Herpes on my lower leg

[niki2]

I have had 3 episodes in the last year of what was initially diagnosed as Shingles and is now been diagnosed as HSV. It always begins with a tingling sensation in the area followed by a pink rash which then progresses into blisters that eventually errupt and scab over. This always comes back in exacly the same area (my lower left leg near my ankle). Because I am only 21 and this continues to reoccur during intensely stressful situations, my physician has decided that it must be HSV and not Shingles.

So here are my question: If it is HSV, then do I have gential herpes? I have never had an symptoms or lesions near or arround my genitals, but nonetheless, is this the case? Can I spread this through sex? Do I tell new partners that I have genital herpes or do I say I have herpes of the leg? I'm so confused! =(

[H. Hunter Handsfield, M.D.]

The first and most important thing is that you need laboratory confirmation of the diagnosis.  Indeed you describe features that make HSV more likely than shingles, but they still are sufficiently atypical for herpes (of any kind) that you must have diagnostic tests and not rely only on your doc's judgment.  This isn't a criticism of your doc, just common sense.  S/He may be right, but you should have a blood test to check for antibodies to HSV types 1 and 2; and if/when there is another outbreak, you need to be examined immediately (within 1-2 days, when the blisters are fresh) for direct testing for both HSV and varicella zoster virus (VSV, the cause of shingles).

If in fact this is HSV, it's a very unusual situation.  The comments that follow are based on my clinical judgment; there are no data that permit definite answers to your questions.  That said, the answers depend in large part on whether it's HSV-1 or HSV-2.  Although recurrent HSV-2 is typically described as being localized "below the waist", in general it is limited to the "boxer shorts" area, and I have never seen a case with recurrences below the mid-thigh.  But if you have HSV-2, you should assume you initially acquired the infection genitally, in which case it is likely you periodically have genital area asymptomatic viral shedding, with the potential to transmit to sex partners.  But if it turns out to be HSV-1, the likelihood of a genital origin or of sexual transmission seem very low.  But with either virus, suppressive therapy with valacyclovir (Valtrex) or one of the other anti-herpes drugs should be effective in reducing both the frequency of recurrent outbreaks and the chance of transmission.

I hope this helps, at least as a start.  Good luck--

HHH, MD

[niki2]

I did insist on a swab to be taken of the fluid inside the blisters when I went to see her. Unfortunately, I was unable to get to the doctors sooner, and so I have had this most resent episode for 6 days now and she said that she would take the swab but that it will be unlikely that she will be unable to type it because I didn't get it tested when the blisters initally apeared. The blisters had not errupted yet before she took the swab (she had to brreak them open to get some fluid). Is what she said regarding the typing of the herpes correct?

[H. Hunter Handsfield, M.D.]

I don't understand your doc's comment about virus typing.  If a culture is positive for HSV, the virus can be typed.  It is true that the longer the lesions are present, the less likely the culture will be positive.  But if the vesicles were still intact, the odds are it will be positive if HSV is the cause.  I hope the specimen was also tested for VZV (shingles).

HHH, MD

[niki2]

are there other HSV types that can infect normal skin as opposed to the genitals or mouth? I ask because I wonder if I have some type of HSV that has infected my leg that was not contracted through sexual contact. I understand that this sounds like really stretching but I have only had sex with one person and we were both virgins. I understand that he could be lying but we have been together since High School and I do believe him. Side note: does caffine aggrevate herpes?

[H. Hunter Handsfield, M.D.]

If this is a herpes-type infection at all, the only possibilities are HSV-1, HSV-2, VZV (shingles).  If HSV of either type, it could have been acquired genitally, but not necessarily by intercourse.  If you and your partner had oral sex, you could have acquired a genital HSV-1 infection regardless of his prior virginity.

You still need a blood test as well as the virology test currently in the works.  When all those result are available it the time to speculate about origins of the infection.

Caffeine isn't known to affect herpes recurrences or severity.  (Same for stress, by the way--despite common "wisdom" that stress can trigger outbreaks.)  For oral herpes due to HSV-1, other illnesses clearly trigger outbreaks (hence the names fever blister and cold sore), and so do other local injuries, like sunburn.  But for all other HSV infections, no definite triggers have ever been proved. Most recurrent outbreaks are simply random.  Don't worry about medications, diet, stress, menstruation, etc, etc.

Feel free to come back with other questions after the lab results give more clear answers.  Until then I'm not going to be able to say anything more.

HHH, MD

[niki2]

I got my results back and it is HSV-2. So am I assuming correctly that I have genital herpes even though I have never had symptoms on my gentials and that I have a STD? Also, I'm guessing my boyfriend must have cheated on me. Is this also a safe assumption? What do I do now? Do they have therapist who specialize in people with STD's or anything like this. I really need to talk to someone.

[H. Hunter Handsfield, M.D.]

Very interesting.  (Pardon my intellectual interest--it doesn't mean I don't care about the issues on your mind.)  I would say condolences and how sorry I am, but I don't want to reinforce a slanted view about genital herpes.  While I do not trivialize it and neither should you, the large majority of infected persons learn over time that it's not as big a deal as it first seemed and that having genital herpes is entirely compatible with normal, healthy, and fulfulling sexuality.

You need to assume you have periods of asymptomatic genital area shedding.  The exact site (cervix, vagina, labia, anal area) cannot be known.  Even if you someday develop symptoms at one or more of those sites, shedding from the others still will be possible.  The risk of transmission to partners can be markedly reduced by consistently using condoms and by therapy with valacyclovir (Valtrex) or other antiherpetic drugs.  (Valacyclovir is one that has been specifically studied for prevention efficacy.)

Your partner didn't necessarily cheat on you.  He could well have been infected before your relationship began, or you could have been infected before the two of you got together, if you had other sex partners before him.  I can't say he didn't cheat, but don't assume it.  The two of you need to have a sober, nonjudgmental, mutually caring conversation.  He can be tested to show whether or not he is asymptomatically infected with HSV-2, which seems probable but not certain.

Look up the American Social Health Association (www.ashastd.org).  ASHA has a truly excellent telphone-based herpes counseling service--not toll free, but well worth the calling costs.  They can also help you find herpes-knowledgeable health care providers and counselors in your area, and they have excellent books and other literature about living with herpes.  Another excellent source of herpes advice is the website of the Westover Heights Clinic in Portland, OR (www.westoverheights.com).

Open a nice bottle of wine for the holidays and try to relax.  Truly, this will settle into something less painful than it seems now. Best wishes.

HHH, MD

[niki2]

Except I've never had any outbreak in that area. With 4 outbreaks on my ankle, it seems like if I was genitally infected, I would have some sort of outbreak there.

I called my physician back beacuse I was so upset and her opinion and diagnosis is not genital herpes because I've never had an outbreak there and by definition you have to have an outbreak in your gential area to be called genital herpes. She also doesn't think that I am shedding genitally because I've never had an active outbreak there. However, she did say that I could have shedding arround the area I typically have outbreaks (my lower leg).

Should I see an STD specialist on this? It just sounds like a totally bizarre occurance to have HSV-2 on my amkle and then call that gential herpes even though I understand it is the virus that causing genital herpes. Nonetheless, just because it causes genital herpes, it sounds, and the research shows, that it can infect any area on the body. Just because it has infected my ankle, it seems bizarre that now I have to assume I have genital herpes.

[Alisa W]

I check this forum every so often due to my own hsv2 infection.  I too have only had lesions on my right leg behind the knee and on the calf. I have never noticed any genital symptoms.   However, my doctor agrees that I "may" have occasional genital shedding. They really don't know for sure since most infections are not in this area.   If I read your post correctly, your doctor says because of the location, your infection isn't classified as genital herpes?  That really seems a bit misleading to me.  We may not have genital outbreaks but the infections is still classified as genital herpes.  

Yours is the first time I have read of anyone besides myself having outbreaks on the lower leg.
I am sorry you are having to deal with this. Over time it does get better and isn't all that big a deal.  I only have visible lesions about once a year. I think I actually prefer having them on my leg rather the usual areas. It seems like it must be much less painful on the leg.

Take care and don't let the diagnosis get you down.

[drake001]

In 1/06, I had an itchy rash on an ankle which at the time, I attributed to a bug bite.  A similar one appeared on my lower calf and behind my knee, (different legs).  While I thought bug bites, I went to the Dr. as I was concerned this could possibly be Herpes Zoster as I had a history of Chicken Pox infection at age 30 and had not had any genital symptoms.   I was shocked to get blood test results that showed HSV-2.  I have since had rashes on my hip and mid to uppper thigh but they seem to mainly recur on my angle, calf and knee.  I had my boyfriend of 4 yrs show me results of STD screening before commencing any sexual activity and he retested when I explained this diagnosis to him, both of his tests are negative for any HSV.  He was my only sex partner during this time and being monogamous, we have been using no protection.  I tend to have bilateral knee pain during the prodrome period of a recurannce.  Also, the prodrome, burning sensation does not occur where the rash is but in a much larger area on the front of my leg above the knee.   Today's recurrance (the back of the left knee) during a seasonal cold prompted me again to do some research online finding your comments.    Before, I had seen no one else with similar symptoms including a lack of any genital symptoms.

[H. Hunter Handsfield, M.D.]

Niki, you are grasping for straws and your doctor is wrong.  Sex is the only way anybody ever gets HSV-2 (except babies born to infected mothers).  Three quarters of people with HSV-2 have no recall of genital symptoms, but that's still the original site of infection.  HSV-2 recurrences are limited to the lower part of the body because during the initial infection the virus sets up housekeeping in the nerves near the spinal cord.  The lower leg is physically a long way from the genitals, but neurologically it is right next door.  Near the spinal cord, all the nerves for the lower part of the body--genitals, rectum, buttocks, legs, toes--are all in a tangle very close to one another.  HSV-2 easly jumps to nearby nerves.  Even though the lower leg is a rare recurrence site, sexually acquired initial genital infection is the only realistic explanation.

People with non-genital but nearby recurrent herpes (e.g., anus, buttocks) still usually have asymptomaticgenital shedding of the virus--cervix, vagina, labia.  This hasn't been studied for more distant outbreaks like the lower legs, but most likely it is the same.  Unfortunately, there is no accurate test to routinely detect asymptomatic shedding of HSV-2.  In terms of preventing transmission to uninfected sex partners, you (and alisa and drake) are ethically obligated to inform your partners there is a risk of transmission and, unless they say otherwise, take steps to help prevent it.

From drake's description, it is unlikely all the rashes and other symptoms of her legs are due to herpes.  First, 2-sided symptoms generally are not due to herpes.  Every nerve in the body serves only one side of the body, and herpes generally persists in 1 or 2 nerves on only one side.  Second, recurrent herpes almost always is limited to a very restricted area.  Niki's experience is typical, with each outbreak in more or less the same spot of the same leg.  Drake probably has asymptomatic genital HSV-2, with other things causing the leg symptoms.

This will be my last comment on this thread.  You all need to be sure you have herpes-knowledgeable health care providers, and also be sure you get other information, such as counseling, from reliable sources, like the sources I cited above.

Best wishes to all--  HHH, MD

[Alisa W]

Yes, anyone with hsv2 is obligated to tell any current or future sexual partners.  That was why I was questioning her doctor telling her that due to location her infection wasn't genital.

[niki2]

Have either of you ever given someone gential herpes?

[Alisa W]

Nicki I don't mind sharing about my situation but I am concerned that my answer might change how you handle your paticular situation.  You MUST tell all partners that you have the virus.  I am in a committed ten year relationship. If I ever were dating again and thinking of being sexually active with other partners I would, without a hesitation, share this important information with them.  Try to put yourself in their shoes. You would want someone to tell you if this were reversed. It is only fair.  There are many threads on this forum about measures that can be taken to prevent passing the virus to others. I think it would be good for you to have some counseling with a good std doctor or counselor.  Then when you have all the facts you can make a plan on how to approach this topic with potential partners.  I promise it will get easier with time.   Don't let this diagnosis define you. You are the same person that you were before learning you have hsv2.

Take care of yourself and get someone with knowledge you can talk to. It will really make a world of difference for you.

[niki2]

No where did i say i wasnt going to tell anyone in my possible future this. I have a boyfriend i ave been wit since high school and I have only slept with him. I hae no desire to go about spreading this at all. I'm sorry if you think that about me, you are completely wrong.

PS, I just got the results back from my boyfriend (the only person I have every slept with and he was negatvie for both HSV 1 & 2. So, now he thinks i must have cheated on him; which i haven't (and i truly have no reason to lie on this forum). Bbesides the complete confusion of how i got it, i was simply asking a question. I was not trying to be too invasive and i also am sorry that you think i would willingly continue to spread this. i hate it, i feel like absolute ****, and my relationship is in total chaos. no way would i wish this on anyone nor would i particpate in any relationship before telling them.

My question more stems for not knowing if sleeping in the same bed with someone and accidently toching feet, if he should be worried since i have an active outbreak on my ankle. So i should have phrased my question with, do you know if you have ever giving anyone HSV-2 from them touching or rubbing you outbreak site on the back of your knee. I guess he and i will just have to wait and see if he gets it.

[niki2]

Sorry, that last post was to alsia

[Alisa W]

I am sorry you were upset by my post.  

Keep the area covered at night or when it might touch someone else, especially if you have an active breakout.


I will repeat that I truly think you need to speak with a professional about your feelings in regards to this diagnosis. I also think you need to get some in depth information about hsv 2 from a reliable source in the medical field.  

[drake001]

Hello, My boyfriend and only sex partner for the past 4+ yrs tested negative on two blood tests.   One test was 4 yrs ago and the recent test was at my request after I tested positive.  I had to explain to him my positive test to explain my concern and need for him to get tested himself.  I was sure he would think I had cheated and was totally sure he would run away screaming but he did not.  We have had unprotected sex now for 4 yrs and have continued to do so.  I'd had a tubal ligation not long ago to eliminate birth control issues.  

My outbreaks on *both* legs, ankle and calf on the right leg and behind the knee and mid thigh on the left leg are classic, recurring in the same area each time, herpes type blistering rashes.  Interesting that the doc said it would only be one sided.  I also wonder if I could have spread it by shaving?  Taking valtrex at the first sign of it greatly diminishes and even stops the blistering from occuring.  Otherwise it is quite painful.  I am considering requesting daily Valtrex at my next annual physical w/my doc.  

So, to answer, no I have not given it to anyone so far that I know of.  When I have a rash on my leg, I cover it up with a bandage to limit any shedding of the virus.  My doc was stumped as to why there are no genital symptoms.  If I had similar rashes genitally, I would really be out of my mind!  My only thought is my ex-husband likely gave it to me during our marriage while he was unfaithful and was asymptomatic as well.  

I've led a rather conservative sex life and have been monogamous in each relationship.  

Good Luck to you two!  

[julia stenner]

I was diagnosed with hsv2 about six months ago. My very first outbreak was probably the worst thing I have ever been through. It only came out on my genital area. Then about a month after that I noticed I had a spot on the inside of my right leg just by my knee, it broke out into a rash of blisters. I went to the doctors and got it tested and sure enough it was the same thing. Then later I had an itchy area inside my right ear, what do you know again tested and again hsv. The doctor had asked if I had been touching these areas. I have not. I have been so parranoid and careful that I cover them and wash my hands constantly. After that another area on my left outter thigh broke out. Now months later I woke up and another area on my right side just on my outter butt cheek. I went again to see the doctor and had a complete melt down. Yes this isnt the worst thing in the world, but not knowing where or why the next area will break out is quite stressful. Do you happen to have any ideas why I am having outbreaks all over? One doctor I had seen  said he thinks it isnt being spread from self inoculation but it is travelling through my nerves and coming out where ever it pleases..If you have any answers I would be grateful to read them.
Thank you.

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