Chronic Prodrome

I have been diagnosed with genital HSV1. It recurs quite frequently (2x/ month) and presents as a rash. I was diagnosed 6 months ago. Since then I have been plagued by chronic itching in various places covered by the sacral ganglia. At first I thought it was my worry over the diagnosis as it happens sporadically during the day every day. After several months the itch was still present. I have been on suppressive acyclovir (2 months) but it has not controlled either the outbreaks or the itching. The itching and the thought that I am in constant prodrome is worse than the outbreaks themselves. My PCP does not know very much about genital herpes other than what it is and how to diagnose it and is unable to help me sort what is and what is not a recurrence. He has been resistant about referring me. Any suggestions?

[Alan Rockoff, MD]

In the first place, your description of the basic diagnosis of herpes ("2x/ month) and presents as a rash") makes me skeptical, since herpes presents as blisters and scabs, and is barely gone in 2 weeks.

Second, I am not familiar wiht the concept of "chronic prodrome."  If you thought the various itches were caused by worry, I'm inclined to think you may be right.  The fact that chronic acyclovir (presumably by mouth) doesn't suppress these symptoms again points to a nonherpetic cause.

Why should your PCP be "resistant?"  Perhaps you should find another PCP.

I suggest that yiu get this checked out by someone knowledgeable and get it off your mind and agenda.

Best.

Dr. Rockoff