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STDs (Expert Forum)
Questionable Diagnosis
Answered by
University of Washington
Seattle - WA
Welcome to the STD Forum, which 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.
Questionable Diagnosis
by GPC10, Oct 29, 2006 12:00AM
Dr. Handsfield,
I was diagnosed in early August with Genital HSV2. Since, I have often referred to this forum for a better understanding of the disease. Thank You!
Many of my symptoms appear to fit “classic” genital Herpes, but there are some inconstancies that have puzzled my medical providers. This past week I consulted a renowned ID specialist and he cast some doubt on my August diagnosis.
Related Medical History:
43 yr. old male. Sexual partner HSV2 negative.
-Mild Psoriasis on Scalp and penis-10yrs. Slightly intensified in last year
- sciatica right leg
- 5 yr. history mild cold sores. Burning, itching and slight bump/redness, no ulcerations. Treated with Abreva and usually resolved within a week.
Herpes History:
Late July a small blister appeared on the top of the shaft of my Penis. With time the blister developed and eventually ulcerated. Coincident, several small blisters developed in scattered sites around the groin. One at the top of the penis shaft in at the right pubic area and two in the left super pubic area (waistline and groin). Very mild flu like symptoms at the time. GP exam a week later and reported that “it could be Herpes”. Herpes Select test indicated HSV2 Positive/HSV1 negative(surprise with the history of cold sores). Prescribed a 10 day course or Valtrex, 1000mg 2x. Penis ulcer cleared up, but all but one of the small blisters remained. Six weeks latter, after another period of travel related fatigue and a sinus infection treated with Z-Pak, the small blister at my waistline began to develop, eventually ulcerating. I commenced another course of 1000mg Valtrex, during which time the blister in the groin area began to develop as well. I also noticed redness and slight swelling in the groin which resolved after a day or two. A week later another small blister appeared in the right pubic area which over time developed with redness, but did not appear to ulcerate. After about 10 days of Valtrex another blister appeared on the shaft of the Penis, close to the spot of the original ulcer, but quickly resolved after 3-5 days. A blister also appeared on the left scrotum, but has remained stable to date. Currently there remains slight redness and tenderness at the sites of the blisters/ulcers and the small blister on the left scrotum. After 15 days of Valtrex I switched to 400mg of Acyclovir 2x daily. About a week ago I began to develop 2 mild cold sores (no ulcers) on my left upper lip. This past week I was examined by the ID specialist. The examination was inconclusive for Genital Herpes. He reported that Herpes usually does not result in single blisters, they are usually not widely scattered and further doubted that new blisters would first appear and develop while on the antivirals. The examination revealed other small blisters on my left inner thigh which he said were definitely not Herpes. He speculated that I may have contracted oral HSV2 in the past and the genital outbreak was something other then Herpes
I was diagnosed in early August with Genital HSV2. Since, I have often referred to this forum for a better understanding of the disease. Thank You!
Many of my symptoms appear to fit “classic” genital Herpes, but there are some inconstancies that have puzzled my medical providers. This past week I consulted a renowned ID specialist and he cast some doubt on my August diagnosis.
Related Medical History:
43 yr. old male. Sexual partner HSV2 negative.
-Mild Psoriasis on Scalp and penis-10yrs. Slightly intensified in last year
- sciatica right leg
- 5 yr. history mild cold sores. Burning, itching and slight bump/redness, no ulcerations. Treated with Abreva and usually resolved within a week.
Herpes History:
Late July a small blister appeared on the top of the shaft of my Penis. With time the blister developed and eventually ulcerated. Coincident, several small blisters developed in scattered sites around the groin. One at the top of the penis shaft in at the right pubic area and two in the left super pubic area (waistline and groin). Very mild flu like symptoms at the time. GP exam a week later and reported that “it could be Herpes”. Herpes Select test indicated HSV2 Positive/HSV1 negative(surprise with the history of cold sores). Prescribed a 10 day course or Valtrex, 1000mg 2x. Penis ulcer cleared up, but all but one of the small blisters remained. Six weeks latter, after another period of travel related fatigue and a sinus infection treated with Z-Pak, the small blister at my waistline began to develop, eventually ulcerating. I commenced another course of 1000mg Valtrex, during which time the blister in the groin area began to develop as well. I also noticed redness and slight swelling in the groin which resolved after a day or two. A week later another small blister appeared in the right pubic area which over time developed with redness, but did not appear to ulcerate. After about 10 days of Valtrex another blister appeared on the shaft of the Penis, close to the spot of the original ulcer, but quickly resolved after 3-5 days. A blister also appeared on the left scrotum, but has remained stable to date. Currently there remains slight redness and tenderness at the sites of the blisters/ulcers and the small blister on the left scrotum. After 15 days of Valtrex I switched to 400mg of Acyclovir 2x daily. About a week ago I began to develop 2 mild cold sores (no ulcers) on my left upper lip. This past week I was examined by the ID specialist. The examination was inconclusive for Genital Herpes. He reported that Herpes usually does not result in single blisters, they are usually not widely scattered and further doubted that new blisters would first appear and develop while on the antivirals. The examination revealed other small blisters on my left inner thigh which he said were definitely not Herpes. He speculated that I may have contracted oral HSV2 in the past and the genital outbreak was something other then Herpes
Doctor's Answer
by H. Hunter Handsfield, M.D., Oct 29, 2006 12:00AM
, Oct 29, 2006 12:00AM
Without even reading the details, I almost certainly cannot help. For a complex or atypical case, no online expert can give more reliable information or advice than a personal provider, especially a "renowned ID specialist".
And now, having read the rest of the story, my initial reaction is confirmed. The clinical course you describe is very atypical for genital herpes. That is, I agree 100% with the ID specialist's comment that "...herpes usually does not result in single blisters, they are usually not widely scattered and further doubted that new blisters would first appear and develop while on the antivirals." Based on the blood test results, it seems you have HSV-2, but most likely it isn't the cause of most (or any?) of the symptoms you describe. So your ID specialist and I agree on that point as well.
I suggest continuing to follow-up with the ID specialist. Good luck--
HHH, MD
And now, having read the rest of the story, my initial reaction is confirmed. The clinical course you describe is very atypical for genital herpes. That is, I agree 100% with the ID specialist's comment that "...herpes usually does not result in single blisters, they are usually not widely scattered and further doubted that new blisters would first appear and develop while on the antivirals." Based on the blood test results, it seems you have HSV-2, but most likely it isn't the cause of most (or any?) of the symptoms you describe. So your ID specialist and I agree on that point as well.
I suggest continuing to follow-up with the ID specialist. Good luck--
HHH, MD
