Herpes and chronic epididymitis

Hi,
I had an initial outbreak of HSV in 2004 (I think HSV1 because I've only had unprotected oral, vaginal always protected, and only two very minor recurrences in the first part of >4 yrs.). This first outbreak was severe but lasted about 1.5 weeks, pretty classic symptoms. I vaguely remember having testicular pain 3 months or so after the first outbreak. It lasted a few days. In 2006, I had another short duration of testicular pain, again maybe a few days. In 2007, I developed epididymitis (bilateral) which has lasted continuously up to this point, so it has now become a chronic condition after 1.5 years. I have not been sexually active since 2004. I have seen doctors and took antibiotics at the beginning, didn't work. I have taken urine tests, no bacterial infection. Ultrasound has shown a bit of inflammation on both sides. Anti-inflammatories are mostly ineffective.

Is there any possibility of a connection between herpes and chronic epididymitis?
If so, how would this be possible?
Could it be that anxiety about the whole situation has prolonged this condition to a chronic state?
What do you recommend doing from here?

Thank you!

[Edward W Hook, MD]

Before we discuss herpes and epididymitis, a few other comments which may be of help to you.

Comment.  It sounds as though your initial episode was not been confirmed by culture.  If that was the case, I would consider getting a type specific serological test such as the HerpeSelect.  Even experts mis-identify HSV about 1 out of 4 times.  Furthermore whether you have HSV-1 or HSV-2 may make a difference in your management approach to your infection in terms of the potential benefits for sorting this out, as well as for sorting out your immediate questions. Now on to your questions:

1.  There are no describe associations between HSV infection and epididymitis.  My guess is that your testicular discomfort and your herpes are not related.
2.  Anxiety could be a contributor.  Don't know much about your level of anxiety or "triggers" for these episodes you describe but certainly we regularly see people who note testicular discomfort that goes away as they feel better about their own anxiety and related concerns.

Hope this helps.  Bottom line - I doubt that your testicular discomfort is HSV-related and would suggest you get a HSV blood test to make sure that indeed you do have HSV and if so, what type.   EWH

[amcs100]

I took your advice and got a blood test for all STDs (chlamydia, gonorrhea, syphillis (syphilis), herpes 1&2, hiv) and all were negative including the type specific herpes tests. I did not see a doctor when I had this outbreak, I was young and stupid,and the symptoms cleared within 10 days, I was certain it was herpes.Looks like I might have been wrong. I was wondering if you could list the possible causes for the symptoms I am about to describe just out of curiosity.
I had a small sore just under the tip of my penis which became a group of sores and then involved the whole area in and around the head of the penis. They were painful and itchy. I also had deep painful pimples that showed up on my inner thighs, some left scars. I had flu like symptoms and swollen lymph nodes. There was a bit of whitish pus that accumulated in the foreskin as a result of the sores, really actually one big sore at its peak. I never had pain urinating. Like I said before, this all cleared up on its own in no more than a week and a half. In addition, twice about a year in spacing(2005 and 2006), I had a pimple like lesion above the penis exactly like the ones during the initial outbreak.They were on the same side. I always had protected intercourse but unprotected oral sex. I had a steady girlfriend at the time of the outbreak but no sexual contact since.

[Edward W Hook, MD]

For me to try to list all of the possibilities at this time is an exercise in futility for us both.  There are many sorts of dermatological processes which can cause solitary or grouped pustules (pimples).  Many of these are not even infectious and, fortunately, many are self limited.  

I'm glad to hear that you have learned that you do not have HSV.  While it is important to know when people have herpes, it is equally important for people who think they might have it to verify that they do (or do not)

Take care.  EWH