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What is the cause of a burnt and a red anus?

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General & Family Physician
Practicing since : 2009
Answered : 9400 Questions
Hi, Roughly 12 weeks ago I had protected intercourse and unprotected brief oral with a women HSV1 postive. She blames this on a rash she has has 3 times in her life, which caused very notable and clear HSV symptoms. She had no sores or blisters on face during this encounter. She is confirmed negative for HSV2 via blood. 2 weeks post exposure: developed itchy lesion which presented as a dark/red rasied area. Never blistered or ulcered and 3 doctors stated it didnt look like herpes. No swab done because it wasn't a sore. Went away after 4 weeks. Hasnt returned. 4 weeks post exposure: severe burning of perenium, single blister formed in the area which I popped and then rush to have swabbed. Result for HSV was negative. 5 weeks post: severe night sweats for 2 weeks, burning on anus and perenium, anal discharge, rectum discharge, tingling on legs. Nerve twitching on legs. BLOOD TESTS: Full STD panel @ 2 weeks, including herpes all NEGATIVE. HSV1+HSV2 IGM @ 3.5 weeks, 6 weeks, 7 weeks all NEGATIVE Swab of burning and red perenium: NEGATIVE HerpeSelect HSV 1 + HSV 2 IGG-type specific @ 2 weeks, 5 weeks, 6 weeks, 8 weeks: All NEGATIVE for both types. HerpeSelect HSV1 + HSV2 Immunoblot @ 10.4 weeks: NEGATIVE for both types. ****Please see the current state of my anus. It has burned and stayed red for over a month now. Was prescribed Doxycycline 100mg and have been taking the drug for 8 days with no relief from burning. Please review my photos, its a rash of some sort. Has also caused constipation. Urologist stated prostate feels normal. Area feels like chafing when walking and i understand herpes can present itself as a rash. IS THIS HERPES? I currently am applying an antifungal prescribed cream with no relief. I believe i have contracted HSV1 on the genitals. What else could this be. All std's negative, but I hear HSV can take time to develop antibodies. All tests NEG through 11.5 weeks, please help!
Posted Tue, 4 Mar 2014 in HIV and AIDS
Answered by Dr. Shoaib Khan 51 minutes later
Brief Answer: I believe this is HSV-1 sir Detailed Answer: Hello sir and welcome. Thank you for writing to us. Unfortunately the images have not been added to our discussion sir. If you do not mind, please attempt to do so again, so I can view your images as requested by you. Based on the description provided, this does sound like herpes sir. Although you should know that it can take several weeks for HSV antibodies to detect in your blood. So a false-positive (which could be your case sir), does not mean you do not have the infection. Especially when tests are conducted when the lesions are healing. The best time to test is when the blister appears or is appearing. It is also important to note the type of HSV with the type of transmission. HSV-1 is transmitted to the genitals through oral skin cells, and HSV-2 is transmitted through vaginal or anal contact. As the individual you had contact with has HSV-1 and you had unprotected oral contact, it is quite possible that she has transmitted the infection to you sir. No other medication will help sir, and I believe this is herpes itself, not any other infections. But other possibilities that can present in a similar manner are: -Candidiasis (which you have been prescribed anti-fungal medication for) -Syphilis -Hand-foot-and-mouth disease -Herpes Zoster -Chancroid It is unfortunate that at 11.5 weeks your test still returns negative, but I believe it is best to start treatment for HSV-1 at the earliest, based completely on clinical presentation. I hope you find my response both helpful and informative sir. Please feel free to write back to me for any further clarifications, I would be more than happy to help you. Best wishes.
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Follow-up: What is the cause of a burnt and a red anus? 1 hour later
Please review my photos. All swabs and blood have been negative and standard testing for HSV for accurate result is 12-16 weeks. I have been negative and my antibodies have remained the same for the virus the entire time since the first test. Does my picture look like a typical herpes outbreak? I have had no blisters or ulcers. I cant see how this could be herpes considering all testing that has been done. Could Prostitus cause such symptoms. A doctor wont prescribe me antiviral meds because the 8 I have seen from a Urologist, to a STD doctor, to a Dermatologist and Family physician have all stated no to herpes. My anus is the only issue but i clearly did not have anal sex. Discharge is also not common with men regarding herpes. What else could this be. I want to believe this isnt herpes based on clinical presentation because doctors have said otherwise. Please review and tell me what you believe my anus rash could be.
Answered by Dr. Shoaib Khan 54 minutes later
Brief Answer: Herpes not ruled out; other causes listed sir Detailed Answer: Hello once again sir. All the facts stated by you are right. Although, in your primary query you stated having presented with a blister which you popped yourself. This appearance of a blister points towards herpes. Also, as you already know, that most accurate testing results only after 12 weeks of the infection contraction, and most of your testing has been conducted only till 11.5 weeks. So we still have to test after 12 weeks, to completely rule out herpes sir. These facts still point towards herpes sir. But after looking at the attached images, a few other conditions come up in my mind, but I cannot confirm which one could have caused such a presentation, as all of these conditions can present in a similar manner. Let me list them out for your reference sir: -Dermatitis (types: contact, seborrheic, atopic) -Psoriasis -Vitiligo -Bacterial infections (eg. streptococcal or staphylococcal infections, erythrasma, etc.) -Fungal infections (eg. Candidiasis, tineas) -Hidradenitis Suppurativa -Human papillomavirus (HPV) -Paget's disease You will have to meet an infectious disease specialist and a gastroenterologist, who will examine your anal region closely and request for a few investigations, which will help diagnose the cause accurately sir. I hope this helps sir. Please do not hesitate to write to me, I am always available to help. Best wishes.
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Follow-up: What is the cause of a burnt and a red anus? 14 minutes later
Dr. XXXXXXX I have an appointment with an infectious disease specialist in 2 weeks. Until then, I want to touch on the single blister I did get on my perenium. It was popped and blood and clear liquid drained. However, I rushed within 30 hours of its presentation for a swab, which the doctor stated would be accurate even in the absence of fluid as active particles of the virus would be on the surface since it was so fresh and i came so quick. That swab was negative. I also took a seperate swab after the burning intensified...again negative. I agree, I will not rule out HSV1, but have you ever seen a rash such as mine in a herpes case? I find it odd and nothing of what i have seen online. My penis is also absent of any lesions. I still have a very small clear-sticky discharge that occurs AFTER urination the last couple of mornings, but no pain during urination or after. If my blood stays negative through 16 weeks, should we eliminate herpes from a cause? I just want to know how long I must wait before getting a more or less conclusive result that herpes is not the culprit. Please advise on if i should put this behind me after a negative IGG test at 12 and 16 weeks. Also, can herpes cause frequent twitching of leg muscles? I also have never heard of this, but experience this since this encounter. Please note: from what I gather somebody who is negative for HSV1 and HSV2 but gets infected typically show detectable antibodies prior to 12 weeks since the body has never seen the virus and builds an attack. This was stated by a well-known herpes expert Terri XXXXXXX Your thoughts? None the less, I will report back with my IGG test next week (after 12 weeks). If negative, i will still see my infectious disease doctor, but would you lean towards another infection if such is the case?Please provide your insight. Could staph really cause this as well, I think it could.
Answered by Dr. Shoaib Khan 15 minutes later
Brief Answer: Very good queries sir, all addressed Detailed Answer: Hello once again sir. It is indeed interesting that your investigations reported negative although you reported for a test soon after the blister was popped, but this could also be because you were still less than 12 weeks into the infection. But this is unlikely, and herpes should be ruled out in such cases, but I would like to still keep it as an option sir; as I am worried about the history of contact with the HSV diagnosed woman. As for the presentation; different patients present in a different way sir. I have not seen a patient with exactly the same presentation, but I have seen a few patients with somewhat similar presentations. The discharge points towards a sexually transmitted infection-cause, which is why your doctor will have to concentrate more on a sexually transmitted cause. That is a very good question sir, to be completely sure of ruling out HSV, I would recommend 2 tests to be conducted at 16 weeks and 20 weeks. Once these report a negative result, we can put HSV behind and move forward to other causes sir. I agree with Terri Warren's observation, that the body has never before seen the virus and should start early to build an attack against the foreign substance. But this again differs from individual to individual. Some individuals have a good immune system and can produce sufficiently detectable antibodies at even 2 weeks, whereas, some can take more than 12 weeks. Terri XXXXXXX has spoken about this as well. Yes sir, please go ahead with the test and keep in touch with your infectious doctor. Of course staph can also cause this sir, but your presentation does not typically match that of a staph infection, and most doctors would/should clinically link it with herpes. But leaning towards other causes after a negative HSV IGG test at 12 weeks would also be considered wise. Best of luck sir. And please do keep me informed.
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