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Suspected Herpes Dx
Hi Dr. Handsfield,
Approximately 10 days ago I noticed a shiny pink area on the underside of my penis at the top of the shaft that looked like a cluster of painless papules. For approximately 4 days prior to noticing the pink papules I had felt strangely tired, had a scratchy throat, was somewhat achy, and didn’t have much of an appetite. I felt like I was getting sick but never actually got sick (no fever, swollen lymph nodes, really sore throat, etc.).
I decided to go see an internist (my normal PCP was out of town) who looked at the papules and dismissed them as the result of too much masturbation or an adverse reaction to lubricant. He advised me to not masturbate for a few days and to call him if the papules did not go away. Three days later, I contacted him and he advised me to go see a dermatologist. At this point, I decided to contact my normal PCP. He looked at the lesions and stated he thought they plausibly looked like herpes. So my PCP tested me for everything including a blood test for herpes and also swabbed the papules on my penis and sent that off to the lab. I am still waiting for him to return the results.
The only sexual experience I have had in the last six months was a guy performed oral sex on me approximately 10 days before I started feeling tired and about 2 weeks prior to noticing the papules. I’m trying to be patient in waiting for the results.
1. Does my timeline of symptoms seem suggestive of a Herpes dx?
2. Could I have acquired HSV-2 from skin to skin contact or oral sex on just a single occasion?
3. If this turns out to be herpes, would you have any suspicions (based on the symptoms) about whether this is perhaps a recurrence of an asymptomatic HSV infection that I have had for a long time vs. it being a new primary infection?
4. Last question: what kind of testing should have been done to dx the herpes? I want to make sure that I ask my PCP the right questions about the Herpes results when I get them.
Approximately 10 days ago I noticed a shiny pink area on the underside of my penis at the top of the shaft that looked like a cluster of painless papules. For approximately 4 days prior to noticing the pink papules I had felt strangely tired, had a scratchy throat, was somewhat achy, and didn’t have much of an appetite. I felt like I was getting sick but never actually got sick (no fever, swollen lymph nodes, really sore throat, etc.).
I decided to go see an internist (my normal PCP was out of town) who looked at the papules and dismissed them as the result of too much masturbation or an adverse reaction to lubricant. He advised me to not masturbate for a few days and to call him if the papules did not go away. Three days later, I contacted him and he advised me to go see a dermatologist. At this point, I decided to contact my normal PCP. He looked at the lesions and stated he thought they plausibly looked like herpes. So my PCP tested me for everything including a blood test for herpes and also swabbed the papules on my penis and sent that off to the lab. I am still waiting for him to return the results.
The only sexual experience I have had in the last six months was a guy performed oral sex on me approximately 10 days before I started feeling tired and about 2 weeks prior to noticing the papules. I’m trying to be patient in waiting for the results.
1. Does my timeline of symptoms seem suggestive of a Herpes dx?
2. Could I have acquired HSV-2 from skin to skin contact or oral sex on just a single occasion?
3. If this turns out to be herpes, would you have any suspicions (based on the symptoms) about whether this is perhaps a recurrence of an asymptomatic HSV infection that I have had for a long time vs. it being a new primary infection?
4. Last question: what kind of testing should have been done to dx the herpes? I want to make sure that I ask my PCP the right questions about the Herpes results when I get them.
MEDICAL PROFESSIONAL
Welcome to the forum and thanks for your question. However, I'm not sure I can help very much. You're essentially asking me to mediate between conflicting professional opinions, which no online expert can do.
That said, your description doesn't sound at all like genital herpes. And of course of all penile skin conditions, herpes is a lot less common than several others. Any number of dermatologic conditions could be responsible and I will be very surprised if the PCR or culture (the swab test from the lesions) is positive for HSV. My view is that you should have followed the internist's advice to see a dermatologist. Most likely a dermatologist would be able to instantaneously make an accurate diagnosis based on simple visual inspection.
To your specific questions:
1) None of your symptoms is typical for a new HSV infection, and the timing also isn't right. Although new herpes can show up as late as 10-14 days after exposure, usually it's 2-5 days.
2) Oral sex never transmits HSV-2. HSV-1 could be so acquired; but as noted above, I doubt you have herpes of either type.
3) I'm not going to speculate on an unlikely outcome. If it turns out you have HSV, despite all the atypical features, we can address the prognosis for future recurrences at that time.
4) If your penile lesions are still present and more or less unchanged in appearance at this time -- which I gather is a week or more after they appeared -- that alone will prove it isn't herpes. In that case, go ahead and see a dermatologist and take it from there. If herpes then seems likely, and assuming the PCR or culture (swab test) and blood test are negative, then the next step would be another HSV blood test in a few weeks, to see if it has become positive. But as should already be clear, I doubt it will come to that.
For the time being, you should go forward with the assumption that you have something other than herpes.
Best wishes-- HHH, MD
That said, your description doesn't sound at all like genital herpes. And of course of all penile skin conditions, herpes is a lot less common than several others. Any number of dermatologic conditions could be responsible and I will be very surprised if the PCR or culture (the swab test from the lesions) is positive for HSV. My view is that you should have followed the internist's advice to see a dermatologist. Most likely a dermatologist would be able to instantaneously make an accurate diagnosis based on simple visual inspection.
To your specific questions:
1) None of your symptoms is typical for a new HSV infection, and the timing also isn't right. Although new herpes can show up as late as 10-14 days after exposure, usually it's 2-5 days.
2) Oral sex never transmits HSV-2. HSV-1 could be so acquired; but as noted above, I doubt you have herpes of either type.
3) I'm not going to speculate on an unlikely outcome. If it turns out you have HSV, despite all the atypical features, we can address the prognosis for future recurrences at that time.
4) If your penile lesions are still present and more or less unchanged in appearance at this time -- which I gather is a week or more after they appeared -- that alone will prove it isn't herpes. In that case, go ahead and see a dermatologist and take it from there. If herpes then seems likely, and assuming the PCR or culture (swab test) and blood test are negative, then the next step would be another HSV blood test in a few weeks, to see if it has become positive. But as should already be clear, I doubt it will come to that.
For the time being, you should go forward with the assumption that you have something other than herpes.
Best wishes-- HHH, MD
I didn't really understand the reference to HCV testing--my derm occasionally makes very odd statements about improbable scenarios which I have learned to ignore over the years. While I am a gay man, I don't have unprotected anal sex (or even that much anal sex at all), don't engage in fisting or anything like that, and have never used injection drugs so it seemed like an outlandish suggestion. Nevertheless, I figure at my next annual physical exam I will mention it to my PCP and let him decide but it sounds like you are saying it isn't necessary and you are the ID doc. Again thanks for all your help.
MEDICAL PROFESSIONAL
I was thinking of mentioning lichen planus, but don't like to speculate too far about likely non STD causes. LP is among the most common genital skin rashes.
I don't understand the advice about HCV testing or why it's in the picture here. You and/or your dermatologist may be among the many who have come to misuderstand HCV as a sexually transmitted infection. In fact, heterosexual transmission of the virus has never been clearly documented and appears to be rare. The only proved sexual transmission scenario for HCV is for traumatic (often bloody) sexual practices (e.g. fisting) among men having sex with men.
Anyway, glad to hear of the good news outcome.
I don't understand the advice about HCV testing or why it's in the picture here. You and/or your dermatologist may be among the many who have come to misuderstand HCV as a sexually transmitted infection. In fact, heterosexual transmission of the virus has never been clearly documented and appears to be rare. The only proved sexual transmission scenario for HCV is for traumatic (often bloody) sexual practices (e.g. fisting) among men having sex with men.
Anyway, glad to hear of the good news outcome.
Hi Dr. Handsfield,
As you predicted, both the blood test and PCR test came back negative. My PCP referred me to the dermatologist in the same medical group who examined it and assured me that it was not herpes but lichen planus. He decided to biopsy for confirmation and stated that if confirmed by biopsy, I should get an HCV test as a precautionary measure. After reading about lichen planus online it sounds very common, almost always benign, and usually totally unrelated to HCV which comes as a relief.
Thanks for this forum. It has saved me money and worries on many occasions! Best Wishes from Chicago.
As you predicted, both the blood test and PCR test came back negative. My PCP referred me to the dermatologist in the same medical group who examined it and assured me that it was not herpes but lichen planus. He decided to biopsy for confirmation and stated that if confirmed by biopsy, I should get an HCV test as a precautionary measure. After reading about lichen planus online it sounds very common, almost always benign, and usually totally unrelated to HCV which comes as a relief.
Thanks for this forum. It has saved me money and worries on many occasions! Best Wishes from Chicago.
You are reading content posted in the STDs Forum
Herpes spreads by oral, vaginal and anal sex.
Herpes sores blister, then burst, scab and heal.
STIs are the most common cause of genital sores.
Millions of people are diagnosed with STDs in the U.S. each year.
STDs can't be transmitted by casual contact, like hugging or touching.
Syphilis is an STD that is transmitted by oral, genital and anal sex.
