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Avatar universal

Herpes initial outbreak or something else?

Dear Doc,

Had a CSW perform unprotected oral and kissing 23 days ago.

Today fever and sore throat. Noticed tens of tiny blisters on my soft palate. Blisters appear to be filled with bright or yellow substance. Blisters are really small, not visible without using a light inside mouth. I would estimate the blisters are no more than 1mm wide. They feel similar to my tongue as allergy bumps (which I get during summer) and bumps I get during a throat infection cold. Not very painful at this stage.

I have been having anxiety issues after the encounter and yesterday I did something stupid. I saw what I though were blisters on my left tonsil so I used my toothbrush to try and see if they would break. I caused a small wound on my tonsil, which felt irritated. I used mouthwash few hours later to clean it.

Questions:

1. Is it 100% sure that this is an HSV-1 initial outbreak? Isn't 23 days for oral herpes quite long incubation time?
2. If yes, what will happen next? Will I get blisters on my lips, face and penis?
3. If this is HSV-1 is it 100% sure that my penis is infected as well, even with no symptoms? (so far nothing on my penis)
4. I've had enterovirus few years back and the symptoms are similar. If I get water blisters on my fingers and hands, would it be more likely that this is an enterovirus?
5. Could my toothbrush incident be related? Could I have infected my throat with a bacteria from the strep family?
6. I cannot see a doctor today as summer season and no appointments available. Also the lab is closed for the weekend. I've reserved a meeting with a doctor for Monday first thing in the morning. Is that too late? The blisters were not there yesterday, I noticed them around 11:00 am today. The doctor meeting is at 9:00 AM Monday morning. This would fit the 48 hour window for swab culture, right?
25 Responses
239123 tn?1267647614
MEDICAL PROFESSIONAL
Welcome to the forum.  Thanks for your question.  The bottom line is good news:  almost certainly this isn't herpes from the CSW contact described.

First, the time frame is wrong. Initial herpes symptoms typically start 2-5 days after exposure and rarely as late as 3 weeks.  23 days is too long.  Second, initial oral herpes usually involves more than the throat.  Although it could occur without lesions of the lips, cheeks, tongue, etc, this is unusual.  Third, absence of significant throat pain is strong evidence against HSV.  Given your similar symptoms in the past, apparently related to allergy, that seems like the best bet this time around.  There also are other viral infections (nonsexually transmitted), and perhaps some nonviral ones, that could explain such symptoms -- although lack of significant pain also argues strongly against strep or other bacteria.  To your specific questions:

1) Correct; see above.

2,3) If this were herpes, you could expect recurrent lesions in the future, most likely on or near the lips.  But your penis wouldn't necessarily be infected just because your throat is.  Beyond that, I suggest you don't speculate, since it is very unlikely this is herpes.

4) Yes, similar lesions on your hands or elsewhere would further support a non-herpetic cause, whether entero or some other virus.

5) I don't think the toothbrush business is related at all.

6) I would not assume a swab test for HSV is needed at all, especially if the visible lesions have cleared up before you see your doctor.  (If that happens, it would be additional evidence against herpes.  Once initial herpetic lesions begin, they can't clear up in under 7-10 days.)

So all things considered, the evidence against herpes is very strong.  My advice is to just sit tight without worry about herpes or other STDs.  See your doctor as scheduled on Monday.  Do not go in expecting or requesting any specific tests.  Just give your doctor the full story then follow his or her advice about what tests to have, if any.

I hope this has helped.  Best wishes--  HHH, MD
Avatar universal
Thanks Dr. HHH,

Your comments are already helping me to cope better with my situation. I've been torn with guilt and regret for the last three weeks. I've got a wife and two kids and I feel like I've betrayed them in the worst possible manner. All I want to do is put this mistake behind me as fast as possible and move on with my life. If I don't do that I am sure I will suffer a nervous breakdown, the last three weeks have been awful.

I will post an update after the seeing the doctor or before if there are some new developments.
With regards to the testing: I've already done Chlamydia, Gonorrhea and HIV at one week post encounter (the HIV was recommended by my doctor as a baseline). All negative.

I've also taken an HSV type specific IGG test at the 3 week mark and plan to take additional ones until I am sure I don't have herpes. Unless of course I will have an outbreak that proves I have it. I feel it is necessary for me to completely move on.

Quick question before I go: so if I understood correctly from your answer, typically in an initial HSV outbreak almost all the symptoms should appear simultaneously? Or do they keep adding up, for example, first you get fever, then sores in place x, then in place y etc. Or is it typically more like: fever and shortly after blisters in places x,y and z simultaneously?

239123 tn?1267647614
MEDICAL PROFESSIONAL
All symptoms would begin over a 1-3 day period, usually painful lesions before fever and systemic symptoms like fever.
Avatar universal
Short update: I think I was just panicking. Yesterday I complained about my sore throat to my wife and told about the small blisters. She had the same ones on her palate as well, only there were less of them visible.

I suspect I've caught a common cold which has irritated my palate so these bumps are more pronounced. I did some research online and it sounds like these are normal tiny salivary glands on the palate. They are only visible when pointing a light in my mouth.

They have not changed in size or burst since yesterday. If anything, the pain in my throat is even less than yesterday. No signs of blisters anywhere else on my body. Still going to see the doc on Monday, just to cover all bases.
Avatar universal
Freaking out again. Called the csw, she said she has herpes but doesnt see customers during outbreaks.The thing that worries me the most was that she said she gets ob's "about once a month". This sounds high and I fear my risk was significant. Also, my symptoms don't seem to fit any common disease well. I have no fever, no runny nose, almost no pain in throat but the tiny blisters remain.

No sores have appeared elsewhere yet. At least I have that going for me but that said, I've read many people get mild or no initial OB at all.

Avatar universal
Forgot to point my comment to the doc.

One additional symptom appeared: my soft palate started to itch in similar manner to allergy and the bumps feel exactly same what I feel during allergy (rubbing my tongue against them).

It's a pity I've never bothered to look how my soft palate looks like during allergic reaction...

I have been taking antihistamine regularly but sometimes it's not enough.

However still worried, the doctor appointment can't come soon enough.

Avatar universal
Itchiness gone, guess it was just a reaction my constant prodding with my tongue. Also seems like there is no more pain in the throat, just a little bit dry feeling.

I actually have another very important question. I don't know if it is ok to ask in this thread or do I need to start a new one? It is related to the same case.

At 15 days post encounter I woke up and while urinating saw two red patches on my penis. Unfortunately I didn't take any pictures but I'm worried that it might have resembled something like this:
http://dermatology.about.com/od/dermphotos/ig/Herpes-Gallery/herpes_abras.htm

However few things speak against Herpes:

1. I was sailing with my friend on the previous night and wore heavy clothing, causing my groin area to sweat. I didn't shower afterwards until next morning and that's when I saw the red areas. The red areas were located on the tip in such way that the skin could have been damaged during masturbation or when I wipe the last drops of urine with toilet paper.

2. The areas disappeared in less than two days by applying hydrocortizone 1% in the mornings and Bepanthen 50mg/g every night.

3. The areas did not itch or emit any fluids.

Would genital HSV-1 appear like that with no prodrome and then disappear as quickly as my red patches did?
Avatar universal
Quick addition: my red patches were not raised and there were no ulcerations on them. Just two patches of red skin on tip of penis.
239123 tn?1267647614
MEDICAL PROFESSIONAL
None of this changes my opinion or advice.

That will be all for this thread.  I won't have any more comments.
Avatar universal
Visited the doctor. She said it's definitely not herpes. She had to ask me where the bumps were to find them. She said they are normal and that my palate was a bit irritated from some food or pollen.

None of my lymph nodes were swollen, no flu like symptoms present, mouth looked clean. No reason for swab testing.

Thanks for your help Dr. HHH.
239123 tn?1267647614
MEDICAL PROFESSIONAL
You're welcome.  Take care.
Avatar universal
Just got test results for HSV IgG test taken at 22 day mark. Both HSV-1 and HSV-2 were negative. I shall retake the test at 12 weeks for final confirmation.
Avatar universal
Doc,

I understand it's getting late for this thread but would really appreciate if you could help.

Yesterday evening (5 and half weeks since exposure) I noticed the same red rash I had 15 days post exposure. It's in different place this time. Again there is no itch, no pain, no discharge, no blisters. It's bright red, but does not look elevated.

I saw a doctor today. He looked at it and said he could not say if it is herpes or not but if it is, it would be atypical. He told me to do nothing but wait and see if it develops blisters which turn to open sores. If, on the other hand, the rash would go away in a few days, then it's most likely not herpes.

Doctor, if my rash on day 15 was herpes, would it be typical for it to come back this quickly?

Last time it went away in 2 days by applying cortisone cream. This time I shall wait and apply nothing on it like my doctor said.
239123 tn?1267647614
MEDICAL PROFESSIONAL
You don't say where exactly this rash is located, and where the previous one was.  Herpes cannot possibly clear up rapidly with cortisone cream; indeed, cortisone can make herpes worse and last longer.  Also, herpes doesn't start as a red patch; from the very beginning of an outbreak, there are separate red bumps that, within a couple days, become blisters -- not a diffuse rash in which blisters then appear.  And finally, the answer to your question about timing is no:  it definitely is not typical for a herpes outbreak to occur this soon after a previous one.

So all things considered, I continue to strongly doubt this or the previous rash was herpes, and I doubt is has anything to do with your oral sex exposure a few weeks ago.
Avatar universal
Sorry,

The previous rash was located left side on top of the glands. Another smaller rash right side bottom of glands.

Second rash only on right side. On top bigger patch and few small blotches further down the glands. Everything on right side.

For the second rash I havend applied anything, only washed it with water and it looks like it is today clearing up (appeared yesterday around 6pm) so in a bit over 24 hours almost gone.

I took some extreme close up photos yesterday and the first set of pictures (taken around 6pm) had no ulcers. Then I went to take a shower and took few new pictures around midnight. I could see 5 microscopic ulcerations, but difficult to tell as they were too small to see with bare eyes. Needed macro photography equipment to even see them.

I took some photos and put them up to photobucket.

http://s1248.photobucket.com/albums/hh500/anderson12341/

password dermatology

I know it's not your policy to look at pictures but just in case. The pictures were taken few hours after I noticed the rash.

I don't have the pictures with the ulcerations up.

But as I said, today it is already clearing up.
Avatar universal
Dr,

This may be desperate logic but since the first rash appeared when taking antibiotics, could this be for example candida balanitis?

The rash first appeared when I was on day 5 of my trimethroprim course. Could trimethroprim disturb the balance of organisms living on the penile skin and cause a fungus or yeast to run rampant?
239123 tn?1267647614
MEDICAL PROFESSIONAL
You're right, we don't examine posted photos. But herpes can't clear up this fast; and if it causes ulceration at all, they wouldn't be so small you could barely see them.  There is simply nothing whatsoever in anything you have written that makes me suspicious you have herpes.

If you are uncirumcised, I would be much more suspicious of nospecfific balanitis or perhaps a superfical yeast infection -- both of which are facts of life some of the time for all men with intact foreskins, and are much more common than herpes, and either of which can be associated with tiny fissures or ulcers.  These are less likely if you're circumcised, but that still doesn't make me concerned about herpes.  

If you remain obsessed with the possibility of herpes, you could have an HSV-1 blood test in a few weeks.  Of course if it is positive, it won't mean you caught it during the oral sex event -- so probably there's not much point.

That will be all for this thread.  I won't have any further comments.
Avatar universal
Thank you for your comments.

I disagree on one thing though. If I get positive results from my next blood test it will in fact mean that I got it from the CSW encounter. I took a blood test 3 weeks after the incident and got negative for HSV-1 and 2.

Of course there is always a chance that the first test was a false negative in the first place but that's speculating too far.

I agree it's time to wrap up this discussion. Thanks for the reassuring comments.
239123 tn?1267647614
MEDICAL PROFESSIONAL
OK, I forgot you had an initial baseline test.  I agree that if it becomes positive, it will indicate you probably acquired HSV-1 in the several weeks earlier.  I will be extraordinarily surprised if that happens.

Feel free to return once more if and when you have a follow-up HSV-1 blood test result to report.
Avatar universal
I investigated the photo with the sores. I'm quite sure it's herpes because I noticed what looked lika a group of tiny blisters with dark heads. The sore looked like a miniscule crater from a popped sore.

Only thing is...the blisters werent there at around 6pm. The pics at 6pm had flat skin with diffuse rash. After the shower the skin was bumpy with the dark blisters (maybe 1mm diameter, about 5 blisters).

I have some sort of papules all over my glands and I'm not 100% sure but the blisters might have been located on top of them...

This appeared on Sunday evening, was much better on Monday evening, slight redness on Tuesday, on Wednesday fully gone.

I will get the second blood test soon and report back the results.
239123 tn?1267647614
MEDICAL PROFESSIONAL
By your description, I believe your penile skin probaly is normal.  But if you are convinced otherwise, return immediately to your doctor so they can be examined before they change or clear up on their own.  I continue to predict your follow-up blood test will remain negative.  Let's have no furhter comment or discussion until that result is available.
Avatar universal
Just got called by my doctor.

All results were negative.

IgG for HSV-1 and HSV-2 negative.

IgM also negative.

Doctor said she feels no need for more testing (She knows my case) and she looked at the visit history from when I showed the rash to another doctor (from the same practice). The doctor who looked at the rash had written in his notes that he had not thought it was herpes. Also my doctor said on the phone that herpes would not heal as fast as my rash did.

I think I will still do a 16 week test just to put this finally behind me but I will take this result as an encouraging step on my journey to finally get over this.

Only thing that is still causing me to worry is the fact that my 2nd rash had ulcers. I did not write it before but the tiny ulcers were emitting a clear fluid that looked like water. I suspect the ulcers did not form by themselves but rather were caused by me wiping the tip of my penis dry with toilet paper. I had just taken a shower and it might be that the warm water had made the rash more inflamed and more soft - therefore more susceptible to damage.

I suppose it could have been nonspecific balanitis or yeast because it appeared after not showering for 2 days. I am uncircumsized so yeast / bacterium could have had the perfect breeding ground under the foreskin.

If possible, could you please leave this thread open until I can post my 16 week results? It might be useful when someone is going through a similar situation and are looking for information on these boards.

In the meantime I plan to continue using protection during sex with my wife and if I get more problems with my penile skin, I will try to see a dermatologist.
Avatar universal
One additional point - this test was done 7 weeks post encounter.
239123 tn?1267647614
MEDICAL PROFESSIONAL
Congratulations; I'm glad for your good news but of course not surprised.  Now it is time to accept the science and the advice you have had; I suggest you re-read all my replies carefully.  There is no need for additional testing.  Whether you do it or not, this thread is over; additional test results will not help anyone except perhaps yourself.
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