Sexually Transmitted Diseases/Is this herpes?

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Question
QUESTION: 23 year old male in Toronto, Canada.

I had an encounter with a prostitute back in February. I went for my IgG today and I have to wait 10 days for my results so I would like to describe to you the issue for your opinion, Mark.

There was no intercourse, but there was genital to genital contact. Condom was used.

I experienced the following two weeks later:

Burning in the left buttock without an actual spot. A spot came up a few days after the burning had started, it lasted 4 days and went away. Because of the location of the spot I couldn't get a good look (even tried with my iPhone). I couldn't show the doctor the spot either because he was away for the first teo days, then it was the weekend.

More recently I've been experiencing burning & pain in the genital region that goes on and off throughout the day, but I have NOT yet seen any sores or redness or rashes.

This is why I haven't uploaded any pictures; there's nothing to see.

Does this sound like herpes to you? If not, what else could it be?

Your answer is much appreciated, Mark, and thanks in advance.

ANSWER: Hello Emil,
The burning you have experienced does NOT sound like herpes or any other type of STD. You didn't mention your work or past injuries you may have sustained to your back, hip, or leg. If you ever had chickenpox, than it is possible-but unlikely-- for you to have an exacerbation known as shingles. Burning and pain are definitely caused by irritation from a nerve, but what is causing such irritation, I cannot say without more information.

Good luck!
--mark


---------- FOLLOW-UP ----------

QUESTION: Sorry I didn't give enough details last time as I was sending from my phone. I got my IgG results back and it was negative. It wasn't type specific though. The only thing to have changed in my life at the time was having been with this woman and I had started going to the gym a month prior. I haven't had any back, hip, or leg injuries.

I have to admit, after receiving the negative results, the burning died down. The doctor had told me that some people think about it so much that they create their own symptoms and I think that might have been the case.

More recently, I felt burning a couple of times at the right side of the base of my penis. It starts intense, then dulls, then goes away, and nothing happens. I check my groin area a lot whenever I feel this because I am still a bit skeptical that it could be genital herpes. I remain fairly calm and remind myself that my results were negative and it does subside but... It's a bit scary.

Aside from getting your reaction on this, Mark, I have a couple of questions:

1. What was that burning and that spot that came up near my anus? It has never happened to me before and is the reason I still have doubt. It was two weeks after the encounter and does sound somewhat textbook herpes.

2. How reliable is the IgG? It was NOT type specific. Would you happen to know the rate of false negatives?

Thanks a lot again, Mark. And sorry for the long read.

Answer
Hello Again, Emil,
It absolutely does NOT sound like herpes! IgG is a long term antibody that persists for life, after the IgM (immediate antibody) goes away. It is not specific for herpes type 1 or 2, so a negative test means absence of evidence for both types of herpes. A positive test means presence of antibody for either one or the other or both types of herpes. IgG is reliable, but it is not very specific in that it doesn't tell you when or what body part was infected. The rate of false negatives depends upon the the manufacturer of the test, and probably can best be determined from that manufacturer's web site.

The burning and "spot" that you noticed was from something that irritated the skin nerves, and may have been due to lots of things, but highly unlikely to be herpes. Herpes 1 or 2 have similar courses of infection, that may begin from a few days to a week or so after first infection. A funny numb, tingly, itchy sensation with a red base quickly evolves to a blister  and ulceration, and eventual healing over about 1-2 weeks.

You may wish to seek counseling, if your worry and anxiety becomes disabling.

Good luck!
--mark  

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Mark P. Behar

Expertise

Almost any question or concern about gay men's health issues, sexually transmitted infections, abnormal Pap smears, anal cytology (anal "Pap smears"), etc. There is no such thing as “d/d free” or “clean” (free of infection), so why do so many of us deceive ourselves into thinking that some people are indeed totally free from a potentially infectious disease, like HIV, herpes, hepatitis, syphilis, chlamydia, warts, gonorrhea, etc., just because they say so? Clinical laboratory tests are not perfect, and having a “negative” or “nonreactive” test does not mean that a person is free from infection. Perhaps at the moment the test was taken, the person was uninfected; or, perhaps, the test wasn’t sensitive enough to detect presence of the infection. There is really no way that anyone can determine that they are truly “disease free,” and there are over a hundred of infectious conditions that can be spread without your knowing anything. Rather than trying to “pre-screen” or “serosort” a potential sex-mate with deceptive questions that are impossible to know by today’s technologies, a wiser option may be to consider everyone infected with something, and either use appropriate protective measures (“safer sex”), or accept the responsibility and consequences of possibly “catching” something from someone who’s hotter than expected (pun intended!). There is much research that supports the contention that an HIV positive person reliably taking HIV medications, and having an undetectable viral load, presents a lower risk for transmission of HIV than people who may think or say they are HIV negative, but are not. Food for thought!

Experience

Family Practice PA since 1981; Volunteer Clinician for Brady East STD (BESTD) Clinic, Milwaukee, since 1977; answered STD questions submitted to their web site. Professionally lectured at national and regional Physician Assistant and Nurse Practitioner conferences, and at national gay & lesbian health conferences on topics including HIV/AIDS, herpes, hepatitis, STDs, human papilloma virus (the cause of venereal warts), abnormal Pap smears, gay and lesbian health issues, among others.

Organizations
Co-Founder, Lesbian, Bisexual, & Gay Physician Assistant Caucus of the American Academy of Physician Assistants, Inc.; American Academy of Physician Assistants; Wisconsin Academy of Physician Assistants; National Co-Chair (2012-16), National Association of Black and White Men Together: A Gay, Multiracial Organization for All People (NABWMT)

Publications
Journal of the American Academy of Physician Assistants (JAPA) Q Visions, Quarterly Newsletter of the NABWMT

Education/Credentials
Bachelor's of Arts, 1972 (University of Wisconsin, Milwaukee, WI) Graduate Credits Experimental Psychology, 1972-75 (Tulane University, New Orleans, LA) Physician Assistant, Bachelor's of Science, 1981 (George Washington University, Washington, DC); Masters in Physician Assistant Studies, 2000 (University of Nebraska Medical Center, Omaha, NE)

Awards and Honors
Colposcopy Recognition Award (CRA), the American Association of Colposcopy and Cervical Pathology; Distinguished Fellow, Clinical Preceptor, American Academy of Physician Assistants; Fellow, Wisconsin Academy of Physician Assistants

Past/Present Clients
Brady East STD Clinic, Milwaukee, WI Milwaukee Health Services, Inc. (Martin Luther King Heritage Health Center), Dept. of Family Medicine and Early Intervention Program for HIV Infected Persons

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