Worried/Confused

[CM2023]

Hello Terri.I am a Male,straight,30 yrs old. My last sexual encounter (protected for genital & unprotected received oral) was on January 13 ,2023. On May 19th, 2023 (first time ever with these symptoms/more than 4 months after encounter) I was sitting at work and was having pain on the back of my left thigh. I went to the restroom and noticed a rash with fluid filled blisters running from the back of my left upper thigh up to the left buttocks and base of spine. I had a couple blisters/redness forming on the back of my left knee, too. Next day I had a couple blisters on my left perineal area, a line of grouped blisters on the left side of my pubic region & isolated looking pimples on my penis (both sides). Was spreading so fast! Next day, I went to an urgent care and the NP visually diagnosed as HSV and took a viral culture swab with the liquid from the blisters on the back of my left thigh (bad rash). Appointment felt rushed with the young NP. The swab resulted as not isolated for both types of HSV. Then I took a Select IgG blood test the following day for both types of HSV and they resulted negative. I took Valtrex for a week. Also, had isolated 3 white bumps on the left side of the glans of my penis that lasted only a day and a half. One of these was next to my penis hole/ urethra and it hurt to pee for one day. These healed fast and none of the blisters left an ulcer/sore.I had balanitis,too.The following week I went to another urg care for a 2nd opinion and a NP diagnosed me that in fact I had shingles (I had chicken pox as kid) based on the photos/symptoms. The rash was healing so I showed her photos of outbreak. She then saw all the purple scarring I have and said they were definitely shingles scars & a couple with bacterial infection. Recently, 2 other Drs diagnosed as shingles too. Had another igG test done which resulted negative (<.90) again (6mths after last sex encounter). Would HSV cause an outbreak like this or shingles? Should I get Blot test? Thanks!

[CM2023]

I wanted to add that the providers who recently diagnosed as shingles stated that my rash followed dermatomes s2 & s3 and to not worry of it being hsv. They saw the photos of my rash. I see other cases online of herpes zoster present this way. I had a terrible rash/outbreak that left me with depression & made me lose 10 lbs.

[Terri Warren]

As I read your post, I also thought “shingles” The swab test that should have been ordered to look both for HSV and varicella-zoster rather than HSV alone. I think you can be quite confident that you suffered a shingles outbreak, though herpes would have been in the differential diagnosis by me as well.

Terri

[CM2023]

Thank you for the responses. Sorry I didn’t numerate my questions.

1. Would HSV cause an outbreak like this how I explained mine?
2. Do you recommend I get a Western Blot (I’m in Los Angeles) test after 6+ months of last sexual encounter? Tested negative for both types with IgG test months after encounter.
3. If I do get tested negative with Western Blot should I move on?
3. Is igG test more accurate after last sexual encounter or after first outbreak?
4. Would HSV cause purple / red raised scarring 2 months after outbreak and cause neuralgia on back of upper thigh?

Thanks so much.

[Terri Warren]

1. Would HSV cause an outbreak like this how I explained mine?
I seriously doubt it, given you test negative 6 months out from last sexual encounter

2. Do you recommend I get a Western Blot (I’m in Los Angeles) test after 6+ months of last sexual encounter? Tested negative for both types with IgG test months after encounter.
It depends on how worried you are about this. We have a great lab in LA that would draw your blood if you decide you want to do the blot

3. If I do get tested negative with Western Blot should I move on?
Yes

3. Is igG test more accurate after last sexual encounter or after first outbreak?
yes, the timing should be from the most recent sexual encounter, not first.

4. Would HSV cause purple / red raised scarring 2 months after outbreak and cause neuralgia on back of upper thigh?
Nope.
Terri

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