HSV-1 Reoccurance

[9848]

Dr.,

I have a question about genital HSV-1 reoccurances.  I contracted HSV-1 via oral sex approximately 3.5 years ago.  I have had (knowingly)a bad primary and one other reoccurance 1.5 years later in the perineum area.   I also suffer from IBS where I get bouts of constipation which causes strain and fissures.  During my primary outbreak, I was also constipated and had fissues along with lesions in the entire gential and anal region.  

My recent outbreak (this would be the third knowingly), I am again suffering from constipation and fissures and thought that I had irritation due to the fissures, but when I went to my doctor she said the irriation (lesions) looked like herpes.  I requested a culture of the fissures and lesions.  The one thing I find strange is that the sores were on both sides (exactly on the same side) just outside the anal area forming a perfect circle.  My doctor has never seen this before and stated that most HSV that is a reoccurance would be a small cluster on one side.  Indeed, it feels more like the first primary outbreak, not the second where there were a few blisters in a cluster. I do not think I have been infected with HSV-2 as I have had only one partner since contracting HSV-1 3.5 years ago. I had sex with this partner a total of 3 times and we used a condom - I was also on Valtrex.  

If this is true that each time I have soreness in the anal region, it might be herpes and not due to IBS or fissures is this normal?  I am a healthly, young person.   With statistics being that 40% of folks with HSV-1 never getting a reoccurance and 50% of folks getting one or two reoccurances than nothing (I thought I was in this category), could there be an underlying concern with my immune system? I find it disturbing that I could be in the minority when it come to reoccuring HSV-1.  The culture should be back next week.  If negative, my plan is to go back to the doctor's if I notice anything red or out of the ordinary for a culture so I can know for sure how often I am having a reoccurance.  Thanks for your help.

[H. Hunter Handsfield, M.D.]

Although it is uncommon for people with genital HSV-1 to have frequent recurrences, a few percent of such persons have frequent outbreaks.  However, your assumption that you do not have HSV-2 is not well-founded; lots of people seemingly at low risk for traditional STDs nevertheless get HSV-2.  Also, sometimes errors are made in initial diagnosis:  how certain are you that your initial infection was HSV-1 and not HSV-2?

I'm not in a position to tell whether your recurrent anal lesions are herpes, fissures related to IBS, or something else.  You and your doctor are right that recurrent herpes generally would be localized to one side or the other.  However, if you have a dual problem--both non-herpetic fissures and herpes--HSV could easily contaminate the fissures.  Your doctor also is the person to ask about immune system problems, possibly related to drugs you might be taking for IBS (e.g., steroids and others).  However, frequently recurring herpes is not usually the result of immune dysfunction.

My only specific advice is to suggest you have blood tests for HSV-1 and HSV-2 antibody (see other threads to make sure your doctor orders the right test, such as HerpeSelect); and also have viral culture of your recurrent lesions to determine virus type.  If the lesions are herpetic, treatment with valacyclovir or related drugs should be pretty effective in preventing outbreaks.

Good luck--  HHH, MD

[9848]

Dr.

Sorry I forgot to add that the individual that transmitted HSV-1 to me was not HSV-2 positive (or at least not to my knowledge, I dated him for two years..).  The other partner I mentioned (we were together about 2.5 months ago), to my knowledge did not have HSV-2 and we used protection the three times we were together. That info might matter.  My primary infection 3.5 years ago was cultured and diagosed as genital HSV-1.  Prior to being with the two year relationship I was in a marriage and monogamous for 15 years and my husband did not have HSV-1 or HSV-2.

[9848]

Thanks Doctor.

I am pretty certain the inital diagnosis was correct it was a type specific culture.  My partner had a history of recurrent cold sores.  

I went immediately to the Doctor for a culture - true primary.  Fever, lymph nodes swollen, pain etc.  

How accurate are cultures in this case?  I plan on getting tested for HSV-2 next week and my doctor cultured my current outbreak yesterday.  

You mentioned that HSV can infect fissues?  My doctor seems to think that I was having an outbreak and complications from IBS.  I remember during my primary however, I did have a bout with constipation and fissues....

My plan is to see a specialist about the IBS...

Thanks Doctor -

[9848]

Thanks Doctor.

Sorry Doctor forgot to address comment to you!!

I am pretty certain the inital diagnosis was correct it was a type specific culture. My partner had a history of recurrent cold sores.

I went immediately to the Doctor for a culture - true primary. Fever, lymph nodes swollen, pain etc.

How accurate are cultures in this case? I plan on getting tested for HSV-2 next week and my doctor cultured my current outbreak yesterday.

You mentioned that HSV can infect fissues? My doctor seems to think that I was having an outbreak and complications from IBS. I remember during my primary however, I did have a bout with constipation and fissues....

My plan is to see a specialist about the IBS...

Thanks Doctor

[MLWTR]

What with the recurrent fissures, it could be possible that you have IBD (inflammatory bowel disease) rather than IBS (irritable bowel syndrome). Mild cases of IBD can be tough to diagnose, and are relatively frequently confused with IBS.

Good luck sorting things out.

[H. Hunter Handsfield, M.D.]

Thanks to MLWTR for that comment. Although I was reading IBS, my brain was interpreting IBF (inflammatory bowel disease), which can be associated with anal fissures.  And it is treatment for IBD, not IBS, that can cause immune suppression.  Sorry for any confusion.

HHH, MD

[9848]

Thanks again Doctor.  

I have one more question.  You said that Herpes could contaminate my fissures.  I got my current fissures via trauma from a bowel movement a couple of days prior to my herpes outbreak.  As discussed above, the multiple fissures (on both sides)were in the anal opening (hard to see by just looking in the mirror) and the lesions (that my doctor feels is herpes)were in a "circle" around the anus.  Are you saying that herpes after on onset of fissures could contaminate the fissues causing the lesions to migrate from one side to another(I know that most recurrent lesions are on one side only)?  Also, with the location of the herpes lesions (and fissures) in such a tight, moist space could infection on one side of the anal area infect the other side if it is constantly rubbing together?

Sorry for so many question Doctor, I know you cannot give a diagnosis on-line.  I am looking for probabilities and possibilities or to be told not likely. My doctor examined me and cultured the lesions on Friday, but most doctor's are not that knowledge on the details of herpes.  I have also made an appointment to test for HSV-2/-1 next week ( 3.5 years ago I had a type specific culture done on fresh lesions during my primary outbreak and it was possitive for HSV-1).

Sorry again to bother you with so many questions.....