Outbreak Question

[Lifestest]

I have been diagnosed with HSV 2 for about a year and a half. I have done extensive research and consider myself a herpes expert almost. I take 1g Valtrex daily and have been for about a year. Without it I would have minor constant obs almost every day. I am very obsessive about this and check myself a few times a day for any bumps etc. The thing is I used to get the obs all on my foreskin so I thought about getting circumcised to try to curb this situation. The 1G valtrex daily has certainly made things much better but I believe it making me miss symptoms or mis diagnose symptoms. I now get small bumps on the glans of my penis. I had a rough weekend of partying etc and then Monday woke up with a little red raised spot. No itching, burning, fluid filled blister just a raised spot with redness. I do get almost daily twinges in the back of my legs etc so it seems as if the virus is active daily. Yesterday I took two showers and also went swimming in the pool. I checked myself this morning and I have a couple more small red raised spots on the glans. The thing about this is I have the nerve twinges etc but I do not get the standard herpes symptons just some zings and zangs in legs and back. I do not get the standard itching, burning, or puss filled blisters that the picturs show and people explain on their outbreaks. Being diagnosed I think everything is an outbreak that I see on the skin, or glans, I used to get the tell tale signs but now on Valtrex I think it might be suppressing the virus just enought as to cause these small bumps but mask the other signs of the virus. I am worried about this because if this is the case I would be shedding multiple days a week and contagious. According to the valtrex studies this is not normal. I guess I will have to opt for daily pcr swabbing to see if what I am seeing is actually obs or just irritation to the glans from something else. I know there are little blood vessels in the glans can they cause tinty raised bumps? I hate it

[H. Hunter Handsfield, M.D.]

Almost all those comments are wrong; it is you who misunderstands "typical HSV2 facts".  For example -- only 2 examples among many among your statements -- research has not demonstrated convincing evidence of the outbreak triggers you mention; and you have misinterpreted the photos you have seen of recurrent versus initial herpes episodes.  I stand by all the statements I made in my reply above.  Most or all of the symptoms you describe are not herpetic.

This is not to invite an ongoing discussion or debate about it.  If you will provide the details about your blood test result (specific test and numerical result), I will be happy to comment as to whether that result is reliable, i.e. whether or not you are infected with HSV-2.  Until then, no further discussion.

[Lifestest]

I do thank you for your response to my concerns. I have to say that your response does not coencide with typical HSV 2 facts. Yes I have been diagnosed via blood test with HSV-2. The reason I believe that these could be HSV symtoms is because off of meds I do get pretty regular symptoms. Anything triggers it alcohol, sun, foods, etc. Herpes can certainly cause obs more than once a month, there is no timer on herpes, it is all the immune system and triggers. I know the tell tale signs of an outbreak. Shooting pains and twinges like electric shocks in the back, upper legs, and genital area. Also if you look at herpes pictures and from past obs it can certainly outbreak all over the area and not just on one side. I have never heard this from any other doctor or herpes sufferer.  Also I can certainly say the valtrex works but I still get symptoms,. I just do not get the tell tale signs of typical herpes obs, I get a red bump or two on the head every few days or so. It is really depressing because I am sure it is herpes but in denial about it. I do not want to think I am shedding virus every day. How could I ever have a normal relationship with such an active virus. I guess what I have to do is have it PCR swabbed regularly to see if it is actually hsv. I think what is happening is that valtrex is stopping a full on ob and these minor bumps are just suppressed outbreaks. That is my take on this as depressing as it is.

[H. Hunter Handsfield, M.D.]

Welcome to the STD forum.  I'll try to help.

I would be able to help you much better if you can describe the initial symptoms that led to your diagnosis of HSV-2 and exactly how the diagnosis was made -- i.e. positive viral test from a genital lesion or blood test; and if blood test, the exact results, i.e. numerical values for both HSV-1 and HSV-2.

Whether or not you truly have HSV-2, that is probably not the cause of any of the symptoms you describe.  Herpes never causes the more or less continuous symptoms you describe; cannot cause outbreaks more often than once a month or so (with no symptoms at all between outbreaks, i.e. most of the time); doesn't cause penile bumps, shooting pains ("zings and zangs") in the back, legs or anywhere else; or such apparently widespread penile symptoms/lesions -- i.e. recurrent outbreaks are always localized to more or less the same spot each time (give or take an inch), and always are limited to one side of the body's midline or the other, never on both sides of someone's penis.  Finally, resistance of HSV-2 to valacyclovir is very rare; therefore, the continuing symptoms while taking suppressive therapy is another strong argument against herpes as the cause.

You may indeed have HSV-2, but if so, you have genital herpes plus something else causing all the symptoms you describe.  Please provide the information I suggested above about the initial diagnosis and we'll take it from there.

Regards--  HHH, MD