Recurrent herpes or something else?

[Rb234]

33 year old male. Had unprotected vaginal and oral sex in October with a friend. No issues after that other than what I thought was minor folliculitis on both thighs. In early April I started to experience a red, irritated meatus, dysuria (not severe), and very frequent urination. It lasted 3 weeks and has come back twice, though less severe (I’ve cut down my caffeine). I then had painful bowel movements and pain with wiping and now I have pain all down my left leg. Could recurrent herpes affect multiple areas at the same time (anus/urethra). The leg pain had me really paranoid that that’s what it is.

[Rb234]

Figured I would use one of my follow ups to clarify a few things. The symptoms of uti is April also had a thicker, clear discharge associated with them and sometimes my meatus would stick together. The anal pain lasted for about 2 weeks and followed multiple episodes of diarrhea. It was almost gone and then a standalone episode of diarrhea caused it to come right back. I have a bad gallbladder so diarrhea is normal. I’ve had sciatica on my right leg for about two years but never on the left. Would the length of the recurrences (3 weeks) and the time between them (sometimes less than a week) be atypical. I thought prostatitis before I felt the leg pain and now I’m scared.

[Terri Warren]

The discharge from the urethra suggest a urethritis or bacterial infection. Have you had any testing at all for STDs, including herpes? The meatus sticking together is a classic symptom of a urethral infection. I doubt that the anal pain is related. Have you noticed any sores or unusual bumps in the genital area?

Terri

[Rb234]

I was tested before the encounter but not yet after. Clear for everything on the tests. I’m in the process of trying to see a urologist but it’s hard with my work schedule. The only thing I ever noticed out of the ordinary was a red bump about an inch above my knee in November. It was about the size of a dime, shiny, painless, no fluid, never ulcerated, and faded away in about six weeks to two months. It never recurred. No bumps or sores on my genitals. I suffer from anxiety and clinical depression (very severe at times, especially the past year). I’ve felt burning on my thighs and sometimes fingertips and I’m always terrified it’s prodome symptoms but no blisters ever appear. If the bump above my knee was herpes, wouldn’t it have stayed in the same dermatome? Do you see people get prodome without blisters? Am I just losing my mind?

[Terri Warren]

You are not losing your mind, no. You are being hyperaware of any genital or genital area symptoms The lesion that you describe above you knee sounds nothing whatsoever like herpes. Nothing like herpes, period.

Terri

[Rb234]

First of all, thank you so much for answering my questions! It is incredibly appreciated. I noticed that my multiple mentions of left leg pain didn’t seem to phase you. It seems like post herpetic neuralgia is something of a controversial issue with most experts saying it doesn’t really happen while some people swear it’s happening to them. I take it you think it’s unrelated? My other question is about whitlow. I know, I know- I should really try to calm down. Since my encounter I’ve had four or five instances of burning pain at the tips of my left thumb and index fingers that last for about a week. No blisters though. Now I have to very itchy red marks on my thumb. Do you ever see whitlow that doesn’t blister but just had prodome symptoms? I would be freaking out but I also got recurrent styes in both eyes since this encounter (textbook presentation) which I’ve never had before. How hard is it to autoinoculate during the first few months of infection. Is it common. Maybe I’m getting staph infections from my new living space. There is a ton of cat hair that I’m not used to.

[Terri Warren]

I’m sorry, your subscription has been filled. If you have more questions feel free to renew.

Terri

[Rb234]

Had to cancel and renew my subscription for some reason. The anal pain has come back minus diarrhea so that’s a bit concerning. It did come after a bowel movement and lots of coffee. There seems to be some loose skin protruding from my anus and when I pull my anus apart it does seem like there is some sort of internal fissure. Does it sound normal for someone to be asymptomatic for herpes for months and months and then have outbreak after outbreak? This would probably be my third time dealing with an anal issue in a month and a half. I’m slowly calming myself and leaning away from herpes because everything is atypical (duration, length between recurrences, no genital ulcers just urethra and anal symptoms) but herpes is so confusing. I’d love to know your thoughts on this and any of my questions from my last post since my renewal went through. Thank you so much!

[Terri Warren]

I think herpes neuralgia does happen, yes, but usually right before an outbreak of lesions. Many people have it as prodrome, it seems, but without the lesions, I don’t worry as much because leg pain is very common indeed.
When I’ve seen herpetic whitlow, it has been truly remarkable – significantly large blisters, as one would expect since the skin of the hand is so thick. And I also don’t think styes are characteristic of herpes either.
The anal pain does sound like a fissure. Have you had someone check that out for a diagnosis?

Terri

[Rb234]

Not the type of selfie I ever expected to take but I took a picture of my anal area. The fissure is at the opening of the loose skin. If you notice small cuts, those are from using clippers on the area for a better picture. I think it’s a hemorrhoid but no, I haven’t gotten to the doctor. Working with them to schedule an appointment. The girl I slept with said she’s tested negative prior us having sex but she doesn’t remember how long. Neither her or boyfriend have ever showed symptoms which is mildly reassuring. Personally I’m hoping for irritated hemorrhoid. Would it be likely to be asymptomatic for so long then have outbreak after outbreak.

[Terri Warren]

I don’ really see anything that looks obviously like herpes to me here, but an exam is definitely the way to go. Sorry, pictures are really difficult unless they are incredibly clearly something specific. Please follow up with your appointment.

terri

[Rb234]

Quick question about prodome symptoms and the time between recurrences. I have an appointment with a urologist in three days and was finally starting to calm myself down when the ache down my left leg came back. It lasted for 10 days or so the first time, went away for a week or so, and now it’s back. Would leg pain as prodome usually last for ten days or would it just be one or two days? I know most of my urinary symptoms point more towards urethritis like you said but I can’t get herpes off the brain. If it was herpes, it’s something that has been affecting me almost constantly since the beginning of April with a few days off here and there. I’ve had the urinary and anal symptoms with no visible lesions but something doesn’t feel right. I know I’m going to see if they can check my prostate because of my weaker urine stream and irritated meatus but I guess I should bring up herpes and see what they think.

[Terri Warren]

Herpes would not cause continuous symptoms of this kind between now and April. I’m definitely leaning away from herpes as a diagnosis, given everything you have said, but certainly another test could reassure you.

I would certainly ask about a chronic prostatitis at your visit.
You have two more questions to ask on this subscription

terri

• This reply was modified 6 years, 11 months ago by Terri Warren.

[Rb234]

Might as well get my money’s worth. I really appreciate you answering my questions! Two questions real quick. 1) I’ve read that herpetic urethritis would present as extremely painful urination and usually be accompanied by external lesions. does this seem true to you? I only had mild dysuria with an inflamed meatus and no lesions. 2) prodome confuses me. I’ve read that prodome lasts 2 hours to 2 days before an actual outbreak. Once the blisters appear, do the prodome symptoms disappear or do they stay the duration of the outbreak? I ask this in regard to leg pain. Again, thank you so much!

[Terri Warren]

I have seen herpetic urethritis seemingly characterized by only internal not external lesions. But not often!
Usually prodrome ends when lesions begin.

Terri

[Rb234]

Hopefully last question! In your professional opinion, do you see pain associated with herpes being more constant or intermittent? I guess what I mean by this is that if I had herpetic urethritis, would I feel pain in the urethra to some extent until the lesions healed. I usually just have mild discomfort with urination but will occasionally feel a sharp pain that lasts less than five seconds. Would the pain be there continuously?

[Terri Warren]

Intermittent for sure. Once the lesions in the urethra heal, you would not feel pain with urination.

Terri

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