Can I relax now?

[jjohnson817]

22, M, bisexual. Had unprotected receptive anal sex on September 26. Didn’t notice any symptoms until October 9, thirteen days later. Had a sore throat and some urinary issues, frequent urge, dull ache inside penis. And slight tingling/burning/itchy in genital/anus region. Over the next two days I became very tired, lethargic, lost my appetite, diarrhea, and somewhat nauseous. Urinary issues were still present. On October 12 I got preliminary STI panel, all negative (herpes was not included). By the next day I felt much better overall, and many of the issues seemed to be gone by the end of the week. Diarrhea and dull burning/tingling/itchy feeling persisted however. I was very stressed during this period so I got an HIV PCR RNA test, negative. The burning/tingling/itchy sensation seemed to get a bit better over the next few days, diarrhea was still present but definitely less severe (more solid). October 23 was the first day I noticed a series of small red bumps forming on my buttocks. The are all scattered randomly, not clustered at all and look like pimples, nothing like blisters I’ve seen online. They didn’t hurt nor itch but did hurt if pressed on, and sometimes felt irritated. Particularly sitting down or wearing tight clothing. October 24 I got retested for basic STI panel, and got a separate HSV IgG test. All negative. At this point still had burning/tingling/itchy feeling all over genitals and anus. It comes and goes but mainly feels like a slight heat in the region. October 26 I had the bumps on my butt swabbed and PCR tested, again negative. At this point (October 28) I still have the inconsistent burning/tingling/itchy feeling and irregular stool. Does any of this sound consistent with HSV in your opinion? I have seen 3 separate doctors at this point that have all said this is stress induced and in my head. Im very emotionally tired and frustrated and want to put this behind me. I intend on testing again at 3 months, but want to relax for now. Thoughts?

[jjohnson817]

I will also add a few additional points:

1. I am certain this (September 26, 2022) would have been my exposure date. I have been tested many times in the past, and this was my first sexual encounter since the last time I was tested (IgG) in May 2022.

2. I have always received testing from STDCheck.com and gone to LabCorp for blood work so my tests don’t have specific values, just <0.91 = Negative. I had the PCR swabs done at a clinic however. I have always been tested for both HSV 1 and 2, always negative for both.

3. I would also like to know how anal herpes presents internally. Like I said the only external lesions I had were the scattered red bumps on my buttocks, which were swabbed and negative. I am worried that I might have things going on inside that I can’t see, but there is little information online regarding the topic. I have had hemorrhoids for a few years now so bleeding when wiping is not new to me, but the GI issues I discussed are concerning.

4. I am unable to contact the other person, as it was a one-night stand in a city I was traveling in. Never got their number or any contact information. However they did say they were negative for everything the last time they were tested, which was a few months before this incident.

5. I also forgot to mention, we also had unprotected oral sex, we both performed on each other. I only received anal sex however, did not give.

• This reply was modified 4 months, 4 weeks ago by jjohnson817.

[Terri Warren]

JJohnson, this sounds nothing like herpes to me. Not at all. but I am very concerned that you are having unprotected anal sex. You are risking so much more than herpes by doing this. You had unprotected anal sex with a stranger in a city you don’t live in. This is really scary. Anyone can say anything about testing, right? We just can’t count on that.

I hope when adequate time has passed, you will test for HIV, Hep B, Hep C, do an anal pap for HPV, HSV, gonorrhea, chlamydia and syphilis. And I hope that you will use condoms with every episode of anal sex from now on.

Terri

[jjohnson817]

Terri,

Thank you for the quick response and concern. Trust me this will never be a mistake that I will make again. I have always been good in the past about ensuring protection, but I definitely had a lapse in judgement. I have 100% learned from this mistake and it will not be happening again.

Can I ask for any specifics regarding as to why this doesn’t seem like herpes at all to you? What do you think could be causing the constant burning itching and tingling sensations? What about the consistent diarrhea for nearly a month now? From all the research I’ve done my GI symptoms sound like proctitis. But again I could be completely wrong, and this absolutely could be anxiety driven. Any specifics regarding your suspicions would be very helpful.

I will absolutely be retesting in 2 months or so as well. Thank you for all that you do!

[Terri Warren]

I’m glad you are going to be practicing safer sex now.
First, herpes symptoms generally don’t last for a month with no sores. Diarrhea is not a symptoms of anal herpes – indeed, many people who acquire HSV genitally have a really tough time pooping. And when the only symptoms people have are itching and burning without lesions, the vast majority of the time their western blots are negative.

Terri

[jjohnson817]

Terri,

So brief update. I have since gotten an additional igg test, again negative. This was 6 weeks post exposure.

A few additional questions:

1. I know a test at 6 weeks is not conclusive, but realistically how should I feel about this result?

2. The majority of my symptoms have disappeared, the only remaining are diarrhea and a “diaper rash” feeling in my anus. Is it possible that the burning/itching feelings I had were an outbreak? Is it concerning that this has stopped seemingly all at once and could indicate the end of an outbreak?

3. I saw an infections disease specialist and he said that he did not think anything indicated sti, but thinks I may have gotten giardia from the sex, which would explain GI symptoms. Any thoughts on this before I take the antibiotics?

4. Would you recommend any additional testing prior to the 12 weeks mark?

5. You mentioned getting an anal pap. I am unfamiliar with this and haven’t found much online about it, outside of testing for HPV. Where would I get this done? Would this pick something up that would not be found via standard testing?

6. What are your thoughts on disclosure? I don’t plan on having sex, if I do it would obviously be protected, but do you feel I should tell someone about this experience if I do end up in an intimate situation?

7. The doctor I saw did not feel I needed any additional testing and told me I shouldn’t be concerned about sti any longer. Any thoughts on this?

8. How likely is it that I may have had an internal anal outbreak and not known it? I’ve been told that if I had herpes I would know it. But I am very unsure about this. I have seen studies indicating that many that have internal outbreaks don’t have external lesions. What are your thoughts?

9. I keep getting red bumps on my butt. They look the same as the ones I had initially swabbed, but I’m afraid I may have done so too late. Does herpes ever “come and go” similar to the way acne does? Any concerns about these bumps?

[Terri Warren]

1. I know a test at 6 weeks is not conclusive, but realistically how should I feel about this result?
You should feel good – about 70% of those who are going to be positive for HSV 2 will be positive at 6 weeks out

2. The majority of my symptoms have disappeared, the only remaining are diarrhea and a “diaper rash” feeling in my anus. Is it possible that the burning/itching feelings I had were an outbreak? Is it concerning that this has stopped seemingly all at once and could indicate the end of an outbreak?
I doubt it.

3. I saw an infections disease specialist and he said that he did not think anything indicated sti, but thinks I may have gotten giardia from the sex, which would explain GI symptoms. Any thoughts on this before I take the antibiotics?
Nope, but I assume testing was done to determine whether you have giardia or not?

4. Would you recommend any additional testing prior to the 12 weeks mark?
no

5. You mentioned getting an anal pap. I am unfamiliar with this and haven’t found much online about it, outside of testing for HPV. Where would I get this done? Would this pick something up that would not be found via standard testing?
I’m not sure where you would get it done in your area, but yes, it would be for HPV

6. What are your thoughts on disclosure? I don’t plan on having sex, if I do it would obviously be protected, but do you feel I should tell someone about this experience if I do end up in an intimate situation?
I don’t think at this point you have anything to disclose.

7. The doctor I saw did not feel I needed any additional testing and told me I shouldn’t be concerned about sti any longer. Any thoughts on this?
If you were my patient, I would ask you to consider testing again for HSV at 12 weeks out.

8. How likely is it that I may have had an internal anal outbreak and not known it? I’ve been told that if I had herpes I would know it. But I am very unsure about this. I have seen studies indicating that many that have internal outbreaks don’t have external lesions. What are your thoughts?
I think if you had HSV internally, you would like also have lesions externally

9. I keep getting red bumps on my butt. They look the same as the ones I had initially swabbed, but I’m afraid I may have done so too late. Does herpes ever “come and go” similar to the way acne does? Any concerns about these bumps?
Not really, no

terri

[jjohnson817]

Terri,

Firstly, thank you for all that you do. This process has been far from easy to cope with and your response and expertise has been a life saver.

A few additional points/questions:

1. I have scheduled an appointment with you this coming Tuesday so I suspect we will discuss my situation then but I wanted to bring these up while they were on my mind.

2. No I was not tested for Giardia. The ID doctor decided to treat it without testing. Do you think this was a mistake to take the antibiotics? Could this affect any results of future testing?

3. Here is the link to the study I found indicating that many patients who experience proctitis from herpes do not have external lesions. This is the direct quote: “Absence of external herpes lesions should not decrease suspicion for HSV proctitis, as only ~30% of men with herpes proctitis have external lesions at the time of diagnosis.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5394410/

4. So two days ago I got a very small cut on my pinkie finger. Right on the middle knuckle. The following day I developed a very small blister, essentially right on top of the cut. It is completely painless unless I press on it, similar to any pain you might get from a standard cut. It is a slight yellow tint and has drained a fluid like substance. Given my situation this obviously made me think of whitlow. Does this sound anything like herpes whitlow to you? I’ve heard that these are very painful and will be associated with prodrome symptoms. Like I said it is essentially painless, but this is the first lesion I have had that looks anything similar to herpes so it definitely has me worried.

5. My GI symptoms are still present. From everyone I’ve spoken to herpes would not cause diarrhea and abdominal pain for this long. Is it safe to say that herpes is not causing this?

7. In your response to my second set of questions you said that many people have trouble pooping. What exactly does that mean? What issues are you referring to?

[Terri Warren]

We did have a good conversation last Tuesday. Do you have any further questions for me?

Terri

[jjohnson817]

Hi Terri,

I did think of a few more questions I’d like to ask in the meantime before I get an additional igg at 12 weeks. Note my current testing status is negative for HIV, Hep B and C, HSV 1 and 2, Syphilis, Chlamydia, Gonorrhea, and Trichomoniasis. All of these tests were done 9 weeks post incident.

1. I’ve seen some info indicating that it can take up to 16 weeks to develop detectable antibodies, but everything I’ve seen you say has said 12 weeks is sufficient. Have you ever seen a false negative at 12 weeks that turns positive later? Or is a negative at 12 weeks as accurate as the igg gets (92% for hsv2, 70% for hsv1)?

2. During our discussion you mentioned you were concerned about my stomach issues. Obviously I am as well and intend to get a GI referral. Is any of this concern specifically related to herpes or another sti? Or do you imagine these issues are related to some other infection/condition that I may have?

3. Also during our conversation you mentioned something called the “multiplex test” that I could get for my GI issues. I’ve done some research and haven’t been able to find much about this, nor any testing service that offers it. Could you possibly point me in a direction for more information about this?

4. Lastly, are my symptoms, particularly the GI issues I have described, something that you have seen before in a positive herpes patient? I have done extensive research into peer reviewed studies and personal anecdotes on various forums and haven’t heard of herpes presenting in this way. Everything I’ve read makes it seem like the timing of my symptoms, the symptoms themselves, the absence of lesions, and negative tests to this point just don’t indicate a herpes infection. But I understand this is a very complex virus that presents differently in everyone, so it’s been very difficult to rule it out. Any thoughts here?

Thank you again for all that you do, and I will reach out again if I do end up wanting to pursue a WB test.

[Terri Warren]

1. I’ve seen some info indicating that it can take up to 16 weeks to develop detectable antibodies, but everything I’ve seen you say has said 12 weeks is sufficient. Have you ever seen a false negative at 12 weeks that turns positive later? Or is a negative at 12 weeks as accurate as the igg gets (92% for hsv2, 70% for hsv1)?
I have not. 12 weeks is adequate

2. During our discussion you mentioned you were concerned about my stomach issues. Obviously I am as well and intend to get a GI referral. Is any of this concern specifically related to herpes or another sti? Or do you imagine these issues are related to some other infection/condition that I may have?
Not related to herpes.

3. Also during our conversation you mentioned something called the “multiplex test” that I could get for my GI issues. I’ve done some research and haven’t been able to find much about this, nor any testing service that offers it. Could you possibly point me in a direction for more information about this?
It is offered at Quest labs – your provider would need to order it.

4. Lastly, are my symptoms, particularly the GI issues I have described, something that you have seen before in a positive herpes patient? I have done extensive research into peer reviewed studies and personal anecdotes on various forums and haven’t heard of herpes presenting in this way. Everything I’ve read makes it seem like the timing of my symptoms, the symptoms themselves, the absence of lesions, and negative tests to this point just don’t indicate a herpes infection. But I understand this is a very complex virus that presents differently in everyone, so it’s been very difficult to rule it out. Any thoughts here?
I don’t think your symptoms are related to herpes.
Terri

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