GHSV 1 Symptoms and Primary Outbreak

[kunemas]

I was diagnosed with GHSV 1 on May 11, 2011 via a culture swab to what looked like a very mild rash on the side of my penis and on my scrotum.  The rash appeared to be disappearing after about a week, but flared up and covered my entire scrotum about a week later.  The rashing on the penis has not gotten any worse, however it has not subsided either.  The rash that covers most of my scrotum seems to be getting better at times (I think) but then flares back up about every week and never truly heals.  In fact, my condition looks just as bad today, 2 1/2 months later, then it ever has. There is some itching and tingling involved, but no blisters or lesions of any sort.  I do experience what I believe to be nerve pain in my thighs. My doctor initially diagnosed me to 2g of Valtrex per day for 3 days with only 3 refills, which I used all of them very quickly as the symptoms were not subsiding.  I then purchased vaslcyclovir from a foreign country, of which I took 2g per day for about 45 days or so.  The symptoms still did not appear to reside at all.  Is it possible for a primary ghsv 1 breakout to last this long without any "classic" symptoms?  What can I realistically expect my experience with GHSV 1 to be like?  Does it seem to be as mild as most studies and doctors suggest?  What is the longest that you have seen a GHSV 1 primary outbreak last?   Any help or comments would be greatly appreciated.  Thanks!

[Edward W Hook, MD]

You had a positive culture for HSV-1 associated with genital lesions.  This is genital HSV-1 unless something most unusual was going on.  Your negative antibody test suggests that the infection was rather recently acquired. The test for HSV antibodies is not as sensitive as the test for HSV-1 antibodies.  I suggest you believe the culture.  It is, as I have also told you, the description of your rash an the time course makes it likely that some other dermatologic process was going on as well at the same time. EWH

[Edward W Hook, MD]

This is not uncommon, it is virtually unheard of in persons who do not have other active lifethreatening diseases.  You nee to see a dermatologist to help sort this out.  EWH

[Edward W Hook, MD]

Welcome to the Forum. While it is difficult to deny your culture results, there may be something other than herpes going on here.  Even initial herpes outbreaks typically resolve within three weeks and your lesions have been present for well over two months.  Furthermore, the absence of response to the high dose of valacyclovir you were taking is also uncharacteristic.  There are a small proportion (less than 5%) of herpes simplex viruses which are resistant to valacyclovir but infections caused by these viruses typically run a normal course, unlike what has gone on with you.  My guess is that you have some other dermatological process going on and that the inflammation associate with it lead to shedding of the herpes virus which was detected in your culture.  My advice is for you to go an seek the input of a dermatologist.  

I hope this comment is helpful. EWH

[Edward W Hook, MD]

This changes everything.  It certainly does not mean that your scrotal rash was due to HSV-1.  In fact, if the blood was drawn only 4 days after your possible exposure it is most likely that this postive test represented an infection acquired before then, possibly long beefore then.  HSV-1, while an ocasional cause of genital herpes is a common cause of cold sores and oral infections.  About 60% of American adults have HSV-1 infections and of these, most do not know they have the infection and have never had a cold sore.  This is likely the case with you.   EWH

[kunemas]

Dr.,

I truly do appreciate all of your help throughout this process and want to thank you for your care and assistance with this matter.  

Upon doing some further research (going back to the clinic where I had my 1st test), I learned yesterday that I did NOT have a positive swab for GHSV 1.  Rather, my IGG blood test was >5.0 for type 1.  If blood was drawn 4 days after the potential exposure, would an IGG test this high if I were so recently exposed to it, or does the high level of antibody suggest that I have carried the virus for quite sometime?  I did make sure to specifically look that the test was IGG and not IGM.  I was a wrestler, which I understand gives some possibility to exposure as well.

Thanks again and take care!

[kunemas]

Dr.,

If you could answer one more thing, I would appreciate it.  If I was exposed, it was on 5/12. My positive swab was taken on 5/16.  I just got test results back from a blood test taken for both types that was drawn on 7/30.  The test came back negative for both types.  Is it safe to say I don't have herpes or is more possible that I do?

Thanks for all of your help with this.

[kunemas]

Dr.,

Thank-you for your timely response, as it does offer some relief and insight on my problem.  As you can possibly imagine, this is almost constantly on my mind due to the symptoms being present at all times.  Have you seen primary genital HSV outbreaks last this long at any time in your career, or is this very uncommon?  Do you think that it would be beneficial to have myself culture swabbed again?  

Thanks again!