Confused Diagnosis – 4 Opinions and Counting

[paul_oregon2009]

Long story with some background…

Bisexual man who had a casual encounter with a man 8 months ago. No penile penetration but vigorous unprotected oral sex and digital with anus. Serious internal pain a few days later, first diagnosis was hemorrhoids. Swollen lymph nodes in groin and swollen rash around anus about a week later and a second doctor visually diagnosed herpes. Blood test weeks later was positive for hsv1 (but I have also had 1/year cold sores since I was a kid) but culture test was not. Was prescribed stool softeners for internal hemorhhoids and antivirals and the worst of the rash went down after 2 weeks.

Since then, I don’t feel like I’ve ever had a single day without some level of discomfort. The discomfort and light rash has not ever gone away completely and about 1.5 months after the first diagnosis, a serious rash had appeared on both sides of my groin. These same first two doctors treated it with steroids first and anti-fungal second. I also had a deep, throbbing nerve pain in my rectum that one of the doctors diagnosed as “post-herpetic neuralgia” and gave me some pills that seemed to dull it. A series of other blood tests revealed I had a relapse with MONO which could have explained the prolonged symptoms.I finally saw a dermatologist who examined that and my anus and called everything candida. The groin rash lasted for about 5 months before going away.

After recapping all this with a second dermatologist last week…he said I need to stop worrying about herpes. His examination identified some bacterial acne and review of my test results likened the perpetual situation to some type of “dermatitis.” He said my situation was unlikely to have caused genital herpes, especially considering my history of cold sores.

As of today, the area around my anus is even more sore/irritated than usual.

I guess my questions are:
1. Does it sound like ghsv1 to you? (a 5th opinion)
2. If so, why have my “prodromal” symptoms been so intense without submission?

[Terri Warren]

No, I don’t think this sounds anything like genital HSV one infection. The main reason is that once you have had cold sores, it is extremely unlikely that you would get the virus in a new location on your body. The other reason is that herpes rash, if you want to collect that, would not stay around for five months. Also, prodrome does not continue for a long period of time. It is normally occurring just prior to an outbreak or sometimes during an outbreak. None of this sounds herpetic to me. I agree with the last physician that you saw

Terri

• This reply was modified 5 years, 3 months ago by Terri Warren.

[paul_oregon2009]

Terri,

Thank you very much for the response. A quick update with some additional questions…apologies if they are outside of your concentration area.

I’ve been doing a lot of researching since the original diagnosis. Since then, I have had maybe 3 occasions where there were “spots” in my anal area. The first two presented like singular pimples/hives and were generally gone in about a day or two using witch hazel and some OTC acne medicine. The third occasion is happening right now…

About a week ago, I noticed 3 painful red spots near rectum. Two stayed red but one filled with white pus (looked just like a big pimple). They all still remain as somewhat open ulcers–and they are next to 2 black scars from the first “outbreak.” The dermatologist looked at the scars and was not concerned. About 5 days after those 3 appeared, another “pimple” appeared on the other side…and another 1 day later (yesterday). Those two new ones are almost gone (again using acne medicine) but they were preceded with some nerve pain on the back of my leg. This whole episode has been marked with periods of rectal numbness and tingling all over…and occasional swollen lymph nodes in groin.

I had these spots looked at a 5th doctor (I am in the military overseas and we get whatever doctor is available) and he says it does not look like herpes but ingrown hairs or foccilitus. Ive looked at images online and I agree it has always looked more like this (especially the scars).

1. Might those other two possibilities explain the recurrences and semi-constant pain/discomfort? I also have a history of staph infections…coincidence?

2. HSV1 IGG test last October was positive after ~2-3 weeks of potential exposure…would that be explained by past history of OHSV1?

3. Like the original episode…I am now breaking out in OSHV1…linked or stress induced?

Because im overseas, new test results will take 2 weeks…more to follow.

Thank you so much, I have already learned so much from this site

[Terri Warren]

1. Might those other two possibilities explain the recurrences and semi-constant pain/discomfort? I also have a history of staph infections…coincidence?

those things don’t hurt. Staph could. Is no one swab testing these areas? They should be!

2. HSV1 IGG test last October was positive after ~2-3 weeks of potential exposure…would that be explained by past history of OHSV1?

Yes, it could be, certainly and likely is

3. Like the original episode…I am now breaking out in OSHV1…linked or stress induced?

So hard to know – these anal things do worry me though – I wish you could have them swab tested!

Terri

Because im overseas, new test results will take 2 weeks…more to follow.

Thank you so much, I have already learned so much from this site

[Author]

Posts