herpes proctitis

I'm a straight man who contracted herpes from a protected encounter with a prostitute in July of 05.

The first outbreak was on the scrotal area and since then I've had outbreaks typically in the perianal area and very close to - in and around - the anus. The symptoms that I've had are burning, tingling and stinging and tiny cracks just in and around the anus.

I've had very frequent outbreaks but haven't been on medication for any of them except for the first one, when I took Valtrex.

The problem that I am now facing is that three weeks back - on 12 June 09 - I appeared to come down with a bout of herpes proctitis - which is a herpes outbreak in the rectum. I was constipated, feeling a lot of pain around the anus, and was passing out tiny quantities of stool which were covered with blood and mucus.

After getting these symptoms, I saw my doctor and then obtained from him Valtrex as well as a box of corticosteroid suppositories for insertion into the anus. Unfortunately, the use of the suppositories made the herpes infection even worse and the pain worsened. By the end of the week - i.e. on 19 Jun 09 - I realized that because they were steroid-based they could have made things worse and that I should therefore immediately discontinue them.

I discontinued them, but continued taking the Valtrex, had a full blood count done and then found that the neutrophil level was slightly elevated, suggesting a secondary bacterial infection. I then commenced a course of antibiotics which I finished just yesterday (on 3rd July 09).

THere has been an improvement in the symptoms (in terms of a lessening of pain) but I still feel the rectal/anal area is a bit numb and that I still have to strain to pass out stool. I also find it difficult to pass gas out of the anus and so have to sort of get the gas to be forced out of my mouth. I also had a colonoscopy done two days ago (on 2nd July) which indicated that there were no obstructions or visible signs of inflammation.

I figure that the colonoscopy did not pick up anything because the inflammation is now subsiding (with the twice-daily dose of 500mg of Valtrex that I have been taking) . However the fact that I still have to strain to pass stool out and that I have difficulty passing out gas seems to indicate that the herpetic proctitis that I suffered had some kind of effect on the sacral nerves, which is what the experts say that it would typically have. I read an article in which it was stated that 'radiculopathy of the sacral nerves' in herpetic proctitis is what causes the constipation (though I believe that the swelling also contributes to the difficulty that one would be faced with in passing out stool).

The big concern I have is this: I've read that it is rather unusual for herpes to reactivate as proctitis except in people who are immunocompromised. For instance, in Famvir's web-site, in an article on HIV and HSV coninfection, it is stated that in HIV-infected people, herpes can affect areas not covered by the skin - for instance, that it can enter the rectum.

However, Dr Hunter in one of his posts suggested that even people who don't engage in anal sex can get anal herpes - that a significant minority of straight men do still get it - despite the fact that they have never engaged in anal sex.

So it seems as though herpes can enter the rectum in some immunocompetent people - unless Dr Hunter wasn't thinking of herpes proctitis when he wrote about 'anal herpes'.

Now in my case I've had most of my outbreaks in the perianal/anal area. Given that this is so, would this then make it more likely for me to get herpetic proctitis even though I am healthy and am not immunocompromised?

These three weeks have been hell for me, and I'm still not out of the woods. I never expected the herpes to enter my rectum.

The shock and distress that I am facing still has not abated.

Any light you throw will be helpful for me.

[gracefromHHP]

How were you originally diagnosed as having genital herpes? What testing was done?

How were you diagnosed with herpes proctitis or is it a self diagnosis for the most part?

grace