Concerned Anal Irritation-Herpes

[scarednow526]

Hi Doc

I am male and had protected vaginal intercourse 10 weeks ago with a call girl.  I had negative HSV IGG tests at week 2 and week 8.5

I had typical genitally focused anxiety symptoms as you have described, but no skin changes.  No lesions.  I have had anal itching and discomfort off and on since shortly after the incident.  I thought nothing of it because this has happened before.

Tonight, it got pretty uncomfortable and inflamed feeling.  I used a camera and mirror and see red (like the skin has been rubbed off in 2 places) irritation directly on the anus.  When I wipe, there is some blood (very minor).

I am now concerned for herpes.  I have never had any sex or even frontage involving my anus.  I don't think I would have missed a primary outbreak on my penis and this is a recurring outbreak?  Primary wouldn't be coming at 10 weeks and on the anus, right?  I have 2 swollen lymph nodes (verified by my GP Friday) on my rib cage. That we are watching.  Related?

I have had loose bowel movements lately and have been wiping a lot.  Should I disregard herpes?

Thanks.

[Edward W Hook, MD]

Fluctuation of negative test results of this sort is normal and in no way suggests infection, at all.  Please accept these results as negative and move forward.  You did not acquired HSV.  

Further. Questions will be deleted without comment. EWh

[scarednow526]

Dr.  I would add that this was the last test as the 3-4 month window was met.

[scarednow526]

I took a 15 week test.  It was negative, but the value rose to 0.180 after previous tests (in order) at .093,  .084,  .114, and .117

Is there any meaning to the rising #?  Please do answer.  I was so happy to get the negative 15 week result.  I just need to hear at the #s are not a trend and don't mean anything.  Else, I will wonder and not be able to enjoy the test result.

I desperately want to rest well tonight.

[Edward W Hook, MD]

Last answer. These sorts of lesions are common in association with diarrheal illness for just the reasons you mention, as well as the fact that diarrheal stool is quite irritating.  You need to get over this.  EWH

[scarednow526]

Hi Dr.

After visiting the Gastro MD, he said he saw no fissures.  He agreed with the assessment that it is damaged skin from diarrhea.  We explored the diarrhea thing and have found nothing.

Today, after another bout of diarrhea this week, I have a single sore/fissurein the same general area (I think the exact same place) as one of the previous ones that healed finally about 2 weeks ago.  Does that skin just get weak and susceptible to damage?

Of course, you know why I ask.  I'm viewing the "recurrence" as a potential to be a herpes recurrence.   I know, I know, the blood test should convince me otherwise, but I also have urethra burning too, which came and went with the last bout.  I realize that dehydration can cause urethral irritation so I have started drinking more water with a little improvement.

Would you mind sharing your thoughts?

Thank you!

[scarednow526]

Thank you Dr.

I am relieved in your confidence as an expert.  I know other MDs are highly trained, but as you surely know, there's a difference in someone who speaks confident knowledge as a life's work vs. someone's who's background I do not know.

Your service fills a gap in this type of healthcare!

Thank you again.

[Edward W Hook, MD]

It is now time for you to move forward from the concerns that you mention without concern.  EWH

[scarednow526]

Hi Dr.

My backside irritation continues.  Yesterday, I was told that I do have small  fissures (2) and was prescribed a nitroglycerin cream for healing and advises to follow up with a Gastro MD.  Again, I was told it looked nothing like an STD by the physician.

As advised earlier, I took an IgG test, at 11 weeks (I will be out of town for the 12th week).  It was negative, of course and at roughly the same low values as the previous test at 8 weeks (.11).

In my situation, is this conclusive?  Can I ignore any further symptoms as Herpes?  

[Edward W Hook, MD]

Glad to help. EWH

[scarednow526]

Thank you Dr.  I see your comment.

[Edward W Hook, MD]

I agree. EWH

[scarednow526]

Thanks Dr.

I went to a walk in clinic this AM as my GP was booked.  Dr at clinic said:

1.  Unlikely Herpes as a primary outbreak would not be on anus as you said. Timing was also off.
2.  Regarding missing the primary and this being the secondary, that is unlikely because the primary would have been worse not less.  I would not have missed this type inflammation on my penis where the primary would have occurred.
3.  By appearance, the area did not look like Herpes.  It looked like irritation due to diarrhea.  They were not ulcers and he says he sees Herpes at least a few times a week.
4.  He would PCR swab for my peace of mind, but he didn't have the proper kit and didn't think it was worth sending me out somewhere else.
5.  Blood test at 12 weeks if I'm still concerned, but trust those results as definitive as condom sex is safe sex in the first place.  Many professionals still believe the risk is zero without repeated unprotected exposure.

If this is all logical to you, I think I can let it sink in.  Is it?

Thank you for your reassurances earlier.

[Edward W Hook, MD]

Welcome to the Forum.  I think you are connecting un-related events.  Herpes is transmitted only through direct contact and it sounds as though there was no direct contact with your anus. Further, 10 weeks is far beyond the time that it would take for an initial episode of HSV to appear and the symptoms you describe are not suggestive of HSV in any way.  

The lymph node noted near your rib cage is unrelated to your anal symptoms.

As far as what your anal symptoms might be, they sound like an anal fissure or even hemorrhoids more than anything else.  you could ask your doctor about this but HSV is not a concern.

I see no reason for further concern about HSV and certain no need for additional HSV blood tests.

Take care. EWH