timing right for herpes

[noahmo]

Had unprotected (hetero) sex 30 days ago with an ex-girlfriend.  Positive IgG 1 (2.59) two weeks ago, no lesions at that time. IgG 2 neg.  Neg. IgM seven days ago.  Red, pruritic, rash around rectum extending outwards maybe an inch with two small raised bumps appeared today.  I have been on antibiotics for 3 weeks for another problem.  My questions are the following:
1)  Isn't 30 days a bit far out for symptoms to begin.
2)  Is it possible to have a primary out break involving the anus when NO anal sex (oral or otherwise) took place.
3)  Any possibility of rash from yeast or fungal overgrowth due to antibiotics.
4)  What next?

So far no obvious ulceration.

[Terri Warren, RN, Adult Nurse Practitioner]

Glad to be of help.

Terri

[noahmo]

Thanks Terri.  You and Dr. HHH have been great resources.

[Terri Warren, RN, Adult Nurse Practitioner]

Your HSV 1 positive test could have come from oral infection as a child, even without symptoms, HSV 1 from another partner at some point, many things.  Current partner status is not the only factor to consider.

Terri

[noahmo]

Even with partner HSV 1 negative?

[Terri Warren, RN, Adult Nurse Practitioner]

I would say that you are likely infected with HSV 1 and not with HSV 2, but you need a test to be more certain at 16 weeks.  The IgM test is not useful.  

Terri

[noahmo]

OK, here are the facts to date.

No acyclovir taken, that has not taken place.

-single exposure vaginal and oral hetero sex
-Partner tested positive IgG for HSV 2,  negative for HSV 1
-I tested positve for HSV 1 IgG (2.59), neg for HSV 2 IgG on day 16 post exposure
-tested neg. for IgM HSV 1/2 on days 23 and 30 post exposure
-developed perianal rash with no vesicles day 30 post exposure, dr. said rash did not look like herpes, treated with fluconazole due to prolonged ab therapy for another problem
-tested positive for HSV 1 IgG (2.6), neg for HSV 2 on day 34 post exposure

I know the "gold standard" is to re-test fo HSV 1 / 2 IgG at 12 -16 weeks.

How would you inerpret my data to this point?

[Terri Warren, RN, Adult Nurse Practitioner]

I'm not sure what your doctor is going to do at this point, it is a bit late in the process, especially since you've already taken acyclovir.  Any results from cultures or PCRs that are negative are potentially impacted by the medicine.  

The lack of vesicles suggests lack of infection but this is not certain.

Terri

[noahmo]

One other thought, what about the lack of vesicles?  Could they be coming later with a herpes rash.  Everything I have read lists them as one of the distinguishing characters of an outbreak.

[noahmo]

Yeah, I'm supposed to see my Dr. tomorrow.  Still hoping there might be an easy solution.

[Terri Warren, RN, Adult Nurse Practitioner]

1)  Isn't 30 days a bit far out for symptoms to begin.

Yes, the average amount of time from infection to outbreak is 5.5 days.

2)  Is it possible to have a primary out break involving the anus when NO anal sex (oral or otherwise) took place.

That would be very unusual, yes.  Very.

3)  Any possibility of rash from yeast or fungal overgrowth due to antibiotics.

Definitely, and that would have been my first thought about the cause of this rash.  
4)  What next?

I think you should go in and have the rash evaluated by a clinician, rather than trying to sort this out yourself.  An easy answer might be readily available!

Terri

[noahmo]

Day two.  Still no overt blisters.  Redness somewhat diminished but may be wishful thinking.

The real delimma.........telling my wife about the episode.  On the one hand I don't want to say anything if it is not herpes.  On the other I don't want to expose her if it is (she has not been exposed so far).