Need your help

[Joeyhurts]

Hello Nurse Warren,

Thank you for your time.

At this point, 23 weeks ago I did very, very regrettable thing and I have been trying so hard to get past this.

I had receptive anal from a trans escort, I am male. This was the only time I have ever done this as I have been in a mongomous relationship for 10 years. It was condom protected and didn’t last long as I didn’t like it. Don’t really know why I did it, alcohol played a big part.

I immediately freaked out about it and went through the process of getting myself tested for everything at the appropriate times since then. I also took 2g azithromycin and 10 days doxy, but I wasn’t really too concerned about the stds that the condom protected from. So basically, I am terrified of herpes 2. I have herpes 1, diagnosed on multiple Igg tests.

I tested negative on herpeselect IGG 5 times: 6, 8, 11, 13, 16 weeks. I never had symptoms, that I could tell. I was fairly detailed in my inspecting. In hindsight, the occasional thing I freaked out about were no bigger than like a day of discoloration on my penis, or pimples on my behind that would clear up relatively quickly.

I felt great after the 13 week test. I went for the 16 week just to put the nail in the coffin, I was in tears when it came back negative, allowing me to pick up the pieces and ready to move on.

But it was in week 17 that things started happenng. The only symptoms I really got were these very random pin-prick like sensations that I would get throughout my peri-anal region. Not painful, usually. Every so often they would be somewhat sharp. I would wake up in the mornng, shower, would feel absolutely nothing in the shower. No pain, no lesions, etc. I sit a lot throughout my day. As the day went on, the sensations seemed to pick up. As the day went on I would constantly keep looking (mirror and flashlight), and would never see a lesion whatsoever. These sensations lasted for a while, like 2 weeks. Each day was the same pattern with waking up feeling fine, nothing in the shower, worse as the day went on. I was very aggressive inspecting myself a few times, and I’m sure I aggravated the situation, so I started getting a little more discomfort in my rectum.

I went to a planned parenthood to get checked out. The nurse there was incredible. She went out of her way to make me feel like I wasn’t total garbage for what I had done, and she listened and explained to me what she was doing in examining me. When she looked she said that it was hemorrhoids causing these sensations. She said she saw a few of them. She did a visual exam and a digital exam. The nurse told me that because there were so many nerves surrounding the hemorrhoids, they do cause those random sensations. I asked her directly if she saw anything that looked like herpes and she said no, she would have seen them if they were there, no reason to swab. Most importantly, I could go back to being intimate with my wife without concern.

Again, I was in tears. Ready to move on, somewhat apprehansive, but ready to move forward. I immediately started feeling better.

Now, it’s about 4 weeks later and those pin-prick feelings are back. It was been about 12 days. Over the last few days I’ve done some very intense inspecting, includng my own digital inspections as I apply prep h. I can’t feel any sores, nothing hurts when I run my finger around. I feel a bit irritated in my anus, but I’m sure that is from all of the inspecting. And i feel like the pin-prick sensations are more frequent and sharper after i do that. I can say with a lot of confidence, I never had a sore on the outside. Pain-like feelings yes, but no sores at all. Anytime I had a sensation, I would look and never saw anything.

When I look back, I had these pin-prick like sensations on quite a few occasions, sometimes lasting for a few hours (like a few very brief per hour) to a few days. Also, I have been having sciatic pain, and about a week or two before these most recent issues the top of my foot was a bit numb. I do have disc issues in both my neck and lower back, so I didn’t really think twice about it.

So that’s my story. What is really freaking me out at this point is the timing of everything. I didn’t have these sensations before what I did 23 weeks ago. I’ve probably had hemorrhoid flare-ups before, but nothing like this. And I never had the top of my foot go numb, and it was almost leading into these new issues. I also read things about pudendal neuralgia being caused by herpes, even though I read you comment that it probably isn’t caused by hsv2.

I’d appreciate any comments you can make. I guess for specific questions:

1) Do hemorrhoids really cause these types of sensations? I’ve seen a few comments that say yes, but I can’t really lock-down much info.
2) Would rectal herpes cause these twingy type sensations, or would the feeling go on a bit longer?
3) probably most important to me, if I did have herpes sores inside my rectum, wouldn’t it hurt quite a bit to pass stool or wipe afterwards? I never had any discomfort with those activities, nor did I feel anything during my self administered rectal exams.
4) is that true that a medical professional could diagnose hemorrhoids over herpes just like that?
5) if I had herpes OB 4 weeks ago, would they clear and come back this quickly?
6) if it was herpes, wouldn’t the sensation change a bit of clear over the course of 12 days?
6 )can I trust my 16 week herpeselect igg and move on with my life with confidence that I don’t have herpes 2?
Sorry for the long post. Thank you.

[Terri Warren]

1) Do hemorrhoids really cause these types of sensations? I’ve seen a few comments that say yes, but I can’t really lock-down much info.

Yes, I think they can cause these sensations, I really do

2) Would rectal herpes cause these twingy type sensations, or would the feeling go on a bit longer?

I seriously doubt that you have anal herpes. You used a condom, it was a one time experience, the likelihood that became infected with herpes is statistically so tiny1

3) probably most important to me, if I did have herpes sores inside my rectum, wouldn’t it hurt quite a bit to pass stool or wipe afterwards? I never had any discomfort with those activities, nor did I feel anything during my self administered rectal exams.

If you had rectal herpes, you might feel these things, I can’t be certain. But the evidence of the testing being all negative, there being no obvious sores, these all speak against you having anal herpes.

4) is that true that a medical professional could diagnose hemorrhoids over herpes just like that?

Yes, of course it is true. Hemorrhoids and herpes look nothing alike at all.

5) if I had herpes OB 4 weeks ago, would they clear and come back this quickly?
Well, that is possible if you did have herpes yes, but I still don’t think you do.

6) if it was herpes, wouldn’t the sensation change a bit of clear over the course of 12 days?

Yes, herpes symptoms would likely fade over 12 weeks, but once again, I got back to the experience you had – protected, once, very low risk.

6 )can I trust my 16 week herpeselect igg and move on with my life with confidence that I don’t have herpes 2?
Sorry for the long post. Thank you.

Yes, you can trust your HSV 2 test results and move on. You don’t mention much about HSV 1 risks. Have you ever had a cold sore in your lifetime? Were you the receiver of oral sex at this encounter?

I think when people have had a sexual encounter that they believe they should not have had, for whatever reason, they really do start noticing every body sensation that they have, when previously, they likely would not have noticed these sensations.

Tell me more about your HSV 1 risk concerns.

Terri

[Joeyhurts]

Thank you for your quick response.

I’m not worried about hsv1 as I know I already have it, so does my wife. I don’t get outbreaks, but I have tested positive on IGG.

I don’t know, I guess I was hoping for something to be definitive, even though I know that hsv testing is not definitive. Or perhaps hear from you something like herpes never causes the symptoms I am having. I know, I’m reaching, but I’m desperate.

I was really hoping you would tell me I’d be dying in pain if I had herpes in my rectum, but I understand that you can’t just make up generalizations.

I was so happy after my 16 week test, and then I started getting all of these other symptoms. It really sent me back down a dark path.

I also understand the assessment of risk in my situation and negative test, etc, but someone has to fall through the cracks at some point. I wish I could be confident in something more than an assessment of risk and a blood test with room for error. And these symptoms, I never had them before this ordeal. I should definitely stop with the invasive self-inspections. It’s definitely not helping matters.

Can I ask a few follow up questions?

1) Can I have any confidence in the fact that since I do test positive for hsv1 on herpes select igg, I would produce the appropriate antibody for the herpes 2 test?
2) of the very few who never produced antibody, were they negative for both types?
3) regarding the 97% sensitivity in the test, does that mean that 3% of people will always be missed, or does that mean that in any one test, I have a 3% chance of the test missing the proper diagnosis, so having another test would fix that? Another way of putting it, if the same person tested 100 times, will the test misdiagnose 3 of those times? Or if 100 people test, will 3 of those people never get the correct result on the herpes select igg?
4) does it sound like just hemorrhoids causing my discomfort?
5) sorry to ask again, but have herpes ever been known to cause those random, intermittent, pin-prick like sensations throughout the peri-anal area, with no visible lesions?

[Terri Warren]

I’m not sure how much more definitive I can be except to say that I think you should believe your 16 week test for HSV 2 that is negative!

1) If you waited 16 weeks, even for a person who has HSV 1 already, that is enough time to seroconvert.
2) I honestly don’t recall the HSV 1 status of those few people who did not seroconvert, sorry. I haven’t had one in about 3 years.
3) In my experience, if the antibody test misses the HSV 2 infection once, it misses it every time. You could try the western blot to give you more reassurance, what do you think about doing that?
4) Yes
5) Ever? Probably, yes but not often and not with a negative HSV 2 IgG.

I think it is very important that you look at the entire picture here – the encounter, which was brief, once and condom protected, and the test results and the lack of lesions. All point to lack of infection.

You have one more question in this subscription.

Terri

[Joeyhurts]

Hi,

Thank you for your input. If I need to, I have no problem putting more money in the meter. 20 bucks is the least of my worries.

I am trying to build up the confidence that you believe I should have.

Can I ask you a few more questions? This may seem a bit irrational, but I’m trying hard to be accept the data at hand.

Understanding the risk, 16 week negative, etc, I am trying to come to grips with the fact that all of a sudden, 17 weeks after this event, I am having anal symptoms that I have never felt before. The timing absolutely stinks. So here is a bit of my line of thinking, please tell me if any of it makes sense, or if I am completely off base.

I am now at around day 16 of these rectal symptoms I have been having. Again, the symptoms being very intermittent pin-prick like sensations all throughout my anal area. I believe I am also feeling these sensations in my groin area as well at times. Actually, they seem to happen completel randomly in quite varied areas throughout the perinatal area. Yesterday and today the symptoms seem to be slightly heightened to a dull ache that I feel occasionally inside my anus at times. Sometimes I feel like in am internally clenching my muscles (if that makes sense) and perhaps that is causing some discomfort too. I don’t know if that clenching aggravates hemorrhoids and this happens, or if they are two separate things, or perhaps the clenching is grabbing a nerve that causes the sensations.

Would I be somewhat right thinking that if this was a herpes outbreak, one that goes on for 16 days, would most likely be considered a fairly robust outbreak (meaning if it was just a light outbreak it would probably be on its way to clearing up by now, if not completely gone)? As far as a viral infection goes, I haven’t had any other symptoms one might get with a virus, I’ve also felt rather healthy. And if it was a decent sized outbreak inside my anus, I’d probably have open sores there. And those open sores would probably cause me considerable pain when I went to the bathroom, if not when actually passing matter, certainly when I wiped myself. I mean, I have never felt any pain while going to the bathroom or wiping.

I’m not worried about sores on the outside, around my anus, because I really have done a very thorough job looking and haven’t seen anything or felt anything directly.

I’m more worried of the chance that I have sores on the inside. The nurse at the planned parenthood I went to in week 17 when I had my fist bout with these symptoms said that she has had patients come in who could barely walk, and if I did have sores and wiped in the bathroom the pain would be tremendous. And she looked and didn’t see any.

I suppose I could think that the sores could be further in, perhaps causing proctitis, but again, if I had a case that lasted 16 days, I’d probably have considerable pain, is that reasonable?

What if I was one of those immunocompromised people, and wasn’t making antibody, wouldn’t I be having, or would have had more noticeable outbreaks prior to week 17?

Is the 16 weeks for the test from possible exposure, or when symptoms are felt? Does it make a difference that I am only now feeling symptoms?

Thank you again. I eagerly await your comments on the above. ive read in ther forums about people who it seems so obvious that they aren’t infected but they go on and on testing, and I would think to myself “oh that poor person”. And now that’s me.

[Terri Warren]

I don’t see why you would be an immunocompromised and not making antibody and not having external lesions. Why would you be the one that is an exception in so many ways? I mean, if you were immunocompromised you would likely have more lesions not less.

The duration of these symptoms, the fact that you have no external symptoms, the fact that you test negative at 16 weeks all speak against herpes for me. I never say never, as you may have noticed beaus there are always exceptions, but I’m not feeling like you are one of them. I would once again encourage you to get a western blot to clarify your situation. Is there a reason you aren’t getting one?

Honestly, I don’t think I have anything to add here about you having or not having genital herpes.

Terri

[Joeyhurts]

Hi again,

Please continue to help, I’m still trying to work my way through this. I’m not trying to be a pest. I was actually starting to have some confidence and believe the negative igg, but the symptoms seem to get worse just when I think they’re getting better.

I understand the level of risk and the low probability that I have herpes, but I am still very concerned. I will be pursuing a westernblot test through your office.

Can I ask you to please just focus on my symptoms? I feel that as soon as I mention that I had a negative hsv2 igg at 16 weeks everyone automatically discounts the possibility that I might not be testing accurately at 16 weeks. ive heard such differing rates of accuracy for that test that it has me worried.

Also, I am so unbelievably depressed with all of this. I tested all the way to 16 weeks, negative, with no noticeable symptoms. I felt so good and was ready to move on but these symptoms came up. And they are pretty strong symptoms, not in my head. And because the symptoms are inside my rectum, sight of the sex act in question, I am so worried. I don’t remember having anything like this before this all started. The coincidence is astounding..

If I came into your office and we talked about my symptoms, what would you think?

So, my symptoms started in week 16, the week I tested negative. It doesn’t make sense that it would be based on anxiety because that particular week I couldn’t have felt less anxious about this as I tested negative. They lasted for around 2 weeks. I went to a planned parenthood because I was feeling all of these nerve like pinching sensations all around my anal and rectal region with some “roughed up” feeling in my anus. The nurse there did a visual and digital exam and told me it is hemorrhoids. I thought she did a fairly thorough exam so I was at ease with her diagnosis. The issue went away fairly quickly after that.

Then, 3.5 weeks after that died down all of the pinching nerve feelings came back. I am at this point at almost 3 weeks with these symptoms. And they seem to be getting a little bit worse as the days move on. Ive been putting prep h cream on it like the nurse prior told me. I haven’t been putting it on regularly, but I have been using it and it doesn’t seem to be helping me. The symptoms get better, then worse, then at times I feel like maybe I’m okay and nothing is gong on, but then the symptoms always come back, worse some times. Now I feel like there is a stinging sensation when i pass stool. Not terrible or long, but a stinging sensation nonetheless.

So I will get a western blot, but what do those symptoms make you think? Also, what symptoms do folks with herpes in the anus/rectum?

Thank you

[Terri Warren]

I’m wondering if it would be helpful for you to see a proctologist. The specialize in concerns of the anus and rectum and might be able to do an internal exam that might reveal more than an external exam can provide. What do you think about that? Perhaps you’ve been just pursuing the wrong specialists. I will say, however, that stinging with bowel movements is definitely something that goes on with hemorrhoids, just so you know.

No, I don’t think a visit to our office would give you any more information than you’ve been giving me here. All I can say is that your symptoms and the timing of your symptoms does not sound like herpes to me.

I know you don’t seem to want me to consider the tests you’ve had done nor the kind of experience you had but that’s like not how I practice medicine so it’s very difficult to consider only your symptoms.

Can you find a proctologist in your area, do you think?

Terri

[Joeyhurts]

Thank you again for your response. The painful area seems to be just inside my anus, so I have some level of confidence that they could be seen. I will try to pursue a proctologist.

I re-upped for more questions to write the above question, so perhaps a few more?

1) Do you feel that if I have a negative western blot that it would be dfinitive against herpes? How accurate is it at 5.5 months for people who already have hsv1?

2) I haven’t seen any bleeding occur. But I have noticed what could be dried up blood flakes when I wipe, is that possible?

3) I know anything is possible, but is it usual to have herpes inside the anus with no visible sores on the outside?

4) in your experience, when people have herpes inside anus, what is the level of pain like? I’ve seen on boards people say that the pain is awful. Those might just be the strong cases, and not take into account the weaker cases. I wouldn’t say my pain has been terrible.

5) does it make sense that my symptoms would continue to 3 weeks and not start getting better, but possibly worse?

6) I’ve had muscle soreness in my lower-mid back, both sides. And towards the end of the day I’ve been getting a bit run down, possible getting a slight fever. Is that possible prodrome? Or would I be past that point?

That’s all from me. Thank you for your kind advice.

[Terri Warren]

I think if you had a negative western blot for HSV 2, you could stop worrying about this, yes
The blood is likely from the hemorrhoids
It can happen, yes, but would be less common
Everyone I have seen with anal herpes has external lesions as well as internal ones and is pretty uncomfortable.
Not really, for herpes.
Prodrome would not last this long.

Terri

[Joeyhurts]

Hi nurse warren,

I have a phone appt set up with your office to get a WB test. I guess I should feel fairly confident that it will be negative, right?

I have one more post available, so I figured I would use it. It helps me a great deal to hear your responses. I know I am beating a dead horse, but I’d like to ask a few more quick questions.

1) I read you mention that there have been quite a few false positives of equivocal results on the WB test. Should I be worried? As far as I am aware, I have had hsv1 for quite a while, but have had no symptoms that I can remember. I am worried that this might mess with the WB result, which would be a huge blow to me.

2) I have been having rectal symptoms for a month now. Sometimes they get a little stronger, sometimes it is just a faint thing. This past week they seemed to be a little stronger. I used hydrocortisone cream and it seemed to improve them quite a bit by the next day. And it is often hard to pinpoint the exact location but it seems to be originating around my anus, where I was diagnosed with hemorrhoids the first time I had these symptoms 2 months ago. My question is: if I did have a herpes outbreak in my anus that has hung around for 4 weeks, wouldn’t it most likely be a fairly strong outbreak that would cause me quite a large level of discomfort? Is it reasonable to use this as another reason to feel confident that I don’t have herpes?

3) I am very confident that I have hemorrhoids and that they are causing some (hopefully all) of my discomfort. But I have been feeling pin-prick like sensations all over that area. I’ve read about the debate of herpes causing neuralgia. Is that a possibility in my case? Or would chronic pelvic pain syndrome be a possibility? Would CPPS be a reason for my hemorrhoids to bother me more?

Thank you. I appreciate what you do so much.

[Terri Warren]

There are not false positive on the WB. There can be indeterminate results, especially in people who have low positive ELISAs for HSV 2.
Yes, I think if you had anal herpes your symptoms would be more remarkable, yes.
CPPS is also a possibility for you. have you made an appointment with a proctologist?

Terri

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