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HSV & HPV
24 year old male.
2007:Got HSV-2. Doc diagnosed with swab/urine test both positive but clear of other STDs.
2008:1 outbreak a year after 1st.
2009:2 outbreaks. I take famvir tablets & symptoms disappear < week.
2010:Had regular outbreaks, 8 in 9 months. Most on frenulum. Major change is I graduated from Uni end 2009 & started work fulltime.
Apr-10:Protected sex/unprotected oral. 2-3 week later found wart base of penis where hair meets shaft. Week later doc looked & said it was HPV & froze it off. Seemed to go but couple weeks later came back. Went back to different doc in June & doc said it was scar tissue.
Aug-10:Scar tissue still there so went back to docs. Told my history & that it was scar tissue before showing her. She didn't seem sure but said it was scar tissue & if it got bigger come back or if it was bothering me then she’d cyro it off. Not sure if it's any bigger but it's still there. Had blood/urine tests negative for everything (no HSV test).
1) Only difference in 2010 is full-time job. Can’t give up work & last thing I want is suppressive therapy. Don’t stress with work but is this possible cause for regular HSV compared to 3 in 2 years at uni?
2) Is the frenulum common for outbreaks?
3) Can HPV increase frequency of outbreaks?
4) Try to exercise, eat healthy & sleep well to prevent outbreaks. Binge drink once fortnight. Drank regularly & binged during uni & didn't get outbreaks. Can this be a cause now?
5) Anything, apart from suppressive therapy, that I can do?
HPV
1) Is scar tissue common? Can scar tissue result from cyro?
2) Does scar tissue ever disappear or fade?
3) If it is scar tissue & wart free for 3 months HPV gone? I read after 6 mnths wart free the body destroyed the virus, is this true?
4) Can scar tissue be removed via cyro or will this make it worse?
5) Could it be anything other than HSV-2/ HPV? Negative test results for everything else, but new frequency of HSV-2 & scar tissue are making me paranoid.
Thanks, any help appreciated.
2007:Got HSV-2. Doc diagnosed with swab/urine test both positive but clear of other STDs.
2008:1 outbreak a year after 1st.
2009:2 outbreaks. I take famvir tablets & symptoms disappear < week.
2010:Had regular outbreaks, 8 in 9 months. Most on frenulum. Major change is I graduated from Uni end 2009 & started work fulltime.
Apr-10:Protected sex/unprotected oral. 2-3 week later found wart base of penis where hair meets shaft. Week later doc looked & said it was HPV & froze it off. Seemed to go but couple weeks later came back. Went back to different doc in June & doc said it was scar tissue.
Aug-10:Scar tissue still there so went back to docs. Told my history & that it was scar tissue before showing her. She didn't seem sure but said it was scar tissue & if it got bigger come back or if it was bothering me then she’d cyro it off. Not sure if it's any bigger but it's still there. Had blood/urine tests negative for everything (no HSV test).
1) Only difference in 2010 is full-time job. Can’t give up work & last thing I want is suppressive therapy. Don’t stress with work but is this possible cause for regular HSV compared to 3 in 2 years at uni?
2) Is the frenulum common for outbreaks?
3) Can HPV increase frequency of outbreaks?
4) Try to exercise, eat healthy & sleep well to prevent outbreaks. Binge drink once fortnight. Drank regularly & binged during uni & didn't get outbreaks. Can this be a cause now?
5) Anything, apart from suppressive therapy, that I can do?
HPV
1) Is scar tissue common? Can scar tissue result from cyro?
2) Does scar tissue ever disappear or fade?
3) If it is scar tissue & wart free for 3 months HPV gone? I read after 6 mnths wart free the body destroyed the virus, is this true?
4) Can scar tissue be removed via cyro or will this make it worse?
5) Could it be anything other than HSV-2/ HPV? Negative test results for everything else, but new frequency of HSV-2 & scar tissue are making me paranoid.
Thanks, any help appreciated.
MEDICAL PROFESSIONAL
Welcome to the STD forum. These questions are pretty complex and partly replicate ones the Dr. Hook answered on the HIV prevention forum about 4 months ago. I will answer your questions briefly, but if not yet done you should visit the Perth Sexual Health Centre and let the experts there give more direct, personalized advice than is available from this or any online forum.
I am somewhat skeptical you have had recurrent herpes as frequently as you describe. Monthly outbreaks are possible, but unusual; most people with genital HSV-2 have symptomatic outbreaks 3-6 times a year. The next time you have an apparent outbreak, get professionall examined ASAP (within a day), preferably at the SHC, for direct examination and confirmation of the diagnosis, if this hasn't been done before.
As for genital warts, if your doctor is experienced in STDs and believes the remaining abnormality is scar tissue and not an actual wart, probably you can rely on that. There's nothing a distant expert can do to judge anything different.
To the specific questions (which you present in 2 groups of 5; I'll just number them 1-10):
1) Contrary to popular belief, stress, anxiety, etc have not been shown in research studies to increase frequency of recurrent herpes outbreaks. But if you do have herpes, why is suppressive therapy "the last thing" you want? If indeed you're having such frequent herpes outbreaks, suppressive therapy is exactly what you need. It's easy, safe, and effective.
2) Herpes outbreaks can occur anywhere on the penis. However, in some men the frenulum may be easily injured during intercourse or masturbation -- so maybe the location goes along with herpes not being the primary cause of recurrent sores, and perhaps with a scar at the same spot.
3) HPV has no known effect on HSV outbreaks.
4) Just as stress doesn't increase frequency of outbreaks, good health habits do not decrease them. That's another urban myth about herpes.
5) Nothing but suppressive therapy has been shown to reduce the frequency of recurrent herpes oubreaks.
6) Scarring isn't all that common, but it can happen after any wart treatment, including cryotherapy. But I can't say whether scarring explains what you are observing.
7) Scar tissue often becomes less prominent over time, but usually never goes away entirely.
8) It can take several months for HPV to be cleared up to the point the virus can't be detected. I often advise my patients that 6 months is a pretty good benchmark -- i.e. if no recurrence of treated warts after that time, there probably is a low likelihood of recurrence or of transmission to partners. But it can take a couple of years or as short as a few weeks; there is simply no way to know for sure in any individual patient.
9) Further cryo will probably make scarring worse; it certainly will not get rid of a scar.
10) Already answered: you might have something other than herpes, and your apparent wart probably is scar tissue.
Collectively, Australia's SHCs are probably the world's best STD clinic network. Please take advantage of the world class expertise that is available and visit the Perth SHC to sort out all these issues. Please report back after your clinic visit; I'll be interested to hear their perspective.
Regards-- HHH, MD
I am somewhat skeptical you have had recurrent herpes as frequently as you describe. Monthly outbreaks are possible, but unusual; most people with genital HSV-2 have symptomatic outbreaks 3-6 times a year. The next time you have an apparent outbreak, get professionall examined ASAP (within a day), preferably at the SHC, for direct examination and confirmation of the diagnosis, if this hasn't been done before.
As for genital warts, if your doctor is experienced in STDs and believes the remaining abnormality is scar tissue and not an actual wart, probably you can rely on that. There's nothing a distant expert can do to judge anything different.
To the specific questions (which you present in 2 groups of 5; I'll just number them 1-10):
1) Contrary to popular belief, stress, anxiety, etc have not been shown in research studies to increase frequency of recurrent herpes outbreaks. But if you do have herpes, why is suppressive therapy "the last thing" you want? If indeed you're having such frequent herpes outbreaks, suppressive therapy is exactly what you need. It's easy, safe, and effective.
2) Herpes outbreaks can occur anywhere on the penis. However, in some men the frenulum may be easily injured during intercourse or masturbation -- so maybe the location goes along with herpes not being the primary cause of recurrent sores, and perhaps with a scar at the same spot.
3) HPV has no known effect on HSV outbreaks.
4) Just as stress doesn't increase frequency of outbreaks, good health habits do not decrease them. That's another urban myth about herpes.
5) Nothing but suppressive therapy has been shown to reduce the frequency of recurrent herpes oubreaks.
6) Scarring isn't all that common, but it can happen after any wart treatment, including cryotherapy. But I can't say whether scarring explains what you are observing.
7) Scar tissue often becomes less prominent over time, but usually never goes away entirely.
8) It can take several months for HPV to be cleared up to the point the virus can't be detected. I often advise my patients that 6 months is a pretty good benchmark -- i.e. if no recurrence of treated warts after that time, there probably is a low likelihood of recurrence or of transmission to partners. But it can take a couple of years or as short as a few weeks; there is simply no way to know for sure in any individual patient.
9) Further cryo will probably make scarring worse; it certainly will not get rid of a scar.
10) Already answered: you might have something other than herpes, and your apparent wart probably is scar tissue.
Collectively, Australia's SHCs are probably the world's best STD clinic network. Please take advantage of the world class expertise that is available and visit the Perth SHC to sort out all these issues. Please report back after your clinic visit; I'll be interested to hear their perspective.
Regards-- HHH, MD
MEDICAL PROFESSIONAL
And I forgot to say congratulations for visiting the STD clinic. Smart move. Any additional questions will be best answered by the clinic and/or the doctor you saw there.
MEDICAL PROFESSIONAL
Anybody in an STD clinic sees lots of people with herpes recurrences as frequently as you might have them. However, that's a very biased sample; of course people with frequent recurrent outbreaks seek care in STD clinic more often than those with few episodes. The research is clear on 2 points: only about 1 in 20 persons with HSV-2 have outbreaks more often than 6-8 times a year; and as you suggest yourself, it is unusual for someone to have say only 2-3 episodes a year and then start having more frequent outbreaks. So I think there continues to be some doubt you are really having such frequent herpes outbreaks. On the other hand, the opinion of an experienced STD specialist need to be respected.
You're on a path to 2 ways to answer the question: if your current HSV swab test is positive, it will nail the diagnosis (but if negative, it won't mean much one way or the other); and the frequency of oubreaks while taking valacyclovir will be a strong indicator. If you continue with episodes every month or so, it will be strong evidence against herpes; if they are controlled, it will support the diagnosis. For that reason, bite the bullet an be sure you take the valacylovir religiously; don't miss any days. If you skip doses now and then, it will screw up any judgment of the therapeutic effect. Don't worry about "rebound" if and when you stop the drug in the future; after quitting longstanding suppressive thearpy, recurrent outbreaks tend to return at the same rate as before, no worse and no more frequent.
And the "reminder" business is nonsense. What could be a more dramatic reminder of your herpes than having genital sores once a month? Taking the drug won't make any difference in this. And certainly I would prefer not to be taking my Lipitor, which reminds me of my previous cholesterol problem and the heart attack I had 14 years ago. But the benefit of course outweighs the trivial downside. Same for the millions of people who take any medications on a continuing basis. It will just become a part of your daily routine.
As for warts, I agree that despite the uncertainty, the opinion of 3 professionals is strong evidence that the residual genital bump is scar tissue, not a persistent wart. Just sit tight for a few months. If it's a wart, it will grow or others probably will appear, or it will go away. If it doesn't change, probably it's scar tissue.
You're on a path to 2 ways to answer the question: if your current HSV swab test is positive, it will nail the diagnosis (but if negative, it won't mean much one way or the other); and the frequency of oubreaks while taking valacyclovir will be a strong indicator. If you continue with episodes every month or so, it will be strong evidence against herpes; if they are controlled, it will support the diagnosis. For that reason, bite the bullet an be sure you take the valacylovir religiously; don't miss any days. If you skip doses now and then, it will screw up any judgment of the therapeutic effect. Don't worry about "rebound" if and when you stop the drug in the future; after quitting longstanding suppressive thearpy, recurrent outbreaks tend to return at the same rate as before, no worse and no more frequent.
And the "reminder" business is nonsense. What could be a more dramatic reminder of your herpes than having genital sores once a month? Taking the drug won't make any difference in this. And certainly I would prefer not to be taking my Lipitor, which reminds me of my previous cholesterol problem and the heart attack I had 14 years ago. But the benefit of course outweighs the trivial downside. Same for the millions of people who take any medications on a continuing basis. It will just become a part of your daily routine.
As for warts, I agree that despite the uncertainty, the opinion of 3 professionals is strong evidence that the residual genital bump is scar tissue, not a persistent wart. Just sit tight for a few months. If it's a wart, it will grow or others probably will appear, or it will go away. If it doesn't change, probably it's scar tissue.
Hi,
I took your advice and actually got into see the doctor at a STD clinic today. The outcome was as follows:
HPV
She wasn't sure what it was but said that it was 'most probably' scar tissue. Needless to say that this doesn't exactly put my mind at ease, but I suppose if 3 doctors are semi-sure that its scar tissue then it probably is.
HSV-2
I showed her the re-occurance that has happened almost always in the same spot in the last 9 months. She said that it looked like HSV-2, but she took a swab anyway to be sure. I explained that I had had 8 of these outbreaks in the last 9 months and the result was that I now have a script for suppressive treatment tablets (Valtrex 500mg daily). This is the last thing I wanted, just from the point of view that taking a tablet everyday is a constant reminder I have HSV-2.
The Doc also said that outbreaks once a month are by no mean uncommon and that quite a few patients she has seen have a similar frequency. What she couldn't explain was that I have had so many in 2010 after going 2 years with only 3 outbreaks prior. Its supposed to be the other way round with outbreaks becoming less frequent as time goes by.
Have you heard of this? Outbreaks more frequent after an initial period of hardly any?
My main question that I forgot to ask the Doc: Can I become dependent upon suppressive therapy (Valtrex taken daily)?
i.e. once i stop suppressive therapy will the outbreaks occur even more often as my body is used to having the Valtrex to stop the outbreaks now?
Thanks for you help.
I took your advice and actually got into see the doctor at a STD clinic today. The outcome was as follows:
HPV
She wasn't sure what it was but said that it was 'most probably' scar tissue. Needless to say that this doesn't exactly put my mind at ease, but I suppose if 3 doctors are semi-sure that its scar tissue then it probably is.
HSV-2
I showed her the re-occurance that has happened almost always in the same spot in the last 9 months. She said that it looked like HSV-2, but she took a swab anyway to be sure. I explained that I had had 8 of these outbreaks in the last 9 months and the result was that I now have a script for suppressive treatment tablets (Valtrex 500mg daily). This is the last thing I wanted, just from the point of view that taking a tablet everyday is a constant reminder I have HSV-2.
The Doc also said that outbreaks once a month are by no mean uncommon and that quite a few patients she has seen have a similar frequency. What she couldn't explain was that I have had so many in 2010 after going 2 years with only 3 outbreaks prior. Its supposed to be the other way round with outbreaks becoming less frequent as time goes by.
Have you heard of this? Outbreaks more frequent after an initial period of hardly any?
My main question that I forgot to ask the Doc: Can I become dependent upon suppressive therapy (Valtrex taken daily)?
i.e. once i stop suppressive therapy will the outbreaks occur even more often as my body is used to having the Valtrex to stop the outbreaks now?
Thanks for you help.
You are reading content posted in the STDs Forum
Herpes spreads by oral, vaginal and anal sex.
Herpes sores blister, then burst, scab and heal.
STIs are the most common cause of genital sores.
Millions of people are diagnosed with STDs in the U.S. each year.
STDs can't be transmitted by casual contact, like hugging or touching.
Syphilis is an STD that is transmitted by oral, genital and anal sex.
