Herpes without bumps and lesions? tingling?

[Hank145]

This forum has been very informative and thank you for helping all of us out there that are filled with anxiety!

Could you comment on incidence that you have seen in which an individual does not have such severe herpes symptoms; meaning they have herpes, but never had legions or bumps everywhere?  

I am sexually active (protected/unprotected) and just recently have developed the following symptoms which I have never had in my life before: tingling on the surface of my scrotum, penis, glans, the area above my penis (where there's pubic hair), and slightly around my anus.  I have had this persistently for the past 6 days.  Also, I have a very very small bump on the inside or fingerprint side of my thumb.  I was researching herpetic whitlow and thought this, combined with my tingling sensations were enough to diagnose myself with herpes.  I went to an STD clinic and the doctor said that I have no visible signs of herpes, but I already knew that.  And I have read that most individuals with herpes don't necessarily show severe symptoms, and I wonder if I could be one of those individuals.  Perhaps I need to wait awhile longer for the more severe symptoms to emerge?  The doctor also said that I have a minor possibility of urethritis.  I don't have any significant discharge or burning inside my penis to suggest syphilis.

Could you comment on the cases of individuals you have seen that never have severe symptoms?
Is tingling a common, more mild symptom that doesn't necessarily result in the more severe symptoms?
How common is hermetic whitlow?
If not herpes, then what are possible alternatives?
I also am having a blood test for it, but the earliest encounter that put me at risk was about 1 month ago. Is the test worthless?
How long after initial infection is necessary for symptoms to emerge?

Thanks doc!

Thanks!

[Hank145]

Following my just posted previous note...

Testing:  Immediately after my symptoms developed, I was tested for HSV 1, 2, syphilis, gonorhrea, HIV, and came up negative for everything which was not unexpected.  

1.  I am now wondering if I am having a primary HSV 1 infection where I am experiencing very minor symptoms in my genitals as well.  Is that possible?  Though I would have expected the symptoms to show in and around my mouth first, wouldn't you?

2.  Could I have syphilis instead?  My tongue looks like syphilis of the tongue as well as herpes.

3.  With these additional symptoms, am I now more likely to be an individual with HSV2 that doesn't show the severe symptoms on my genitals?  My symptoms in my genitals and on my tongue seem to be too coincidental to ignore.

I still have two more months to wait before I can get tested, though I am inclined to get tested again since one month has pasted.  

4.  At this stage, what percentage of test results will be a false negative?  Would it be worthwhile to get tested again now?  The value in being tested now for me would be peace of mind so I know what I am dealing with.

Thank you again for your help.

[Hank145]

Hi Doctor,

Sorry to follow-up yet again, but my symptoms have adjusted slightly, and I think significantly.  To summarize again for you:

- I had an unprotected at risk encounter August 29th.
- Two days later, I began feeling tingling everywhere on my genitals.  "Crawling" may be a better description.  The sensation wasn't painful, or irritating, but something I've never felt before.
- This lasted roughly 6 days, at which time, some areas of my genitals, both on my penis and on my scrotom had a very faint sensation of burning.  This has gone away, though I do on occasion feel the "crawling" when I get into the right paranoid mindset.
- In hindsight, my scrotom had a general pink coloration, probably scrotal swelling?
- Since those 6 days, I can feel the tingling if I am focused on it, but generally don't notice it.  
- No lesions, sores, or bumps.  I have looked and looked and looked.

The few notes I would like to add are as follows which I think could be significant:

- When I have an erection, I can see very very small red pigmentations on the head of my penis.
- My tongue has a white coating on it, as well as very small red bumps close to the tip of my tongue.  There is one large sphere on my tongue that doesn't have this white coating on it, perhaps a sore?  It is not paintful (yet).  This looks similar to some pictures I have seen on the web of herpes or syphilis on the tongue.  I am not sure when this developed as I don't look at my tongue on a regular basis.  I just noticed yesterday, so about a month after my at risk encounter.  The symptoms as of now are only on my tongue, not on or around my lips or other parts of my mouth.

[Hank145]

Dr,

Thank you for your thorough responses.  I just received my blood test results from last week, and everything was negative, but this was not unexpected because my first at risk encounter was only two weeks prior.  

I know I have to wait a few more months to be tested again for a more definitive answer, and will keep this thread apprised of the results.  Now I can only wait, and cant help but ask the questions: If not herpes, then what?!

[H. Hunter Handsfield, M.D.]

1) "Could you have been" one of those folks with trivial initial symptoms?  I suppose so.  But I strongly doubt it.

2) No.  If you have to look hard to see anything, then whatever you see isn't herpes.

3) HSV lesions usually go from red bump to blister to pimple-like lesion to open sore to scab to healing over 10-14 days, sometimes longer for the first infection, sometimes a little shorter (e.g, 7-10 days) for recurrent outbreaks.

4) The most common forum of urethritis is nongonococcal urethritis (NGU).  About 30% of NGU is due to chlamydia; the other 70% of cases are due to other things.  Herpes is always a possibility, but herpetic urethritis usually is accompanied by external herpes sores; and generally is quite severe.

Can I guaratee you didn't catch herpes?  Of course not.  But I am pretty sure you did not.  No online expert can provide any more information than this.  If you want to be more certain, feel free to have a blood test for it around 3 months after your exposure.  In the meantime, I see no need for the amount of worry you are apparently having.

I won't have any further comments.  Best wishes.

[Hank145]

Additionally, just about all symptoms have gone away since this afternoon.  So I was experiencing this for 7 days.

[Hank145]

Sorry, I forgot about my last question on hermetic whitlow.  My hand was exposed to fluids and skin as well, so given that, couldn't I have gotten herpes on my hand as well?

Thanks!

[Hank145]

Thank you for this, and I would like to provide a follow-up.  In summary, my symptoms, which have maintained themselves for one week, do not seem to be Herpes, at least as I have described them.  Aside from being concerned because I've never felt these symptoms before, I have these remaining few questions really based on the below information, and I hope they are worthwhile for an answer!

Here is what the CDC has published:

Most people infected with HSV-2 are not aware of their infection. However, if signs and symptoms occur during the first outbreak, they can be quite pronounced. The first outbreak usually occurs within two weeks after the virus is transmitted, and the sores typically heal within two to four weeks. Other signs and symptoms during the primary episode may include a second crop of sores, and flu-like symptoms, including fever and swollen glands. However, most individuals with HSV-2 infection  never have sores, or they have very mild signs that they do not even notice or that they mistake for insect bites or another skin condition.

1.  Could I be one of those individuals without "quite pronounced" symptoms of herpes, in which I only have mild burning/tingling/itchy sensations?  Initially, the tingling was all over my scrotom, penis, and around my anus, but has localized to some extent to one part of my scrotom and penis.  I have read that the tingling sensation is from the virus infecting the sensory nerve fibers on the surface of the skin.  Is this inaccurate?  These sensations have maintained themselves for one week, but I have looked and looked and looked for blisters/lesions/sores and haven't found any.  And according to the CDC, "most individuals with HSV-2 infection never have sores."  This is why I think my symptoms could still be a result of an infection and am looking for an explanation for why I am wrong.

2.  Could I have already had blisters/lesions/sores, but they were too small for the naked eye to notice?  If not, are they still a possibility to come in the coming days/weeks?

3.  When blisters/sores begin to emerge, how quickly do they develop, grow, etc?  The skin on my penis is not completely uniform in texture or color, as most penises are not, I imagine, so it is very difficult for me to tell if an area with slightly more pink coloring, and/or combined with an area of slightly different texture is a breakout area.     I have been looking at the areas on my scrotom and penis that have had the more prominent tingling sensation over the past several days, and the color/texture of the skin has not changed dramatically.

4.  As I had mentioned before, the STD doctor found that I had urethritis.  If you feel as though I don't have herpes, from what could this urethritis be a result of?  My symptoms don't seem to lead to chlamydia, gonorrhea, or syphilis.

Lastly, thank you again for all of your help.  I know I'll have to wait for the test results, and then another set in three months I presume, but this guidance and dialog is providing me peace of mind, irrespective of what you think I have.

Thanks!

[H. Hunter Handsfield, M.D.]

Thanks for the thanks about the forum.  We try to help.

The bottom line for you is that your symptoms do not suggest herpes or any other STD.  As you were accurately told on the community forum, no STD can start to cause symptoms the next day after acquiring the infection.  Also, there is a general misconception about asyptomatic herpes and atypical symptoms like tingling or burning.  When people have symptoms, they just about always have genital blisters/sores etc.  But some people might not notice them; and when the diagnosis of herpes is made later (e.g., by blood test), in retrospect they recall "Oh, yeah -- I had that genital itch/burning/tingling back ___ months ago."  But had they looked closely back then, they would have seen lesions.  In other words, tingling, burning, etc probably rarely occur as the only symptom or sign of herpes, especially in people who are very alert to their bodies and have examined themselves carefully.  Also, when such symptoms occur with herpes, they tend to be very localized, i.e. to the spot(s) where the lesions are.  Generalized itching or tingling of the genitals does not suggest herpes or any other STD.  Mostly those are symptoms of either a dermatitis of some sort (if there is redness, flaking, etc) or of genitally-focused anxiety.

To your specific questions:

1) Most people with genital herpes never have "severe symptoms", i.e. among people with positive blood tests for HSV-2, most don't recall any symptoms at all.  But likewise, few if any have the sort of symptoms you describe.

2,4) Re tingling and alternative diagnosies:  See above.

3) Herpetic whitlow is uncommon.  In 30+ years in a busy STD clinic, I have seen only 2 cases of whitlow in association with genital herpes.  I have never heard of whitlow occuring along with the mild sort of genital symptoms you describe.  Herpes whitlows are very painful and looks like a very obvious infection.  Whitlow is not a realistic possibility for the minor sort of "small bump" you describe.

5) An HSV blood test 1 month after exposure is not completely worthless; about 60% of people with new HSV-2 infections would have positive results by then.  In other words, a negative result won't prove you didn't catch herpes.  For that you have to wait about 3 months.  But all things considered, the chance of herpes is so low that I don't recommend testing for it at all.  In fact, if you were to have a positive test for HSV-2, my professional conclusion would be that you had been infected at some other time and have asymptomatic HSV-2; and that something else is the cause of your symptoms.

5) In people with symptomatic genital herpes, the lesions generally start to appear 3-10 days after exposure.  Up to 3 weeks is possible but uncommon.

As you were told on the community forum, you should return to your provider if your symptoms persist or you remain concerned.  But I see no realistic chance your symptoms are due to herpes or any other STD.

Best wishes--  HHH, MD