A novel on anxiety…

[befuddled]

Hi Terry,

First of all, thanks for your time and everything you do here. The past 6 months have been a nightmare of stress and being able to consult here is such a relief amongst all of the craziness flying around about herpes…

I’m concerned about some recurring symptoms I’ve been having since a HSV2 encounter in July of 2014. Through the whole time I’ve had nothing but negative type-specific IGG blood tests. This has been a long process, and I’ve repeatedly tried to accept the diagnoses given, but it’s been hard with the things I’ve been going through. From the beginning:

I was abroad in July of 2014, when staying with a friend whom I previously had sexual encounters with. She gave me oral sex and there was mutual touching, but she stopped me before any genital contact occurred and informed me she had HSV2 (only genitally). We stopped any contact there and I was relatively unconcerned as I had never shown any symptoms or tested positive for herpes. We had previously had unprotected sex in July of 2013, but a negative test was taken in november 2013. We had sex again on January of 2014, and I wasn’t tested again till after the July encounter (test occurred in August, all negative IGG). I also had 2 brief encounters with other women between January and July (unknowing of this exposure at the time…), but neither of them ever got symptoms so I don’t suspect I contracted anything before July. They are both also HSV1 and 2 negative.

Around a week later, I had an encounter with another friend, when I noticed pain on my right thigh, close to the groin during sex. I ignored it at the time as I’m fairly hairy and things tend to get pulled/pinched down there anyway. However upon going to clean up, I noticed 10-15ish very small blisters in a silver dollar sized area in the painful spot. They weren’t painful outside of the rubbing during sex, but eventually grew in size over time to look more pimple like (whitish-yellow fluid, some on hair follicles, some not). The area in general felt wet and occasionally hot/burn-y, but never hurt much and never popped or ulcerated, just receded until there were some red marks, though one small blister did sort of re-appear after a masturbation session, which freaked me out. In all took about 3-4 weeks to disappear, but was unable to get a culture/diagnosis as I was traveling between countries every few days until returning to the US in August. By the time I was able to visit my doctor there was nothing left to swab. Also, in the days leading to the “outbreak”, I felt a cold coming on, then felt feverish/had a bad cough/mucus for the next week or so. However, that easily could have been a cold from all the air travel, lack of sleep, and drinking…

Since, I have been having varying ‘issues’:
– Small, painless bumps on the penis occasionally appear, usually after masturbation. Ball point pen tip in size, usually with red rim and white center. Concerning because they usually follow a pattern of appearing, lightly scabbing over, then leaving a tiny hole if the scab was picked. Also, had never noticed on penis before this encounter. Less concerning because if squeezed before the scabbing, acted like a pimple or blocked oil gland and emitted whitehead-like material. Appear on shaft, or just below the head, usually one at a time but sometimes in 2-3, but not clustered.
– Skin feels very “off”. Scrotum is a bright red color, penis skin feels very.. sticky? Fragile? Instead of the usual smooth feeling. Skin tends to lightly flake if scratched, and seems to tear more easily during “normal” masturbation or sex.
– General prodrome like symptoms – lots of tingling over the area, very occasional sharp pains. Willing to chalk this up to the brain and phantom feelings, but still makes for a stressful time..
– Lots of small, red pimple-like bumps in the thigh/groin area, but again willing to chalk this one up to “happens but didn’t notice before”..

And most concerning, after the 4 month mark and another negative test, I started dating a girl, and informed her of the whole situation. We had protected sex, and everything seemed fine other than some blood coming to the surface around the edge of the penis head in a small spot. But the second time, a small, hard bump formed at the base of my penis. I freaked out because at this point I had essentially accepted my negative results.. stupidly tried popping it which just sent blood into it and didn’t accomplish much else. 2 small, painful, red spots formed around 2 adjacent hair follicles, which eventually formed into very tiny pimples/blisters and popped. The initial bump fell off and left a scabbed but not very painful raw spot. Meanwhile, a second itchy bump appeared about an inch away on the groin (not on a follicle), but it receded on its own after a short time. A planned parenthood clinician examined everything and said while the scabbed spot was somewhat ulcerated and suspicious, the other spots seemed non-typical and to not worry about it. Tested again and negative. Girlfriend tested and also negative.

After that had healed, we talked about it and had sex again, this time without a condom (agreed upon), and the next morning I had about six sore red spots, similar to the previous ones, centered on hair follicles at the base of my penis. It was pretty painful for the first day, but these didn’t form any lesions and the pain/redness was gone in about 2 days. My primary care doctor examined them and couldn’t say much, but did another blood test (at this point, the most recent) in mid-December. It was also all negative. Concerning because other than the “initial outbreak”, I’ve never had an issue with an area/hair getting inflamed after sex before.

So, at this point.. I don’t know what to do. On sunday (1/11), I noticed a small bump on my last middle finger joint, and it has become very painful, and now I’m concerned about whitlow… It looks like there’s possibly some blood under the surface, but also with a large yellowish perimeter, and the whole area is soft/sore to the touch, almost like a blister under the skin. I intend to go get it lanced and swabbed tomorrow at an urgent care…

Because of where I live, I’m unable to get the WB through you guys, however I did do the at-home PCR — when I noticed one of the small painless bumps on my penis, I swabbed that, and the whole area for the following 3 days, but that came back negative as well. At this point, I keep teetering between two ideas:

– I was, at some point, infected and am having negative results and atypical symptoms, possibly with HSV1 from an unknown source as the blood tests are less accurate for that
– Somehow anxiety/bacteria/fungus/something has gotten everything down there mixed up enough for these coincidences to pile up

I keep trying to convince myself of the latter, but every time something new pops up.. it gets really hard to do so… So I guess my questions are:
1. Does any of this sound like herpes? Have you seen any cases like this?
2. Is PCR sensitive enough for just “skin scraping” samples? Or does there need to be a legion? This has been the most frustrating part, as other than the initial symptoms, no lesions have really had enough fluid to sample.
3. Is there any way to get the WB done at this point?

Sorry for the incredibly long post, and thanks for your time.

[Terri Warren]

1. Your comments are mixed – some of what you say sounds like it could be herpes but much of it does not and sounds more like molluscum.
2. Yes, we can recover herpes virus from areas that are not actually lesions, just abnormal feeling or appearing skin. I would say if none of the lesions has had enough fluid to sample, that is a good thing! It is less likely to be herpes.
3. Where do you live?

Terri

[befuddled]

Thanks for the quick response! I live in Maryland, which is apparently one of the states that won’t work with the University of Washington.

I’ve also attached a picture of the sore on my finger, if that helps at all.. about to head to urgent care to get it sampled if possible. It does seem bigger than yesterday but also hurts a bit less. So I guess for my 2nd followups.. Does this look whitlow-ish at all? You mentioned some things sounded like herpes, some did not… which did, specifically? My girlfriend has, thankfully, been incredibly understanding about all of this, but I am beyond terrified of possibly passing it to her… on the chance this is herpes, it’d be great to have an idea of what to look for since it doesn’t seem to be presenting in typical ways. (ie my finger never had an itchy prodrome, just hurt and was raised; itchiness/tingling in general seems non-localized and doesn’t seem to signal any of the possible “lesions”, just happens throughout the day, etc…)

[Terri Warren]

And your finger may or may not be whitlow. Normally, whitlow is significantly bigger in my experience, but I could not completely rule it out in this case. What did urgent care think?

We are currently doing a study where we can collect samples from people who live in those difficult states (as well as others). If you write to info@westoverheights.comc, we would be happy to include you when the study is up and running.

The lesion that the clinician described as suspicious also concerns me just a little – ulcerated and scabbed. But it definitely could be something else too.

I think you should try to get a western blot to put your mind at rest. I think the odds are very strongly against you having herpes but because the test misses 1-2 out of 10 HSV 1 cases, sometimes a back up test just helps to clarify the picture.

Let me know what urgent care thought.

Terri

[befuddled]

Thanks Terri!

I’ll definitely shoot over an email and try to get the WB done. That law definitely came as a big surprise during all of this, haha. And yeah, that particular lesion gave me a lot of anxiety because of how it ended up, but on the other hand, it never hurt and was more of a hard bump than a blister, though me picking at it could have interfered with that phase.

As for urgent care, the Dr took a swab but suspected it was a bacterial infection, almost like a pimple. When he popped it for the swab, it was mostly pus and a little blood. He said viral infections tend to produce clear fluid and didn’t rule out a viral response getting a bacterial infection during development, but said overall he’s fairly sure it was just something bacterial. I thought so as well looking at whitlow pictures, but with the lack of swab able lesions and amount of pain I was feeling figured it was best to be safe. Unfortunately forgot to ask if they do PCR, sounded like they were goig to do a viral culture on it.

[Terri Warren]

I would agree with the Dr. at urgent care that it looked more bacterial, especially if they could get pus out of it. So they did a herpes culture AND a bacterial swab, do you think? Sounds like your basses were covered there.

We have exhausted your three questions. If you have more, you can renew your subscription if and when you need to.

Terri

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