Is this herpes or not ? if not, what else could it be?

[mazaj]

I had sex with a girl on Nov 1st and I am going to list all of the incidents with dates so it can be easily analyzed.

• Nov 5th I started feeling burning sensation on the left hip right where a belt sits.
• Nov 8th I started having burning during urination right in the urethra I felt it in the urethra.
• Nov 10th, I started having an ulcer on the skin under the shaft
• Nov 13th the ulcer seemed like healing with no medication. But suddenly crust of blisters formed north of that ulcer, which became another ulcer on the same day.  Later that day I started having shooting “stinging ”pain in my legs, buttocks, back of my thighs, and in the area between scrotum and anus.
• Nov 14th, a doctor said it was herpes just by looking at both, and prescribed me famciclovir pills and acyclovir 5% cream which I started taking right away.
• Nov 18th, both of the ulcers almost healed and left pink color scar on the skin. But burning sensation and tingling on my thighs, behind my calves, pubic area where hair grow, and groin. Plus I started peeing more often and bladder feels irritated.

I did Urine culture, Microscopic examination, Urine Chlamydia, urine for mycoplasma, and ureaplasma urealyticum. They all came out negative. I still have the burning sensation on pubic & legs. The skin where the ulcer and blisters formed stiff and wrinkly and has a loss of sensation.  

1. Is there a possibility that my symptoms could be something other than herpes?
2. How long does the burning sensation on those areas last with herpes?
3. Both ulcers are almost healed,  with a pink color scar looking skin, can I still take a swap from them?
4. Are any of my symptoms unusual with herpes?
5. Is there any quicker way to find out if I really have herpes or not and not wait 3 months for antibodies to reach detectable level?
6. Is it possible I had herpes long time before now and never knew it? Because I have never had such symptoms before.
Thank you very much for your help.

[Edward W Hook, MD]

I will offer a few further comments related to your post.  Your partner has a positive test for HSV-1 but her HSV-2 result is in an area where about half of so-called positives may not be due to HSV-2 infection but represent cross reaction with other, non-HSV-2 antibodies.  In answer to your questions:

1.  As I said in my initial reply- "There are many other possibilities. To tell what might be going on you should be seen by someone who is familiar with genital dermatologist- either someone in the local STD clinic or a dermatologist. "  

2.  While half of people who have genital herpes develop positive antibody tests as soon as 2 weeks following the outbreak, in others it may take considerably longer, typically up to 3-4 months but in a few even as long as 6 months.

3.  Obviously I cannot tell you if your test will be positive in 3 months.  For the herpes lesions of an initial outbreak to heal in just a few days (week or less) is rather unusual and suggests there may have been some other cause for your lesions.

4.  Prostatitis does not cause genital rashes.  The pressure symptoms you describe do not suggest herpes.

5.  Almost certainly not.

6.  When the test is positive it is very helpful.  In your case the test was taken after the lesions had healed and after you had taken medications for herpes.  A negative test does not help to clarify things much.  

Sorry I cannot be more help.  It sounds as though your rash has resolved. if this is the case, it may be difficult to determine what caused it.  It is not at all clear that it was herpes.  My advice is to deal with your other symptoms with your own doctor assuming that they are not due to herpes.  If the genital rash recurs, don't take medications but get it test, preferably with a PCR test as soon as possible.

There is not much more I can say. EWH

[Edward W Hook, MD]

There is a lot of misinformation about herpes symptoms out on the internet.  Sunburn-like sensation in the absence of lesions and on both sides of the body is not a sign of herpes, not matter what others say.

The PCR test is a lesion test, not an antibody test. I would suggest you have that performed on your healing sore.

EWH

[Edward W Hook, MD]

Welcome to our Forum. some of the symptoms you complain of such as the discomfort and the genital lesions are certainly suggestive of genital herpes.  Other symptoms however such as the initial discomfort in the region of your belt, burning on urination and itching in your pubic region with the presence of lesions is rather unusual.  I suspect you will need to work with your doctor over time to sort things out.  

If this is herpes, it may not be an initial infection.  I wish your doctor had done a culture or PCR test.  it would be helpful.  Your ulcer began healing sooner than might be expected with an initial outbreak of HSV. Thus a herpes antibody test might be helpful at this time.  While a negative test will not be helpful, if positive it could represent either a recently acquired infection (at 3 weeks over half over persons with HSV already have positive tests) or an infection that has been present for some time.

Let me work through your questions for you:

1.  There are many other possibilities. To tell what might be going on you should be seen by someone who is familiar with genital dermatologist- either someone in the local STD clinic or a dermatologist.
2.  The discomfort of HSV typically is present a with the appearance of lesions and lasts until they have begun to resolve.  The duration of discomfort you describe is highly atypical.
3.  The chance of a positive test is lower but it still might be positive.  I would suggest asking for a PCR test rather than a culture (the doctor may not know it but the two largest commercial laboratories now offer HSV PCR).
4.  See above.
5.  See above.  you can test for antibodies at this time.  While not definitive, the results may be helpful.
6.  Yes, in about 1/3 of patients the first outbreak is missed or attributed to something else, then becomes apparent at a later time.

I hope this helps.  As I said, the amount of help I can offer over the internet is limited.  Given the atypical part os your problems, you need to be seen by an experienced clinician to get the best answers to your questions.  EWH

[Edward W Hook, MD]

This thread appears to be going on and on with you repeating questions that have already been answered.  It is time for it to end. This will complete my answer.

These tests are negative but are too early to be definitive.  I've siad that before.  

I've already commented on the PCR testing.

IgM testing is a waste of time and likely to be falsely positve.    EWH

[mazaj]

Thank you very much Doctor,
I just came back from the lab and numeric results came back as this:
                         HSV I (IgG)  + 0.416 index (pos = > 1.0)
                         HSV II (IgG) + 0.219 index (pos = > 1.0)
test was taken two weeks after exposure. Four days after symptoms (ulcer)
what do you think of this Doctor Hook ?

I am very sad to know that the PCR test i've done on 24th NOV might have been affected by the famciclovir pills and Zovrirax cream on 14th NOV. 1st ulcer healed on the 16th and the blisters turned into an ulcer and healed on the 18th. I thought PCR looks for the DNA !!. Was that enough time for ulcer's DNA to dissappear completely ?

Now I am gonna have to wait for a new ulcer to appear and I doubt that because I've already started taking valtrex, or maybe wait 3 months for a western blot blood test.

Do you recommend having an IgM test now ? would that be helpful ?

I know I'm loaded with questions but I'll try to make these my last
Thank you very much.

[mazaj]

Thanks Dr,
Let me simplify the whole story now that I made the girl get tested for HSV I and II( IgG).
Her numeric values are HSV I (IgG)  + 3.183 index (pos = > 1.0)
                                , HSV II (IgG) + 1.998 index (pos = > 1.0)

We had sex on Nov 1st, and she told me she had laser hair removal in the down area a day before. The next day after sex she complained about inflammation in that area and a Dr prescribed her a powder of magnesium, citric acid, and standard pyridoxine to drink. 10 days later I developed blisters exactly just like you described in your previous reply. I couldn't think of those ulcer and blisters as anything other than herpes, following pictures and your description.

1- If she’s low positive and I am negative, then what explains my breakouts and symptoms that I had 10 days after sex? Knowing that she didn’t have sex for almost a year and never had such symptoms.

2- My (IgG) test (during the outbreak) on the 14th Nov for both came back negative but don't you think I took the test too early?

3- Am I going to get positive results in 3 months based on the symptoms I had 10 days after exposure and according to what the Dr said when he saw my blisters “herpes”?
He actually prescribed me famciclovir pills and Zovrirax cream on 14th NOV. 1st ulcer healed on the 16th and the blisters turned into an ulcer and healed on the 18th.

4- I feel constant pressure on the prostate and burning sensation  that was on my thighs and calves last week and now it moved to the inner thighs and pubis area. Does Prostatitis cause blisters or ulcers on genitals?

5- Am I suffering from post herpetic neuralgia?

6- On 22nd NOV, I did a PCR test like you suggested but on a healed ulcer when it was still pink, and I am waiting for the result. How confirmative is this test in detecting the virus in my case?

I’m sorry for my prolonged message but I am so worried.
Thanks

[Edward W Hook, MD]

The hallmark of genital herpes is genital lesions which go quickly (over a few hours) from bumps to small blisters which then burst to become shallow ulcers.  These sorts of lesions can be associated with varying amounts of discomfort in the area of the lesions.

The clinical presentations of herpes however are highly variable. For that reason testing of possible lesions is recommended.

With this, lets cease the "what if" questions.  I also suggest you stay off the internet.  Your situation, like that of many of our clients represents a great example of the power of the internet not only to inform but also to mislead.  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.  As I have already said, you should discuss your problems with a trained health care provider.  EWH

[mazaj]

I've read a lot of different symptoms for herpes in the internet which you don't agree with. And I don't know why a lot of medical websites and real patients discuss the leg pain as a main symptom for herpes, since the virus is a nerve-attacking species I guess.

It’s getting confusing and I'd like to use this opportunity to ask such experienced medical doctor instead of surfing around the net.
From your own valuable experience, Could you please list all the main “ reliable” symptoms for herpes?

[mazaj]

Thank you Doctor. That was helpful and I completely understand that your help is limited over the internet.I am going to ask for HSV-PCR as you suggested.

What I meant by burning sensation on pubic, legs "calves and inner thighs", and on groin. It's similar to that feeling of a sunburn and as you said that is a not herpes symptom. However, I've read somewhere that this might be herpes symptom which makes me confused. Nothing itches on these areas, except around the lesion during an outbreak, and not the lesion itself. Now the lesions healed and this burning sensation still there.

1- How soon after a first infection can someone use PCR test if he/she has just recently been infected? does it need a waiting time like "Antibody tests" ?
2- what about the shooting "nerves" pain all over the buttocks and legs ? do these symptoms precede before an outbreak or during an outbreak ?

Thanks again Doctor