Herpes and Epididymis

Hi,
I am a carrier of the Herpes simplex virus that manifests itshelf with cold shores on the lips area.Before about 7 years the virus manifested itshelf on my penis with some small white bumps on the forehead that used to hurt. The urologists I visited then run blood tests and took swab sample. The later came out negative on everything. The first one I think came positive on HSV1. Since then the virus never manifested itshelf again on my penis.However after intense stress and fatique I have what it looks like a swollen Epididymis. The urologist I visited about 2 years ago ruled out STDs and came to the conclusion that I had Epididymitis and he had to operate me to correct the situation. The problem is that even after the operation, the Epididymis keeps swelling as it did after intense stress/fatique although much more rare. When I pointed out that to the urologist he said that it probably was a bacterial infection and treated me antibiotics. I must point out that the swelling lasts only a few days (3 to 5).I must also point out that I always had safe sex.Also I am a blood donor so I get reqular tests for HIV,Syphilis and Hypatitis that are all negative.Could you please give me your opinion about the connection of the swelling Epididymis, herpes simplex (that I have on my lips) and stress/fatique situations?
Do I have a kind of Genital Herpes? Is is transmitted via intercourse or other way? Does it affect fertility? Must I do something about it?

[H. Hunter Handsfield, M.D.]

You give a confusing history that, in many aspects, makes no sense.  Having a long history of oral herpes due to HSV-1 makes it extremely unlikely you actually ever had genital herpes due to the same virus.  If you caught the infection at both sites at the same time, it is possible.  But prior infection with HSV-1 provides a high degree of immunity to new infection with HSV-1.  Also, 'small white bumps' on the (fore?)head of the penis doesn't particularly suggest herpes.  If a virus culture from the penis really showed HSV-1, I have to accept the possibility you are the rare exception to the rule--but I am skeptical of that report.

Second, surgery is not a normal treatment for epididymitis, certainly not for epididymitis due to infection.  Further, no STD causes persistent or recurrent epididymitis; and if an STD was the cause, you would have had a positive test, most likely for chlamydia, less likely for gonorrhea.

Finally, you have seen at least one health care provider about your problems--apparently at least 2 urologists.  If people with their expertise cannot come up with clear answers by direct examination and testing, certainly I cannot.

So to answer your direct questions, I doubt you have continuing epididymitis; I cannot comment on your oral herpes; and I doubt you have genital herpes.  You can be tested for HSV-2, the more common cause of genital herpes--but from your description, I doubt that's a problem.  And of course a hundred things can cause stress and fatigue; I can't even guess about the possible causes.  The other questions--about transmission of herpes, infertility, etc--would require me two write several pages.  There are plenty of online sources for accurate information about genital herpes.  Try the CDC (www.cdc.gov/std), the American Social Health Association (www.ashastd.org), and/or my former health department (www.metrokc.gov/health/apu/std).

Good luck--  HHH, MD