How quickly do initial onset herpes symptoms come and go

[john352]

Hey Doc.  I have found your responses informative and helpful.

Timeline:
Day 1:  Condom protected sex with what I consider high risk individual
Day 2:  Regret, shame, guilt, conscious of consequences, frantic internet surfing
Day 3:  Some red bumps on my upper thighs next to genital area where shaved.  Not necessarily unusual after shaving.  Self exam revealed no blisters on penis, shaft, head, base scrotum.  Hard to see under scrotum.  Couple bumps, one left cheek, other right cheek, again no unnecessarily unusual.
Day 4:  Bumps a little more pronounced.  Many with hair follicles, some little white heads.  Bumps spread, not clustered or vesicle appearing.  At next morning bumps subsided, not red.
Day 5:  Some sensitivity on both inner thighs from crotch down 5-6".  Not painful, just aware or over-aware after surfing internet for days.
Anxiety at 100+ bordering on panic attack. At night some burning sensation on backside of scrotum.  Bumps on thighs remain subsided
Day 6:  Constant awareness of sense of slight burn at base of scrotum or right groin throughout day.  By 11:00pm, no burn sensation anywhere.  Bumps on shaved part of thigh hardly noticeable, many appear to have hair follicles.  No sensations in legs, scrotum, groin.

What was this?  Can one talk oneself in to somataform symptoms or perceptions based on guilt and fear?  The mind is a powerful thing or is this denial?

More intense symptoms exacerbated and subsided within about 36 hours of becoming aware.  No sight of blisters etc.    Depending on what source, initial onset is 2-7 or 10 days or 2 days to three weeks.  If this is an STD onset, what is it and is it over with onset or more to come?  Having an MD exam asap.

[Edward W Hook, MD]

Glad I could help. In my opinion, if you do not deveop lesions suggestive of genital herpes within 2 weeks of exposure, I see no need for further testing.  

You are correct.  About 1 in 4-5 adult Americans had genital hepres an of those, only aobut 80% know it.,  This is most often because they attribute their HSV symptoms to something else.  EWH

[Edward W Hook, MD]

There are almost no side effects from valacyclovir, it is just a waste of money as well as putting you at miniscule risk for side effects.  It may compromise your abiltiy to get a definitive diagnosis.  While there are no studies, some of us who see lots of patients with HSV have noted that taking antiviral therapy very early in the course of infection can delay anitbody production, making diagnosis with a blood test difficult.

In general, I have little patience with doctors who give their patients medications "just in case".  On an individual level it is a waste of resources, can obscure or delay the diagnosis of what is really going on, and in many instances (probably not yours) places patients at risk for side effects.  It is also a cop-out since in doing this the health care provider typically does not provide the patient with a realistic discussion of risks and the downstream possiblities.  On a societal level the practice drives up health care costs and contributes to development of antibiotic resistance which, in turn, makes it more difficult to treat proven infections.  Taken together, while it's often perceived of as the part of least resistance, it is bad medicine.  EWH

[Edward W Hook, MD]

I would stop taking the valacyclovir if I were you.  It is, of course, up to you.

Regarding the folliculitis,  Shaving is highly associated with folliculitis.  The shaving increases the chance that pores and hair follicles will get clogged, leading to folliculitis.  The shaving is analgous to squeezing a pimple when it occurs, it can open up the clooged pore and allow for heaing.  EWH

[Edward W Hook, MD]

Your anxiety is getting the best of you and has put you in a compromised state in terms of really finding out what is going on.  You describe classical folliculitis in an area which was covered by a condom and then start taking anti-viral therapy which can compromise testing.  You are tying your doctors' hands.

If you have herpes (unlikely) condoms will reduce the chance of transmission.  Additional studies indicate that valacyclovir, taken regualrly also reduces the risk of HSV transmission more than 50%.  EWH

[john352]

Thank you for a thorough and reinforcing nature.  I did see a dermitologist today that had the same impressions of you.  I was examined and he said it was early but that he might have expected to see a red patch of skin as I approach the 10 day mark.  He suggested that I return if there is an actual onset of symptoms or wait about three weeks so he can runs some tests. He took a history and reached a similar conclusion. He stated my risk was very, very low. Admittedly, your suggestion of 1/10th of 1% is even more encouraging.  At least between the two of you, I will finally get some rest tonight which I have not done for a week.  Thank you.  One other question.  I read over and over again that somewhere between 40-60m people (generally insinuating HSV1 & 2) have herpes and that 60% of people with Herpes do not know they have it. Or is it that that number of people have some "form" of herpes (I found 8) and are not aware of it.

[Edward W Hook, MD]

Welcome to our Forum.  I'll try to help.  Your risk for STD following a single episode on condom protected sex is very, very low- less than one 1/10th of 1%.  On the other hand, sometimes after an exposure that, in retrospect, one wishes they had not had, persons tend to examine themselves and be far more attuned to genital sensations than in periods when they are not concerned.  This in turn leads to noticing what turn out to be normal sensations that might have been not noticed or ignored at other times.   In your case, the combination of guilt and shame, mixed with a healthy dose of internet fueled anxiety have probably made you worry unnecessarily.  While there is much useful information available on the internet, much of it is also taken out of context or a bit unbalanced and some of it is just plain wrong.

The genital region has many "bumps" and irregularities which typically go unnoticed until persons start with overly vigilant self-examination.  The likelihood of bumps and such irregularities occur normally in the genital region and are still more common in reaction to shaving which it sounds like to do from time to time.  Further, among the symptoms which are regularly generated by the power of suggestion (i.e. self examination and heightened self-awareness) and uncommon for STDs are itching.  finally, your symptoms really came on far earliey than is typical for most STDs which cause symptoms, at the earliest, at beyond 3 days.

You are doing precisely the right thing by having a trained health professional take a look. Hopefully they will have the experience to be able to assist you in sorting out whether the symptoms you are experiencing reflect a problem (unlikely) or represent heightened awareness on your part.  Parenthetically, I hope whomever you see will not offer to treat you "just in case" and particularly without testing. such approaches can often just make things worse by not addressing the real problem and due to side effects of un-needed treatment.  On the other hand, negative tests are to be believed.

I hope my perspective and comments are helpful to you.  EWH

[john352]

Is the suggestion to stop taking valacyclovir due to your assessment of my risk being low, the potential side effects being high or is your suggestion to let nature takes its course.  As I stated, the physician I saw assessed my risk as very low but suggested that if I wanted to be precautionary, he would prescribe the meds.  I want to reconcile the two opinions.

[john352]

Thank you.  Sorry for being a pest. Last post on this thread. My thought was, just to be as safe as possible, I would take the Valtrex for a couple weeks while waiting for the time to pass to be tested as there have been no blisters or leisions.  (This is more of a better safe than sorry tactic on my part.)  My impression from the physician I saw was that I would have to wait three to four weeks before being tested. Should I stop taking the Valtrex now or, if not, how long should I stop taking the medication before I plan to get tested?  (Should I avoid shaving as normally when I get folliculitus, sometimes carefully shaving helps resolve it?)

As a final note, I really, really want to compliment and thank MedHelp.com for making this service available and to you for being so responsive.  It is Sunday and you have taken the time to provide information and support.  It is extremely helpful to have this kind of access to a physician who is an expert in this area.

[john352]

Doctor, I do not want to abuse my privilege but am a little, "panniky".

At day seven, almost to the hour, I noticed a small red area around a hair follicle on my penis and in an area I believe should have been covered by the condom.  I can't be entirely sure as an erection is the furthest thing from my mind.  In my panic, I gently pulled the hair without digging in to the skin.  I squeezed that spot lightly and a little bit of blood emerged.  All of this would be normal as I shave in the region.  When I do not shave and hair starts to emerge, its not unusual for a bump to appear and I usually do the same routine.

I cleaned the area and put a little neosporin on it.  This morning, I looked and it still has a reddish tinge.  Also, the physician I saw did prescribe Valtrex at my request as a precaution as it was too soon to test.  I initiated the medication in response to seeing the reddened area.  

My question is, what should I look for next?

How long would it take a small red area to emerge in to a blister?  

Will the Valtrex inhibit further development or will it only facilitate faster healing if a blister emerges?  Is there anything specific that I can look at this spot to see?

Finally, in one weeks time, I will be in a situation where I will be expected to have sex.  If I use a condom and am on Valtrex, is it safe for the other person?