Anal outbreak untested six years ago

[Benevolent14]

An anal outbreak six years ago (age 18 gay male, latino) surrounding anus, perceived to be flat-ish (warts?), diagnosed by a doctor as hsv2 without any swab or blood testing. The outbreak cleared up within a month, but left flat blemishes/scars still there six years later. There have been zero outbreaks since.

Other details: cold sore on mouth five years ago, so confirmed ohsv1?

What type of testing can be done now to determine if ghsv2, ghsv1, anal warts, or something else like shingles, etc? Can a visual inspection of the scars provide insight into what it is/was?

With already having ohsv1 (assuming with cold sore) how would you determine if ghsv1 is present? I feel like there’s little hope in getting an exact diagnosis if hsv2 negative.

[Terri Warren]

No one can diagnose herpes with typing by looking. One might GUESS that someone has herpes but HSV 1 and 2 look exactly the same. And no, you can’t tell anything by looking at the scars. Swab testing of the area should have been done for a diagnosis – but apparently it wasn’t?
So you had this happen 6 years ago and 5 years ago, you got your first cold sore? Could you have gotten oral and genital infection at the same time? Had you had a recent sexual encounter prior to diagnosis? What sort of contact? The best antibody test is the western blot but you could start with the IGG test. Anal warts would stand out from the skin, not be ulcerated.

Terri

[Benevolent14]

No swab testing, just visual. The outbreak was not ulcerated or clumps of sores, more individual and slightly raised, isolated. Cold sore would indicate hsv-1, so I guess there’s no hope in isolating if it was genital hsv-1 (if not hsv-2)? Wouldn’t even be able to test for HPV. And I guess a visual inspection of scars couldnt determine if it was something not related to herpes or hpv.

For people who receive genital herpes and never have an outbreak or never did swab testing, it sounds like it would always remain a mystery, because someone could be asymptomatic oral hsv1. It seems almost criminal that a doctor could diagnose hsv-2 without any bloodwork or swab.

[Terri Warren]

Honestly, as you describe the lesions, I’m not at all sure they are herpes, much less HSV 2.
I think you can have these tested for HPV if they return – most labs have that available now.
Did you have an antibody test that was negative for HSV 2?

Terri

[Benevolent14]

Thank you. Is there a reason you can give as to why you don’t suspect herpes, much less hsv2? Anal warts people say there’s no way you could confuse anal warts for herpes. From my understanding, warts seem to stick around for a long time, but these only stuck around for about a month.

Would an std specialist be able to look at scars/blemishes and have a pretty good idea, or at least a good guess of herpes or something else?

I’m going to do igg for hsv1 and hsv2, then do western blot just to be safe.

[Terri Warren]

I don’t think it is herpes because 1) herpes lesions are not something one would describe as “flat” 2) herpes lesions don’t last a month, normally 3) HSV 2 would normally recur 4-6 times per year, on average. These are the reasons I don’t think this sounds much like HSV 2. I could be wrong, no way to tell for sure without testing.
And I would agree that it would be challenging to mix up HPV with HSV but I’ve been totally amazed at the lack of diagnostic skill of some clinicians in this area.
And no, no one could look at tell if a scar was caused by one thing or another. I have rarely seen herpes scar.

This is your final post on this subscription. If you have more questions, feel free to renew

Terri

• This reply was modified 3 years, 8 months ago by Terri Warren.

[Benevolent14]

Thanks, I subscribed for the three additional questions. I guess this is where I put them:

This question is completely unrelated to previous questions/context/individual. Pretend I’m a different poster, lol. I’m wondering what risk you think I should apply to a sexual experience. If I go by the stats, it’s extremely low, but it was just two sexual experiences with the same person, not within a long term relationship:

I was igg tested for hsv1/hsv2 Feb 2018, negative. I had done the same testing twice before over two years and was negative for both both times.

March 2018 I kissed someone with tongue but not aggressively.

February 2019 I had first sexual encounter since herpes test in Feb 2018.

This encounter was with a nurse who was fearful of herpes, had read studies, claimed to have tested negative since last sexual partner, wanted to make sure I was herpes clean, and he has not contacted me since regarding testing.

Both sexual encounters included kissing, and anal sex where I was the insertive partner. The sex was less than an hour in duration each time, and involved unbroken condoms. There was zero oral sex from either of us. Zero fingering, etc. Honestly not even much kissing.

I haven’t had any sexual encounters since, only kissing, and no symptoms. Well, I did develop a mysterious muscle issue the morning after last sexual encounter, that lasted for a month. Right leg immobility, pain in knee at times, resolved now due to myofascial/massage work, etc.

I want to test for herpes again, but mainly for a sexual partner who has more clear reasons to test. I’m perfectly aware I could have gotten ohsv1 from what I’ve described since my last herpes test, and I’m fine with being hsv1 positive. But I’m wondering how much I should worry about having ghsv1 if I come back hsv1 positive. I know many don’t test asymptomatic cases for this reason, that you can’t differentiate. But am I correct in assessing that I really don’t need to suspect ghsv1?

[Terri Warren]

OK, new poster, the experiences that you have had put you at no risk of acquiring genital herpes. Good for you for using condoms.

As you know you could get oral herpes from kissing but not genital herpes.

Terri

[Benevolent14]

Question 2: I have noticed a small pea sized flat-ish red bump on my buttocks pop up every few months or every six months. It feels kind of hard under the surface, like there’s a very small mass, but not tumor like…it always happens in the same spot, which is right where a chair or the ground would touch. It’s weird, it will come on slowly until it’s a hard-ish lump again and even larger, and it will be painful if I sit on hard surfaces only. No itching, irritation, oozing, but it’s possible there’s some scabbing (not sure). I’ve noticed this seems to coincide exactly with times where I’m sitting on concrete for long periods of time, but perhaps there have been times where this hasn’t been a variable. I can’t say it’s been an issue for very long….but maybe it has. I did have an unprotected sex experience a couple years ago. I’ve been igg herpes tested twice since then as negative.

If not herpes, maybe hpv or a boil?

[Benevolent14]

This “sore” isn’t really pus or blister-like, but maybe it has been at times…at the latter end of the cycle. It takes about two weeks to go away.

• This reply was modified 3 years, 8 months ago by Benevolent14.

[Terri Warren]

That does not sound like a typical herpes outbreak but since you have identified that it is always in the same place last for a few weeks, I would encourage you to have the bump evaluated the next time it comes up. It does not however sound like herpes to me.

Terri

[Benevolent14]

Thanks, I noticed this last round it appeared and was gone within five days. A few weeks would actually not be typical, but it probably did that once. Do you know the lifecycle of boils typically?

[Terri Warren]

I don’t know very much about boils in the genital area in terms of their typical duration, no.

Terri

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