Differentiating Between Shingles and Herpes Simplex: A Guide

Differentiating between shingles and herpes simplex virus?

Hello, doctor.
A while ago, I visited a massage therapist for a hand job service.
Two days later, I received the HPV 9-valent vaccine.
On the third day, I started experiencing intermittent sharp pain on the outer side of my right thigh, which lasted for 1-2 days.
After that, I noticed blisters and rashes appearing on my right leg.
I have attached a photo: https://imgur.com/p6OkswZ.
The rash includes areas on my thigh, foot, knee, and the back of my knee, with only red spots on the back of the knee.
I noticed the back of my knee because it felt burning before the rash appeared.
I consulted a doctor and took medication for herpes, which gradually alleviated the symptoms.
After 8 days, the herpes type 2 IgM test came back negative.
I also had a combined test for types 1 and 2 IgM and IgG, which showed negative results for all four items.
Since the time frame is quite short, I'm unsure about the accuracy of the tests.
I'm still feeling some psychological stress.
Could you please advise what type of herpes this might resemble? Thank you very much.

Youyu, 30~39 year old female. Ask Date: 2017/12/28

Dr. Wu Yuxin reply Dermatology

The Medical Act states that "a physician shall not administer treatment or prescribe medication without personally examining the patient," and therefore, online diagnosis is also not permissible.
If you are experiencing significant distress, it is advisable to seek medical attention promptly.

Reply Date: 2017/12/28

More Info

When differentiating between shingles (herpes zoster) and herpes simplex virus (HSV), it is essential to consider the clinical presentation, the history of exposure, and the results of laboratory tests.
Shingles is caused by the reactivation of the varicella-zoster virus (VZV), which is the same virus that causes chickenpox. After a person recovers from chickenpox, the virus remains dormant in the nerve roots and can reactivate later in life, often due to stress, immunosuppression, or other factors. The hallmark of shingles is a painful, unilateral rash that typically follows a dermatomal distribution. This means that the rash appears in a specific area of the skin that corresponds to the nerve affected by the virus. The rash usually starts as red spots that develop into fluid-filled blisters, which eventually crust over.

On the other hand, herpes simplex virus (HSV) infections can be categorized into two types: HSV-1 and HSV-2. HSV-1 is commonly associated with oral herpes (cold sores), while HSV-2 is primarily linked to genital herpes. Both types can cause lesions in either area, but they tend to recur in the same location. The lesions caused by HSV are usually painful and can appear as small, fluid-filled blisters that rupture and crust over. Unlike shingles, HSV lesions do not follow a dermatomal pattern and can appear in clusters.

In your case, you mentioned experiencing pain in your right thigh followed by the development of a rash with water-filled blisters. The presence of a burning sensation prior to the rash and the unilateral nature of the symptoms suggest that this could be shingles, especially if the rash follows a specific dermatome. However, the fact that you had a sexual encounter and are concerned about herpes simplex adds complexity to the situation.

Your laboratory tests showing negative results for both HSV-1 and HSV-2 IgM and IgG antibodies indicate that there is no current or past infection with herpes simplex. IgM antibodies typically indicate a recent infection, while IgG antibodies suggest past exposure. The absence of these antibodies may reduce the likelihood of a herpes simplex infection, but it is important to note that these tests can sometimes yield false negatives, especially if the infection is very recent.

Given the symptoms you described, it is crucial to consult a healthcare provider for a thorough examination. They may perform a physical examination of the rash and consider additional tests, such as a viral culture or PCR test, to confirm the diagnosis. If it is indeed shingles, antiviral medications can help reduce the severity and duration of the outbreak, especially if started early.

In summary, while your symptoms could suggest shingles due to the unilateral rash and pain, the negative herpes simplex tests make it less likely that you have an active HSV infection. It is essential to follow up with a healthcare professional for an accurate diagnosis and appropriate treatment. Managing stress and maintaining a healthy immune system can also help prevent future outbreaks of either condition.

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