Long Herpes OB...what could be the cause?

Hello Dr.,  

I am a 28 year old, heterosexual male, with a healthy diet, and regular exercise for over 10 years.  I got HSV-2 over 4 years ago from a girl that mentioned nothing of the condition to me.  We even used a condom, but I got 2 red bumps about 4 days later at the very base of my penis where the condom failed to cover (it would have been impossible to do so).  Later confirmed - HSV

I have not had symptoms of HSV for over 2 years.  Recently, I got a slight outbreak at the very base of my penis that almost totally cleared away in about 6 days.  Then, on the 7th day, I got an apparent "flare up", where the little red bump was (I never get blisters, or sores, etc...just 1 red bump).  The bump doubled in size and was more sensitive, glans (glands) down there swolen for a couple days...then 2 days after that, a "patch" of skin about the size of a shirt button started to turn a little red and sensitive.  This was on my pubic hair region, well away from my penis.  It got raised, but after about 8-10 days, went away.  

The "bump" at the base of my penis where the pubic area and shaft meet has gotten smaller and less red.  Now its sort of like a raised pinkish-slightly reddish hard patch that does not hurt and isn't sensitive to the touch.  When I pull the skin taught, its like there's a small "lump" under the skin.  The lesion has shrunk a little and is less red, but it is still  there after over 3.5 weeks.  The original outbreak that occured for about 6 days and the second outbreak are now pushing this whole debacle to a month, which is a big concern to me after only 2 mild OBs in 4 years.

I don't have any other pains, apart from obvious fatigue from worry, and a very, very, very dull headache that hits me for a few seconds from time to time (not even worth taking an aspirin over).

Dr., can you help explain to me what might be causing this long OB?  Should I be concerned about HIV or another health concern?  Can recurrent herpes in healthy people last this long, as a simple bump or two?

I have read that prolonged 1 month recurrent herpes attacks can be a sign of HIV and that scares me. I have no other STDs, btw.  Your response is much appreciated for this anxious man as I just don't know what to think...

[H. Hunter Handsfield, M.D.]

You don't say how your herpes initially was confirmed.  Presuming you in fact have genital herpes, though, the present problem likely is not only herpes.  A biphasic course--initial outbreak, starting to improve, then flare-up (which is what I think you are describin)--often indicates a secondary infection.  That is, perhaps you have staph, strep or something like that, which gained a foothold in the herpes lesion.  The location, extending into the pubic hair area, also is unlike herpes but typical for folliculitis or other bacterial infection.  The situation is similar to having a cold, and after several days, when it should be clearing up, developing more gunky nasal drip or worse cough due to bacterial sinusitis or bronchitis.

If the problem is finally clearing up, you might just sit tight and let it go away on its own.  If not or if uncertain, see a health care provider.  In any case, I doubt you have a prolonged herpes outbreak per se, and this is not the kind of condition that suggests HIV or any other kind of immune system problem.

I hope this helps.  Best wishes--  HHH, MD

[t1234]

Are you sure you have Herpes?  Have you taken an antibody test, ie HerpesSelect?

I think you need to be sure.  Maybe a second opinion is in
order.

[HSV Question]

Thank you Dr. Handsfield.  Your comments make a lot of sense from a clinical perspective and I definately see what you are talking about.

Herpes moving to the pubic area where it has never been before and lasting this long is definately strange and I never thought about a secondary infection. The potential secondary infection could also be the cause of the swollen lymph nodes, correct?

You are the first Dr. that actually gives pragmatic, sensible, and realisitic advice and opinion unlike many of your "non-medical" contemporaries.  Many kudos.

Is there any topical ointment that you could suggest, OTC, that I could try to help bring down the bump's swelling?

[probably_nothing]

Based on all the info you give I would question your HSV status. Did you have a HerpesSelect or Western Blot? If your diagnosis 4 years ago was just visual or with the IgM test you really should get a HerpesSelect. One bump in your pubic hair sure sounds like folliculitis to me.

[HSV Question]

If I were to have folliculitis, wouldn't there be pus/liquid filled lesions that "could" itch?  This bump is raised, painless, and not filled with pus.  It's about 1/4" wide and  it's really filled with nothing that can seep or weep out of it.  It's just been around for 3.5 weeks which is very, very odd and makes no sense unless something else was going on there.  

Any thoughts now?

[monkeyflower]

I don't think a painless, non-fluid filled bump sounds like herpes. Dr. Handsfield has often said that herpes is more "on" the skin, rather than in/under the skin.

[probably_nothing]

Doesn't sound like herpes to me. Dr. Handsfield also often says is doesn't commonly occur in "hairy" areas. Folliculitis, on the other hand, almost always happens in the pubic hairs. get the current blood tests and find out for sure.

[sham489]

A related discussion, Is it Herpes was started.