Help with diagnosis – thank you.

[Snowiness6423]

I am male 40 have been with the same sexual partner for years.

26th March received unprotected oral sex from a CSW.

5th April felt fatigued and had some tingling sensations in my testicles.

7th April broke out in a red rash in both groins (in the creases between my thighs and scrotum, right around to my butt). The rash did have one or two spots with redheads on them but was not itchy or painful. As far as I could tell there were no blisters. No other symptoms. This lasted 4 weeks and didn’t change much.

Since then, I have seen 3 men’s health docs and 2 dermatologists who all said that my rash is not herpetic. I have tested negative for every STI including HSV2 IGG at 6&9 weeks after contact. HSV1 positive but I get cold sores.

Other symptoms have included pain at the tip of my urethra, pain in my urethra and occasional scant white discharge.

After 6 weeks of the rash, it seems to subside but when it did it was extremely itchy and it felt like my scrotum was prickly. It was driving me crazy! The tip of my urethra felt sore and rubbing on my underwear. It looked like there were two tiny spots just inside the urethral opening. I started to dribble after urinating. No pain when urinating. I started taking Valtrex 2g per day for 7 days. After 3 weeks of this, it started to feel better but recently woke up and the rash suddenly reappeared and was red raw and very painful. Almost like an outbreak of something. The dermatologist said it is intertrigo. Urologist checked my testicles, urethra (tip), prostate and urine flow. All seemed normal.

1. Does this sound remotely like Herpes to you?
2. Could this be recurrent outbreaks or could an initial outbreak cause damage to the skin?
3. Would the initial outbreak be on the penis shaft? I have had nothing on my penis.
4. As I received oral my concern has been GHSV1. Is this possible as I already have OHSV1?
5. My dermatologist said that 30% of oral herpes infections are HSV2. Is this true? Could it be HSV2?

[Snowiness6423]

I know I am fixated on HSV but as all other tests have been ruled out then this seems like the only logical conclusion. This all started immediately after the sexual encounter. Until then, I was perfectly healthy. This has had huge implications for my physical and particularly my mental health. My anxiety is through the roof and I am struggling to cope.

Thank you for taking the time to read this. Much appreciated.

[Terri Warren]

1. Does this sound remotely like Herpes to you?
Not at all
2. Could this be recurrent outbreaks or could an initial outbreak cause damage to the skin?
I don’t think this is an initial outbreak or a recurrence.

3. Would the initial outbreak be on the penis shaft? I have had nothing on my penis.
Yes
4. As I received oral my concern has been GHSV1. Is this possible as I already have OHSV1?
that was my next suggestion – once you have HSV 1 orally, it is highly unlikely that you would acquire it genitally.

5. My dermatologist said that 30% of oral herpes infections are HSV2. Is this true? Could it be HSV2?
That is certainly not consistent with the research, not at all. Oral HSV 2 is rare.

Terri

[Snowiness6423]

Hi Terri, thanks for your reply

1. I failed to mention that I had the most recent rash and the inside the tip of my urethra was swabbed for PCR last week. It came back negative for HSV1 & HSV2. There are no ulcers/sores to swab though. It was quiet dry. How accurate is this?

2. I will go back to do HIV, Syphilis and HSV blood tests on 19th June (12 weeks after sexual contact), if my IGG blood test comes back negative for HSV2 at (like it did at 6 and 9 weeks) am I safe to have sex? My partner has OHSV1. I live in Asia so the Western Blot is not a possibility for me.

3. I started to feel tired and some sensations/tingling in my scrotum around day 10/11 but the rash didn’t appear until day 12/13. I have seen you give a timeline of 10 days for sores to appear. How does my timeline fit with this?

4. My worry is that no medical professional saw the rash for the first 4 weeks. I had a red rash all over my groin folds (both sides) with 3-4 small raised (mountain-shaped) spots with tiny red heads on them. In my groin next right next to my scrotum. Not touching each other but fairly close. Could this be a primary OB?

5. My OHSV1 presents as typcial coldsores that blisters etc… If I had GHSV would it present in the same way? Is that typical for people who have OHSV and GHSV?

6. I had an obvious rash which was large and in both groins. With this in mind, how likely is it that there was a small OB on my penis and I didn’t see it? With such a reaction in my groin would you expect to see a severe outbreak on the penis too?

7 I have read that the igg blood test Sensitivity is 96% to 100% and the Specificity is 87% to 100%. Which in of these is most important for getting a correct negative? Where does your calculation of 92% missed vs the WB come from?

Thank you.

[Terri Warren]

1. I failed to mention that I had the most recent rash and the inside the tip of my urethra was swabbed for PCR last week. It came back negative for HSV1 & HSV2. There are no ulcers/sores to swab though. It was quiet dry. How accurate is this?
it is accurate in that no HSV 1 or 2 was present at the time of the swab.

2. I will go back to do HIV, Syphilis and HSV blood tests on 19th June (12 weeks after sexual contact), if my IGG blood test comes back negative for HSV2 at (like it did at 6 and 9 weeks) am I safe to have sex? My partner has OHSV1. I live in Asia so the Western Blot is not a possibility for me.
The IgG picks up 92% of HSV 2 infections so quite good. If it is negative, I believe that you can count on that result.

3. I started to feel tired and some sensations/tingling in my scrotum around day 10/11 but the rash didn’t appear until day 12/13. I have seen you give a timeline of 10 days for sores to appear. How does my timeline fit with this?
Herpes generally doesn’t present as a “rash” it is more commonly described as sores.

4. My worry is that no medical professional saw the rash for the first 4 weeks. I had a red rash all over my groin folds (both sides) with 3-4 small raised (mountain-shaped) spots with tiny red heads on them. In my groin next right next to my scrotum. Not touching each other but fairly close. Could this be a primary OB?
This sounds exactly like a fungal infection to me, not herpes

5. My OHSV1 presents as typcial coldsores that blisters etc… If I had GHSV would it present in the same way? Is that typical for people who have OHSV and GHSV?
Genital HSV 1 would appear as blisters that break open, ulcerate and scab.

6. I had an obvious rash which was large and in both groins. With this in mind, how likely is it that there was a small OB on my penis and I didn’t see it? With such a reaction in my groin would you expect to see a severe outbreak on the penis too?
yes, I think your rash was fungal

7 I have read that the igg blood test Sensitivity is 96% to 100% and the Specificity is 87% to 100%. Which in of these is most important for getting a correct negative? Where does your calculation of 92% missed vs the WB come from?
I would disagree with the specificity of the test it has many false positives.

Terri

[Snowiness6423]

Terri,

Thank you for your help so far. It is very much appreciated. A few more questions from me.

1. If I had a herpes OB in my urethra would it hurt? Even if it was a tiny blister?

2. What causes herpes discharge? What does the discharge look like?

3. I tested negative for HSV2 at 12 weeks using an IGG blood test. Despite my rashes and pain in my penis/urethra. What would you advise in terms of conclusivity and moving forward?

4. What are the odds (% or 1 in however many) of having OHSV1 for 25 years and then getting GHSV1?

5. With regard to the timeline for the onset of symptoms, is it 10 days for sores to appear or 10 days before any symptoms (fatigue, tingling etc…)?

Thanks again.

[Terri Warren]

1. If I had a herpes OB in my urethra would it hurt? Even if it was a tiny blister?
It certainly would hurt, yes

2. What causes herpes discharge? What does the discharge look like?
The discharge is caused by cells in the urethra breaking open and dumping their contents into the urethra and then outside the body. It is normally clear.

3. I tested negative for HSV2 at 12 weeks using an IGG blood test. Despite my rashes and pain in my penis/urethra. What would you advise in terms of conclusivity and moving forward?
I suggest you move on. the risk from receiving oral sex is HSV 1, very very rarely HSV 2.

4. What are the odds (% or 1 in however many) of having OHSV1 for 25 years and then getting GHSV1?
We don’t have that percentage but I have only seen it once in my entire career

5. With regard to the timeline for the onset of symptoms, is it 10 days for sores to appear or 10 days before any symptoms (fatigue, tingling etc…)?
10 days before sores appear.

Terri

[Snowiness6423]

Hi Terri,
I’m having constant pain in my penis and the skin feels like it is burning. My meatus is also very irritated and is rubbing on my underwear. The rash in my groins has calmed down lots but is still there. It’s been many weeks now.

Docs can’t see anything abnormal when they examine my genitals (apart from groin rash) and my Derm said that this lingering feeling might be herpes and that the igg blood test is so inaccurate that they could have easily missed the HSV2 (HSV1 has been picked up in all 3 of my tests – I get cold sores). He has given me two months of Valtrex at 500mg per day to try to suppress.

I feel like I can’t move on from this with these symptoms lingering and causing pain, despite the neg blood tests.

My questions are:
1. What are your thoughts on the above symptoms?
2. What are your thoughts on what the Derm said?
3. If I had a herpes OB in my urethra would it hurt when I pee? Even if it was a tiny blister at the very tip? (I know I asked this already but forgot to add the “when I pee” bit).
4. Does the fact that I have HSV1 make the HSV2 blood test less accurate?
5. When would the suppressive dose likely relieve these symptoms? I am struggling to function day to day.
6. What countries are the Western Blot available? I really want to take it but I am not in the US.
7. Any advice for managing these symptoms or getting relief from this pain?

Thank you so so much.

[Terri Warren]

1. What are your thoughts on the above symptoms?
I’m not sure what to make of these symptoms, so sorry

2. What are your thoughts on what the Derm said?
The Igg test does miss 8% of HSV 1 and 30% of HSV 1 infections.

3. If I had a herpes OB in my urethra would it hurt when I pee? Even if it was a tiny blister at the very tip? (I know I asked this already but forgot to add the “when I pee” bit).
Herpes in the urethra hurts when people urinate, yes

4. Does the fact that I have HSV1 make the HSV2 blood test less accurate?
No, but low positives on the IgG are often there due to high HSV 1 results, not the other way around

5. When would the suppressive dose likely relieve these symptoms? I am struggling to function day to day.
It usually works well with 3-5 days

6. What countries are the Western Blot available? I really want to take it but I am not in the US.
We can usually get the blot to the US from any country

7. Any advice for managing these symptoms or getting relief from this pain?
I’m so sorry you are having this pain but I don’t know what it is or why you are having it.

Terri

[Snowiness6423]

Hi Terri,

It’s been nearly 2 months since I last posted and since then I have had more tests for HSV 1&2. This means that I have tested negative for HSV2 at 6,9,12,14 & 19 weeks post potential exposure. All are IGG test. I have had every other STI test possible and they are all negative too. I keep testing positive for HSV1 though, but know that I have OHSV1.

The skin in my groins is completely clear, there is not signs of any skin infection and I have had no blisters or anything that resembles a traditional outbreak.

However, I am still having the following symptoms: Itching in both groin creases, tingling in my scrotum/testes, a slightly swollen meatus, occasional scant clear/white discharge and very occasional urethral pain.

1. Do any of the above symptoms sound like HSV?
2. Do you think I would have had a lesion/blister if it was HSV by now (22 weeks since potential exposure)?
3. I thought it could be GHSV1 but I have had OSHV1 for 30 years.What are you thoughts on this?
4. Surely if it was HSV2 at least one of my tests would have picked it up?
5. Can you get the WB test sent to in Asia?

Thank you so much.

[Terri Warren]

1. Do any of the above symptoms sound like HSV?
No, they don’t
2. Do you think I would have had a lesion/blister if it was HSV by now (22 weeks since potential exposure)?
Not sure what you mean here?

3. I thought it could be GHSV1 but I have had OSHV1 for 30 years.What are you thoughts on this?
Extremely unlikely

4. Surely if it was HSV2 at least one of my tests would have picked it up?
I think so yes

5. Can you get the WB test sent to in Asia?
We’ve done it from there but it is expensive and very complicated. You would need to have someone to draw and spin down your blood and then shipping to the US is very expensive. I don’t think you need to do this.

Terri

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