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Herpes and Leg Pain
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The STD Forum is intended only for questions and support pertaining to sexually transmitted diseases other than HIV/AIDS, including chlamydia, gonorrhea, syphilis, human papillomavirus, genital warts, trichomonas, other vaginal infections, nongonoccal urethritis (NGU), cervicitis, molluscum contagiosum, chancroid, and pelvic inflammatory disease (PID). All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.

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Herpes and Leg Pain

I get severe herpes type 2 outbreaks on my buttocks and lower back (over tailbone). The first outbreak was wrongly diagnosed visually by a doctor as shingles.  I was given Valtrex 1000mg 3 times a day for a week.  This caused extreme nausea.  The sores started to go away after just a few days but near the end of treatment my legs and arms began to ache.  This was over 3 months ago.  My legs and arms still ache as well my hands and feet.  I have started to have fasciculations in both my arms and legs (mostly my calves and thighs).  They come and go but the aching is almost every day.  It seems to intensify in severity with the outbreaks.  Can herpes cause this type of pain by interferring with a nerve?  Can herpes cause benign fasciculation syndrome since it is a virus?  I have been seen by a neurologist who chalks it all up to stress but that was before the fasciculations began.  I have no associated weakness or muscle wasting.  Thanks.
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Because HSV-2 is a neurotropic virus--i.e., it sets up housekeeping in neural tissues--it is logical that it might cause neuropathic pain syndromes, which is what your symptoms sound like they could be.  It doesn't happen often and actually isn't very well documented in the medical literature, but I suspect it is real.  However, I have never heard of fasciculations (for other readers, that's muscle twitching) due to herpes.  I can't comment on your neurologist's diagnosis of stress--but if you're not convinced, consider getting the opinion of a second neurologist; or see if there is an infectious diseases specialist in your community, or someone else who is expert in herpes infections.

You undoubtedly were given the large dose of valacyclovir (Valtrex) because your provider initially suspected shingles, which requires much higher doses than HSV infections.  As you may know, 1 gram (1000 mg) once daily is plenty for genital herpes, or 500 mg twice daily.  Even the large dose you received rarely causes nausea or other side effects, but definitely the lower dose won't do so.  Don't be afraid to try suppressive therapy in the right dose.

Good luck-- HHH, MD
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