STDs Expert Forum
Can it be something besides herpes type 2?
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The STD Forum is intended only for questions and support pertaining to sexually transmitted diseases other than HIV/AIDS, including chlamydia, gonorrhea, syphilis, human papillomavirus, genital warts, trichomonas, other vaginal infections, nongonoccal urethritis (NGU), cervicitis, molluscum contagiosum, chancroid, and pelvic inflammatory disease (PID). All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.

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Can it be something besides herpes type 2?

HX:

I got oral in 2008 from my gf and contracted type 1.   I have not had sex since.   I rarley got OBs in this time frame after the initial OB. (Once initially and then 2 other times I got a small crack in the skin). Both times the swab tests came back negative.

Recently I started running again and after each run I would get painful cracks in my skin in the fold between the leg and the privates. Sometimes both sides. DR said it was friction burn.

I would also get sharp pains in my anal region and inside my penis, but never a sore.

8 days ago I had sex again (with a condom). two days later I started feeling pains. As the week went on I started having more pain, like I did years ago. Headaches, sharp leg pains, anal pains, itching on my buttocks, urethral pain, just bounced around like it did before. So I asked her if she had anything and she said she was clean, tested and had antibodies for type 1 and 2. Says she has never had a sore before.

So I am really freaking out now. I have been on 500mg of Famvir for a month as I had pain a while back and just kept taking it. After our sexual encounter I started 1000 mg and for a week have kept that up.

This morning I went to the ER cause I developed the same sort of rash I mentioned before on my fold between my leg and privates. The ER Dr walked in glanced at it and said Candida and walked out. He didn't even look at me for 5 secs. I wonder if it's possible this 'Candida' diagnosis is way off? I have never been a normal HSV case. I had severe pains for years, but not in sores. I get painful shocks in my privates and legs, but the skin looks fine. This 'Candida' idea would make me happy as I fear type 2. Maybe Candida would explain the reason I have cracked painful red skin the day or two after running.

Going to get tested.

The pain is less this time, but I have a type of herpes already and Famvir so the OB is probably just reduced.

I wore a condom and we only had sex for like 3 minutes :(
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239123_tn?1267651214
Welcome to the STD forum.

Your newer symptoms don't sound like herpes at all; and it was unlikely you would catch HSV-2 during condom-protected sex. Also, it pretty much impossible to acquire a new HSV infection while taking famciclovir (Famvir).

Whether HSV-1 or HSV-2, almost certainly herpes is not the cause of the rash/irritation in your groin, for several reasons.  Recurrent genital herpes due HSV-1 is rare.  Many people have no recurrent outbreaks at all, and most of the rest have only 1-2 outbreaks over a couple of years, then none.  When there are recurrent oubreaks, it's usually on the penis.  The groin, and in particular the fold between the thigh and abdomen, almost never is involved, and getting anal outbreaks after an initial penile infection is uncommon.  Recurrent herpes oubreaks are almost never bilateral; involvement of the groin on both sides is strong evidence against herpes.  Recurrent outbreaks are pretty much only in one place, i.e. it would be unusual to have them be both your groin and anus.  It is unlikely you would have outbreaks while taking famcicoovir (Famvir).  Finally, herpes doesn't cause pain without blisters/sores -- those lesions can be painful, but pain alone generally is not a herpes symptom, further arguing against a new HSV infection causing the penile and rectal pain.

It is very easy for an experienced clinician to diagnose a superficial skin infection such as candida or other fungus, even with a 5 second exam.  Candida itself is not a common cause of fungal infections in the genital area, so your ER doc might not be up to speed on the details; jock itch (due to a fungus different than candida) or a bacterial infection like staph or strep may be more likely than Candida.  But he certainly is correct that it isn't herpes.

In general, ongoing suppressive treatment, such as famciclovir, is not necessary or recommended in people with genital HSV-1.  The recurrent outbreaks usually are too infrequent to be worth the expense and inconvenience, and sexual transmission of genital HSV-1 is not common, so continuing treatment probably doesn't help very much in protecting partners.

For all those reasons, I see no need for repeat testing for HSV.  The main reason would be if there is any question about the initial diagnosis of HSV-1.  However, if these issues remain uncertain, you could have a blood test, which would tell whether you are infected with HSV-1, HSV-2, or both viruses.

Feel free to return with a brief follow-up question if this remains unclear, or if you want to say more about your initial herpes diagnosis in 2008.

Regards--  HHH, MD
5 Comments
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Avatar_n_tn
I appreciate the info.  I went to my PCP today and he said the rash was not herpes.  He did a IgG and IgM blood test for herpes anyways to see if that was causing my sharp pains.  He knows I have type 1.  He felt, like you, it would be against odds to get type 2 using a condom, but did say he sees it.  Condoms don't cover the whole genital area and I did get her fluids on me and did touch my genital area to her's some.

He also wondered about the Famvir helping prevent a new HSV infection? He said he has never heard that before.

He was aware that I have had off and on sharp pains in my boxer short region for years now and that it moves around.  I never get sores.  I have seen neuro and they say it has to be herpes.  I guess I'm that rare case.

I was very happy after hearing 3 years ago I had type 1 because the doctor said it would likely be a one time deal.  Why has it been so bad?  

Again thanks for the help!  Very appreciated.
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239123_tn?1267651214
Notice I said it is unlikely you would catch herpes despite using a condom, not impossible.  But that's the least important part of my reply.  The reasons that herpes doesn't explain your symptoms would be overwhelming even if you had not used a condom, and even if your partner were known to have HSV-2.  If your HSV-2 blood test happens to be positive, it would indicate you have an asymptomatic infection plus some other cause of your symptoms.

As for catching herpes while taking famciclovir:  your doc is technically correct, if his point is that there are no data to prove the point.  But animals cannot be infected with HSV if they are being given antiherpes drugs and I see no reason to suspect this wouldn't apply in humans.

"I was very happy after hearing 3 years ago I had type 1 because the doctor said it would likely be a one time deal.  Why has it been so bad?"  You were correct to be happy at the news that you had HSV-1 and not HSV-2.  The only reason it has been "so bad" is that your ongoing symptoms aren't due to herpes.  

Let's hold off on additional comments/questions until your blood test results are available.  In the meantime, continue to work with your doctor about other explanations for your symptoms.
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Avatar_n_tn
Dr,

My results from blood test just 9 days post exposure:

IgM - 1.34
IgG Type 1 - 1.38
IgG Type 2 - .04

I told him I had pain still and he gave me Gabapentin and it relieved my pain and I slept well.  

I will re-test in a month to see if this was just too soon to catch the antibodies for type 2.

Thanks!
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239123_tn?1267651214
As your doctor undoubtedly told you, the blood test is positive for HSV-1, as expected, and negative for HSV-2.  Ten days is definitely too soon for a positive result, even if you had a new HSV-2 infection.  The risk of herpes as a cause of your symptoms is too low to warrant a test at 4 weeks, which also will be too soon; around half of newly infected people have positive results by then.  If you want final assurance against HSV-2, you'll need a test at 12-16 weeks.  Also, definitely stop taking Famvir or any other anti-herpes drugs; continuing treatment could delay positive test results even longer.

Improvement of the pain with gabapentin is further evidence against HSV-2, which would not respond at all to that drug.

That will be all for this thread.  Your own doctor can interpret any additional HSV blood tests that you have.  I will have nothing more to say.
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