positive for GHSV 2, swab test using a sample from a lesion. Male, uncircumcized.
My outbreaks seem very frequent and long lasting, and difficult to define in terms of a start and then end date. Over the last 8 months since my primary, I have had only 3 occasions with visible lesions, but still about 60% of the days over the last 8 months, I have had some form of irritation, from mildly annoying to quite painful. I have seen some redness at times in some spots which hurt, but other times have also felt pain from areas which looked ok. The pain can vary from burning, rawness of the skin, a dull ache, to stinging. The pain most frequently emanates from the spot where I have had my worst initial herpes lesions, but sometimes a larger area can just burn or feel raw. I have also had some tingles down my thigh. The best I can describe all this as is a "frequent prodrome feeling" and it has been pretty tough on me at times due to its chronic nature.
I have been on suppressive acyclovir, 400mg 2x daily, for the last 2 months, and my frequent prodrome feelings have continued, though less severe. I think I had 2 weeks across the last 2 months feeling normal, with 2 incidents whereby it felt like I was having an outbreak, with burning, "rawness" feeling of my foreskin, some red splotches, and tingling. But no lesions.
Could this be something other than herpes? Could it be a fungal effection taking advantage of mild herpes outbreaks? As I understand it, it is very unusual to have such long period of discomfort around an outbreak (~6 weeks of not feeling right per "outbreak") and also unusual if on suppressive therapy. Let me make one final note that in the past I have used fungal cream (before i realized it was herpes), and it did not end the frequent prodome feelings 100% even after a few weeks. I have started to try anti fungal again, but wanted to also for this site's opinion. I'm in asia, and my doctors seem a bit confused.
It is unlikely that herpes is the cause of most of your symptoms. Herpes simply doesn't do the sort of things you describe. I have never seen a case in which the patient was not completely symptom-free between overt outbreaks, nor have I ever seen anyone with such frequent outbreaks that s/he was symptomatic more than 10-20% of the time. The symptoms you describe as "prodrome" don't really sound like that. And persistence of symptoms while taking acyclovir also is strong evidence against HSV as the cause.
The whole story is atypical enough that it makes me wonder about the basis for the original diagnosis. If you had an outbreak with blister-like lesions or open sores, from which a specimen was positive for HSV, that would confirm it. Absent that, if your blood test is positive for HSV-2, that would also be strong confirmation. If such tests have not been done, that needs to be your next step; it could be you don't have genital herpes at all.
As to other possible causes, I doubt it's a fungal infection, which also should have responded to appropriate therapy. More likely some other form of genital dermatitis.
In summary: If the original diagnosis of herpes is in doubt, have the appropriate tests. Find a herpes-knowledgeable provider; a dermatologist would make sense, since apparently you aren't confident in the STD knowledge of your primary health care provider. Or, depending on where in Asia you are, look for an STD or genitourinary medicine (GUM) clinic or specialist; excellent services are available in some countries.
I have had a positive test for herpes from a swabbed sample taken from a lesion 5 months after the primary outbreak. But I had a negative IgG test result about 3.5 - 4 months after the primary outbreak, so its been confusing. Still, as I understand it, a positive culture test is 100% guaranteed form of diagnosis. (since herpes cannot grow from your cultured sample if it doesn't exist)
I will go see a doctor for possible dermatitis. Its quite odd though since I never had any issue like this before herpes and have stopped using soaps for washing my foreskin and head (now just rinse with water), plus no major change in underwear. But it is reassuring to hear you have never had a case of herpes with symptoms more than 10 - 20% of the time, so hopefully I can find a solution. Thank you.
A positive culture is close 1o 100, but labs make errors, such as mixing up two patients' specimens. Most likely you are infected, but the negative blood test calls the diagnosis into question. In any case, you can be sure that herpes isn't the main cause of your ongoing symptoms.
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