HSV-1: Vague and Invisible Symptoms

[Respite]

Dear Dr. Handsfield,

I had an encounter three months ago. I developed extreme anxiety and a litany of symptoms: tingling, a rash sensation on the perineum, and slight discomfort in my urethra (not pain or discharge, urination fine). At ten days, I was examined: jock itch on my thigh, but the doctor saw nothing in the perineum area suggesting a rash.

I felt the invisible rash to some extent for six weeks. At four weeks, I was comprehensively tested. Results: negative for everything but HSV-1. My doctor thought it unlikely I had acquired it at the time of concern as my antibody levels were greater than 5.0, which she thought would be strange had I acquired it a month ago. She also noted that I had no white blood cells in my urine.

After I received the results, I felt more urethral symptoms, like there was a drop of urine which refused to come out. I was suspicious it was psychosomatic, but it persisted and after a week I went to the doctor; he thought herpes was unlikely given lack of pain, but tested my urine for white blood cells; none showed up.

I finally began to feel somewhat normal again, but then I felt discomfort in the crease betwixt the thigh and genital area. I fell back into a cycle of anxiety and obsessive behavior. I began to feel the perineum rash (again, examined by doctor, nothing suggesting a rash). It started to fade after two weeks, but it

[meghaman]

A related discussion, Flu like symptoms was started.

[gracefromHHP]

This is very unlikely to be hsv1 genitally is what Dr H is telling you.  Your hsv1 is most likely a previous oral infection which would give you significant protection against contracting hsv1 genitally later on.  If the cold sore on the gal was scabby then she wasn't shedding very much if at all anyways by that point. Hsv1 genitally doesn't often reoccur as frequently as you are having symptoms either - especially without having obvious lesions associated with your symptoms.  It's time to move past herpes as a potential cause of your symptoms.

it's hard not to worry that you have something going on genitally. The more you worry and obsess over it - the more you'll find reason to worry more. Drink plenty of water to keep your bladder flushed out and call off the crotch watch.  When you feel those odd sensations try things like soaking in the tubby with either baking soda, epsom salts, aveeno bath or even 2 cups of vinegar thrown in for comfort.  When you can - go bottomless - do so to cut down on friction and to get cool, drying air to your genital area.  You can also try using topical anesthetics too like dermoplast spray and such when you have these sensations to help stop them so you aren't constantly thinking about your genital area. Sprinkling corn starch  on your genital area before getting dressed also helps to cut down on friction so that you aren't constantly reminded of your nether regions during the day.  

if this continues perhaps a visit to the dermatologist for skin scraping to rule out fungus is a good idea ( it's not anywhere near as painful as it sounds I promise! ).  Try to be seen while you have your rash that seems to always disappear by the time you see a medical provider ( doesn't that alway seem to happen? ugh ).

grace

[Respite]

In essence, I'm just looking for your opinion. I trust in my doctors' judgment, but since it's such a vague, variable affliction I remain concerned. And, the event of concern involved oral sex with a girlfriend who had a scab above her lip. In abject stupidity, I dismissed it as simply acne and failed to ask her about it (I didn

[H. Hunter Handsfield, M.D.]

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Also, I probably will not be able to respond to any follow-up comments or questions.

To your question:

The symptoms you describe do not suggest HSV-1, not even close.  (Had you come to me with such symptoms, I would not have suggested testing for HSV or any other STD.)  Your blood test indeed shows you are infected with HSV-1, as is half the population, but you can be sure it has nothing to do with your symptoms.  If they continue and/or you remain concerned, follow up with your personal health care provider.

I won't have any further comments.  Good luck--  HHH, MD