Herpes II or Follicultis?

[dmd786]

Hello Doctor- I have a great concern and am beside myself right now. For the past eight years I have been shaving & clipping my pubic hair(male). During that time frame I was with my ex-wife and before that a girlfriend for six years. About eight years ago, a few days after shaving, I developed a red rash in my pubic area an inch above the penis. My ex-wife said it appeared to be an infection(estetician) and she used a tweezer to pull out infected hairs. The hairs had a clear film attached to it and were very sticky and formed an open lesion a day or so later. After peroxide and neosporin for a week it cleared up. This same problem occured 5 or more times over the past seven years and it seemed to happen a week or so after shaving/clipping. It happened again in June 08', Oct 08'. In October I went to primary physician and he said it was chronic follicultis and gave me an antibiotic. Again, with neosporin it went away within a week. Then last week it appeared again a day after shaving...I wanted to get to bottom of this so I went back to physician and he took blood to check for herpes. Test came back today negative for herpes 1, but positive for herpes 2?? I have appointment with him this saturday. I can't believe this! I'm scared to death! I was monagamous for my entire marriage and years before that? My ex-wife never showed signs of any problems, but when this happens it always occurs in the same exact spot..nothing on the penis at all just in the pubic region above the penis. Do I really have herpes? I've had a girlfriend for the past seven months, she shows no signs? What should I do? Please advise. Thank you for your time. dmd786

[H. Hunter Handsfield, M.D.]

There are two problems here, and they probably are not related to one another.

First, it seems clear you have had recurrent folliculitis.  Herpes rarely occurs in hairy areas, and your description sounds quite typical for folliculitis.

The second problem is your apparent HSV-2 infection, based on the blood test.  If indeed you have HSV-2, it may not be not the cause of the recurrent outbreaks you describe.  As I said above, the occurrence in the pubic area is atypical for herpes.  On the other hand, the repeated recurrence in more or less the same spot is typical for herpes and not for folliculitis.  

The first thing to do is confirm the blood test.  If you have the numerical result of your test, I can help figure out whether or not it is truly positive.  If it's in the borderline range, you may not have it; repeat or confirmatory testing usually can sort it out.  In addition, it would be a good idea for your girlfriend to be tested.  The result might help sort out your situation (especially if positive), and it also will guide what needs to be done to protect her, if you have it and she doesn't.

In the meantime, don't panic.  Nobody wants genital herpes, but it's generally not such a big deal.  Let me know the details of your test result and then we'll go on.  In the meantime, take a look at http://www.medhelp.org/posts/show/593272 to see why it's important to know more about your test result.

Regards---  HHH, MD

[dmd786]

Thank you for your reply, I will try and get the number results from the physician. I have an appointment with him this Saturday. Possibly I can get it over the phone before that. I just can't believe I'm going through this!! Feel like world is upside down....

[dmd786]

I called doctor's office today and they said I was HSV1 0.61 negative and HSV 2 5.0 high positive. I suppose this means I definitely have HSV 2-genital herpes? I know you said in your post that it is rare to get herpes in a hairy area, how is it possible that I only get the lesion there? Also, I started getting this eight years ago and my ex-wife never showed any symptoms? I know for a fact I was only with her my entire marriage!! Now I've been with girlfriend for nearly ten months...what is the possibility I gave it to her? I assumed I was safe because I was with ex-wife for 8 years? I never had a lesion on the penis, only above in the pubic area...a condom doesn't cover that area! Does this mean I will not be able to have sex again!!?? because of the location. I see my primary physician Saturday, I don't know how I got this..please give me some insight- Thank you

[H. Hunter Handsfield, M.D.]

Yes. that's a definitely positive blood test result.

Although atypical, a lower abdomen site is not peculiar.  There is no way to predict exactly where recurrent outbreaks will occur or why they occur in atypical places in some persons.  Recurrent genital herpes can occur anywhere in the "boxer shorts" distribution, i.e. from lower waste to upper thighs.  Still, to be certain the outbreaks you describe indeed are herpes, you should see a provider immediately (within 1-2 days of onset) for your next episode.  If seen early, the lesions can be tested for HSV; if positive, it will nail down the diagnosis for sure.

It is difficult to predict whether you have asymptomatic viral shedding -- i.e., outbreaks without symptoms -- that involve the penis.  Maybe not, which might partly explain why your former long term partner never was infected.  However, you can't be sure it isn't happening, so you will be obligated to tell your current and future partner(s) about the risk.

Herpes rarely need be a significant impediment to sexual activity and a completely satisfying sexual and romantic life.  Among other things, avoiding sex when having an outbreak; using condoms consistently; and taking suppressive anti-herpes therapy all are effective in preventing transmission.  If all three of those approaches are used together, the likelihood of transmission to a partner probably is very low.  Still, your partners need to be informed.  (BTW, don't start on suppressive antiviral therapy until you have another outbreak, if you want it to be tested to confirm the diagnosis.)

As to when and were you were infected, you may never know.  All that can be said is it was sometime before you started having the recurrent outbreaks (assuming they are confirmed as herpes).

Lots of information about these aspects of herpes is available on the MedHelp herpes community forum.  There also are several excellent websites.  The latter include the American Social Health Association, the nation's premier private nonprofit STD prevention organization (www.ashastd.org) (full disclosure:  Dr. Hook and I are on ASHA's Board of Directors); CDC (www.cdc.gov/std); and the Wesover Heights Clinic of Portland, OR (www.westoverheights.com).

So no panicking, please.  A cool, sober approach is what you need.  Your world isn't coming to an end, either sexually or any other way.  What has changed is not the fact that you have herpes, just you knowledge of it.  It shouldn't turn into a significantly bigger deal now than it was a week ago.

[dmd786]

I so much apprecaite the time you have taken to respond in length to my previous questions, you are indeed, a caring individual. I am however, still holding out on a little hope that I am not positive for HSV2......with all your experience, do you think there may be a very small chance that I am not and maybe it could be a form of follicultis or something else for that matter to cause a 5.0 HSV2...could a HSV2 blood test come up positive for something else,(follicultis). Why would my doctor, back in October say it was chronic follicultis and not give a blood test!!!! I'm just trying to hold onto something here..Also, when I pull the hairs out using a tweezer on and around the infection, they have a clear whit film attached to it...would a herpes lesion infect the hair follicle like that? Again Doctor Handsfield, thank you for your time and understanding.

[H. Hunter Handsfield, M.D.]

Sorry, there is no chance the good test is wrong.  You have it.  There is a very small chance you have 2 unrelated problems, asymptomatic HSV-2plur recurrent folloculitis.  I doubt it, but that's one reason I suggest seeing a provider for direct testing for the virus next time you have an outbreak.

Thanks for your kind words.  In that spirit, don't view these comments as uncaring, even if blunt.  Call it tough love.  You need to accept the realit and move on, not grasp at straws.

[H. Hunter Handsfield, M.D.]

First line is supposed to be blood, not good.  I'm on iPhone, not facile w small keyboards.

[dmd786]

Thank you again Doctor, I appreciate your help and advice in this matter. I must now accept this like you have said and move forward the best I can.

[dmd786]

Hello again....I went to physician Saturday and he said that the Igm from blood test was negative..and the IgG positive. He said that means I most likely didn't come into contact with the herpes virus most recently and added  I was probably exposed awhile ago. Does this mean that I most likely didn't receive the virus from my current girlfriend? We've been sexually active for nearly 9 months...can you please explain further. Thank you again for all of your time.

[H. Hunter Handsfield, M.D.]

IgM testing is unreliable and your history is a better measure of duration. See http://www.medhelp.org/posts/show/541451 (and maybe show it to your doctor).  Since your recurrent "folliculitis" goes back 8 years, that's probably how long you have had HSV-2.    

Your partner needs to be tested for HSV-2.  If her test is positive, it won't tell whether you infected her, or vice versa, or neither one.  (Since 20% of the US population has HSV-2, you could both be infected independently.)  That would be good news, in a way:  since people are immune to new infection with the same HSV type, there would be no risk of tranmission between you.

More likely, her test will be negative.  If so, the two of you can make decisions together about how important it is for her to avoid transmission and how to go about it together,   i.e. what mix of condoms, anti-herpes suppressive therapy, and avoidance of sex during outbreaks works best for you. This should be a couple's choice, not something for you to decide on your own.

This thread has gone beyond the norm for detailed follow-up advice.  I'm going to suggest that you do the reading suggested above (see the websites I suggested 2/18) and hold off on further discussion unless you want to return to let me know your partner's HSV-2 test result.  Also, please follow my advice above about confirming that your "folliculitis" really is herpes, before you consider starting any anti-herpes therapy.

You also can get additional advice on the herpes community forum.  In addition, two days ago MedHelp added a separate, professionally moderated Herpes Forum.  But don't pay to start a new question there, at least not yet.  I will ask the moderator, Terri Warren, to scan this thread.  She or I will let you know if she has anything to add.

[dmd786]

Again, I thank you, you have been very accommodating. God Bless

[dmd786]

Dr. Handsfield- I know you said that this thread has gone beyond the norm for detailed follow up advice,but I ask that you please consider answering a couple questions as I am confused. I went back to physician Monday as he wanted to take culture to see if lesion was in fact herpes,but couldn't do it b/c it was dried up. He said he wasn't going to put me on anti-virals and I should wait to see if I have another outbreak and then come in for test. My concern is..a condom doesn't protect where my outbreak occurs b/c it's in pubic area...I know to abstain from sexual activity if having outbreak, but when I am not having an outbreak..what I am supposed to do? If not having an outbreak, will I always be contagious no matter what? Or am I only contagious when having an outbreak. My outbreak consists of one lesion in pubic region and I have never noticed other symptoms. Can I only give it to someone if my lesion comes into contact with her skin?

[H. Hunter Handsfield, M.D.]

Sorry, can't go further.  You are asking reasonable questions, and you can expect conflicting advice from various health care providers.  If I answer these, there will be more -- that's just the way it is with this disease.  Also, some of the answers are embedded in the comments above; read carefully.

A couple of 30 minute live conversations with a knowledgeable provider and/or counselor will cover what would take 10 rounds here.  If you ask around, you probably can find a herpes knowledgeable doctor in your area.  You also can phone the American Social Health Association and speak personally with a knowledgeable counselor; and ASHA also offers some excellent written materials.  Go to www.ashastd.org.  (Disclosure:  Dr. Hook and I are on ASHA's board of directors.)  Finally, excellent information, and feedback from others with herpes, is available at MedHelp's herpes community forum, at no cost.

Good luck.