Is this herpes?

[worriedtom]

Dr's

I wonder if you could help. I am male. Nearly 9 months ago I received unprotected oral sex from a female sex worker, thought I had NGU after a few days (no discharge) and was treated. Symptoms took a while to settle but did. 4 weeks later developed sores on anus right around the opening like little fissures and red inflamed area, these have been persistent now, sometimes worse, sometimes resolving a bit but never going for nearly 8 months. Never any anal touching etc. Don't recall any initial blistering on the penis but could the NGU have ben from herpes?

Could this be herpes from the oral sex? I have heard it can present as fissures?

I have had all the usual STD checks, including HIV to 6 months, Syphilis IGG/IGM @ 2 and 6 months, Gonorrhoea, Chlamydia etc. Had type specific HSV1 and 2 @ 4 months both negative and again at 6 months. How reliable are all these?

I know herpes can recur in the same dermatomes, I know the genitals are covered by the S2 and S3 dermatome but I thought both of these covered the buttocks and backs of legs but short of the anal opening which is S4 and 5. Is this correct or can herpes recur in any sacral dermatome?

There must be other viruses etc that one can catch from the saliva of oral sex, could anything else be caught of give similar symptoms?

I did wonder wether it was a fungal problem from taking antibiotics at the start but it does not respond to topical fungal cream, it did get a bit better with 2 weeks of fluconazole tablets but has come back.

Thanks in advance for your thoughts. I want to put an STD cause behind me but find that the start of this problem was too coincidental with the oral sex exposure.

[Edward W Hook, MD]

NGU is caused by herpes less than 2% of the time and this is recurrent infection, not newly acquired HSV.  I really see no reason for you to worry about HSV.

As far as the possibility of a fungal infection is concerned, 2 weeks of low dose fluconazole likely would have improved it. As I said, I'm better this is hemorrhoids.  EWH

[worriedtom]

Thank you for your comment.

The symptoms did occur a month after at that site, however, the initial NGU could possibly have been herpetic in origin? I have have had a clinician look and he did not think it looked like herpes either. My only concern was that it can be atypical as he also said.

If it were fungal would two weeks worth of fluconazole (50mg) a day usually be sufficient in these areas to treat a fungal infection? If it would be then this possibly rules this out as well. I think things did improve a bit whilst taking these tablets (now finished).

Thank you

[Edward W Hook, MD]

Welcome to the STD Forum.  You are correct that HSV recurrences can spread within nerve dermatomes however, experience tells is that most recurrences still occur at the site of an initial outbreak.  In your case however, these facts are probably not related to your problem for the following reasons.

1.  You did not experience an outbreak at the site of exposure which is typical for HSV.
2.  When you did experience symptoms, as I understand it, they occurred a month after exposure- too long to be typical of HSV.
3.  You have had negative tests for HSV at a time when they should be positive.
4.  The continuous symptoms you describe are not suggestive of HSV.

Bottom line, I would urge you do put consideration of HSV acquired through oral sex aside as a cause of your symptoms. The symptoms you describe are far more suggestive of hemorrhoids,  an anal fissure or a fungal infection than HSV.  The best way to address this possibility however is to have a knowledgeable clinician take a look.

I hope this comment is helpful to you.  EWH