Genital HSV-1, Yeast, Dermatitis?

[simplyparanoid?]

For the past year, I'd been getting periodic outbreaks of oral HSV-1.  Most took place inside the mouth, and were easily resolved by taking Valtrex.  5-6 weeks ago, I had an oral outbreak outside the mouth for the first time.  Later that night, I also experienced a genital irritation for the first time--specifically, burning. I hadn't had any sexual contact for over a month prior, and have never in my life had unprotected vaginal or anal intercourse. Earlier in the day, however, I had popped one of the sores on my mouth, thinking it might've been a pimple, and later (more than 5-10 minutes) masturbated, likely without having washed my hands.

Rather than simply refill my prescription for Valtrex (500 mg, 3x a day, 5 days), I went to see my physician, who noticed nothing to suggest herpes, but did a blood antibody test--which came back and showed positive for HSV-1, and negative for HSV-2--and recommended that I resume taking Valtrex for the oral outbreak.  The course relieved both the oral HSV and the genital HSV--however, the latter returned two days after the course had finished.  I again resumed taking the same course of Valtrex for a week, to no avail.  Fever, muscle (neck, back, leg), headaches, and weakness / exhaustion accompanied.  

I continued taking the medicine for the following month at the same dosage, still to no avail.  Since I stopped (> 1 week), symptoms progressed with new growths very small bumps exclusively around the rim of the glans, redness, and mild scaliness, and one small white bump also at the rim, which was deemed a cyst.  There are also discolorations (pale patches) on the head, and some more mild irritation at the base of the shaft.  I should note that all of these symptoms, save the burning, are mild.  Tylenol proved to alleviate the pain, and was taken most days that month.        

I've since seen a both a dermatologist and two infectious disease specialists, both of whom suggested I had dermatitis.  I was prescribed a mild moisturizer and Proteque--both of which, upon application, burned and agitated the case.  A DTM culture suggested a superficial fungal infection.  I was then prescribed  Vytone, a 1% hydrocortisone / 1% lodoquinol cream; after the first application, this is also causing a mild irritation.  
I'm awaiting results from a viral culture sample of the "irregular looking" areas of my penis.  My oral HSV-1 has not returned.      

My questions are:

1. Given the symptoms / evidence, might I have auto-innoculated myself with HSV-1?

2. Would the dermal re-agitation caused by the creams also cause for the muscle / headaches to persist?

3. If it is a fungal infection, why might the cream burn, and why the head / muscle aches?

4. Any other suggested next steps?

Apologies for the length, but this has been a continual source of stress for far too long.  Thanks for providing this service.

[H. Hunter Handsfield, M.D.]

First, I'm not certain you have symptomatic oral herpes, which usually causes lesions only on the lips and generally does not recur inside the mouth.  Further, oral herpes generally doesn't recur any more often than every 2-3 months; you only say "periodically", but I have the impression you're having oral symptoms more often than usual.  Although your positive HSV-1 antibody test suggests you have had oral herpes at one time or another, my guess it that the infection is asymptomatic (perhaps no longer active) and that something else explains your oral symptoms.  But of course I would be happy to revise this opinion if you have had a positive culture for HSV-1 from one of the lesions in your mouth.

Second, you provide no evidence to suggest you have genital herpes.  a) Auto-inoculation of HSV (of either type) from one part of the body to another is rare, except during the first few weeks after acquiring the initial infection.  b) If auto-inoculation nevertheless occured, it would not have caused fever, muscle aches, or the other general symptoms you describe.  c) The penile symptoms and lesions you describe do not suggest herpes.  d) Genital herpes due to HSV-1 does not recur or persist so long, and would not recur so quickly (2 weeks) after Valtrex.  e) The opinion of 3 experienced health care providers that you don't have genital herpes is itself powerful evidence against that possibility.

So I conclude you do not have genital herpes; and I'm not sure about symptomatic oral herpes.  In my judgment, the direct answers to your questions are:  1) No.  2) I cannot commment on the cause of your headaches and muscle pains, except to be certain they have nothing to do with HSV.  3) I also cannot comment on why the creams feel the way they do.  Again, that does not suggest herpes.  4) Pick whichever of your 3 specialist providers you are happiest with and stick with that person; believe his/her assessment and follow whatever advice s/he gives.  And don't worry about genital herpes; you don't have it.

Best wishes--  HHH, MD

[simplyparanoid?]

Yes, this seems to be the consensus--a consensus I'd be much more pleased with if anyone could offer some relief.  

As for your oral HSV query, there have been multiple recurrences--more than 5 in the past year.  The first several were "inside the mouth," meaning lesions on the inner lip.  This was a diagnosis made by my primary care physician.  The most recent,"outside of the mouth" one was also a lesion on the lip, though this time on the outer rim.  All outbreaks were consistently and effectively dealt with using 500mg doses of Valtrex 3x a day.    

The infectious disease specialist who interpreted my epidemiology did note that there was an indicator (Img? Igg?) traditionally indicative of a recent infection, but qualified its reliability as being inconsistent.  

Anyway, thank you again for your help.