not definitive, argues that you do not. Nonetheless there is an outside chance that this could be herpes.  If so, the best approach to diagnosis is not to get blood tests but to have a recently appearing lesion cultured or tested by PCR as soon as possible after it appears.  Do not take valtrex before you get a culture, it could make the culture negative.  Lesions of this sort can caused by a wide variety of dermatologic condition.

In answer to your question, it is possible that valtrex could delay a blood test from becoming positive.

Hope this helps.  Let us know what your culture shows.  EWH

[scaredstraight76]

Thanks Doc.

I agree that most of the symptoms that I describe are not characteristic of herpes, and they are more likely the result of the abundant stress that I have been dealing with over the past several weeks.  However I do think that there is an underlying timeline of a herpes infection.  

There is of course no way of knowing until test results prove so, but I have been actually finding it easier to push forward day after day thinking that I do have it! (weird I know).  For the past 8 weeks I have been on an emotional rollercoaster with my mood swinging up when I think that I don't have herpes (esp. after test results), and then my mood swinging rapidly downwards when I believe I see a suspected outbreak or herpes symptoms.  The rapid change in mood and resulting hormones is causing a number on my body and sanity!  I feel like I have aged over 5 years in 5 weeks!!  With that said I rather have my mood be dampened and my esteem/confidence constantly low rather than having both moving up and down dramatically.  

This morning I woke up with another small bump on my top lip that I am going to try and get swabbed for culture testing.  I'll let you know how it goes.

[Edward W Hook, MD]

Please let us know how your test comes out.  I understand your concern and the emotional roller coaster you are on.  I predict the test will be negative and hope that at this time things will settle down for you.  EWH

[scaredstraight76]

Hello Doc last question,

So, unfortunately my bump I think is too small to develop a culture of.  Or is it?  Does there need to be pus to have a culture done or can cells be scraped off the top of the bump?  I went today to see my PCP and he stated that they do culture tests for HSV-2 but he didn't mention anything about HSV-1?  Do I need to see a dermatologist for this, and if not then where would I go to get and HSV-1 culture done?

Also regarding my initial post.  I guess what really concerns me is that I had pain in my right gum with a slight lesion right above it!  I keep my mouth pretty clean and I find it odd to have gum pain 6 weeks after kissing someone heavily.  On top of that the pain completely subsided after taking the Valtrex?  I guess that is what is really convincing me that I have some form of herpes.  Does that make logical sense or not really?

Thanks again for all your help doc,

-Scared-

[Edward W Hook, MD]

No spot is too small to be cultured and a culture for herpes should be able to grow both HSV-1 and HSV-2.

As for your symptoms, the reason for testing is to sort things out.  I remain skeptical.  EWH