Serious herpes outbreak

[MBT]

I recently experienced an outbreak of (genital), herpes the third in about two months. I went to the doctor with the first outbreak and the MD said that it was an abcess (abscess). As I was told over 25 years ago that I had herpes, I did not take this any further, though the MD suggesting opening the abcess (abscess). This was my first visit to an MD in all these years.

However, with this last episode, it seems that the herpes had spread inside my anus and was terribly painful, this along with general malaise, pain in my left groin and fever. It has taken about two weeks to recover.

My question. I would like to know if there is believed to be any relationship between this form of herpes and pulmonary hypertension?

[H. Hunter Handsfield, M.D.]

The first thing is to be certain you indeed have herpes, which generally should not be confused with a a genital (or rectal?) abscess.  How was the diagnosis confirmed 25 years ago?  Have you had recurrences ever since then?  Recurrent herpes rarely causes outbreaks as severe as you apparently are experiencing now.  Your rectal problem sounds more like either an entirely new herpes infection (in which case your initial diagnosis probably was wrong); or it isn't herpes, maybe just a garden-variety perianal or rectal abscess?  Or some other form of proctitis (rectal inflammation)?

There is no relationship between herpes and pulmonary hypertension, with one possible exception:  If you have idiopathic PHT, sometimes an immunologic disease, perhaps you are on treatment with drugs that suppress immunity, such as high-dose corticosteroids or other such drugs.  In that case, you could be more susceptible to severe herpes recurrences, as well as other infections, such as rectal abscess.

Bottom line (no pun intended):  Make sure your current problem is correctly diagnosed as herpes, preferably by virus culture.  If you aren't confident your doctor is knowledgeable in this area, ask for a referral to either an infectious diseases specialist; or a gastroenterologist or proctologist.

Good luck--  HHH, MD

[MBT]

In reply as to how the diagnosis was confirmed 25 years ago: I went to my doctor of that
time, together with my husband. The doctor simply told me that I had herpes, but did no test for this. Neither I nor my husband had ever heard of herpes. At that time the MD told me that it could have been 'caught from a toilet seat'.

I have had had similar outbreaks, though fairly infrequently exept for this year when this has happened about six times. When they occur they are nearly always severe; pain in my left groin and acute pain in the region where the sores appear. I usually have a heavy feeling before this all comes on. The only drugs that I am on are diltiazem 240mg and I take ativan to help me sleep. I don't know if CCBs suppress immunity? I am not in a sexual relationship so there is no new source for whatever it is that I have. And when I was in a relationship (18 years), that was sexual, I never heard of the person having what I had.

I have always presumed what my doctor of all those years ago said was true, but will now take your advise and see if I can get access to a gastroenterologist or proctologist.

Thank you.

[H. Hunter Handsfield, M.D.]

That history sounds pretty typical for recurrent genital herpes; and sometimes recurrences can increase in frequency after many years, for no good reason.  But I'm still not sure this herpes explains the rectal problem, and herpes still shouldn't be confused with an abscess.

The additional information modifies my advice a bit.  You definitely need a blood test for HSV-2; specifically, make sure the lab does the HerpeSelect HSV-2 test.  (See numerous other threads about herpes blood tests.)  The viral culture remains a good idea as well, but only is positive during the early days of an active outbreak.

Diltiazem and Ativan won't affect your immune system or herpes recurrences.

As you undoubtedly know by now, genital herpes is an STD that is not acquired by any route other than sexual contact. However, 25 years ago nobody knew that most cases of genital HSV-2 infection are asymptomatic, and that transmission may not occur until well into a new sexual relationship; and, further, that symptoms may be delayed for weeks or months after infection occurs.  Without this knowledge, when herpes appeared in a person who was monogamous or not currently sexually active, assumptions were made about toilet seats, shared towels, and the like.  So your doc was wrong, but likely through no fault of his/her own.

HHH, MD

[Samkay09]

HHH,
In your 5/26/05 response, you mention that an initial outbreak of HSV may be delayed by weeks or even months. Is it possible that it may be delayed by years?
I was recently diagnosed with HSV, although I don't know if it is type I or II. It was a severe episode not just from the genital blisters but also from extreme flu symptoms that have lasted a full week.
Of course as is likely for most people, I am concerned where I may have contracted the virus. I have been married and exclusive for seventeen years and I am as confident as one could possibly be that my husband has been faithful. My husband does get cold sores (where I have never had a cold sore) but he is very careful to avoid kissing or oral sex when he suspects a cold sore is even coming on.
My outbreak happened about 18 days after our last sexual encounter(which did not include oral sex)! This doesn't fit with the 6 to 48 hour time-frame from exposure or the weeks to months delay that you mentioned.
How is it possible that I have contracted Herpes?!

Thanks so much for your response. This is really causing me a lot of mental anguish.

[Pansy648]

I myself have just been diagnosed with HSV1.  My husband, who I have been with (and monogamous) for 15 years has occasional cold sores but NEVER kisses me when he knows one is coming on.  So this is a bit of a shock after all these years.  Apparently 1% of people with oral HSV can shed the virus without knowing they are doing so.  I hope this reassures you somewhat.  He feels badly and wonders if he can give the kids cold sores now by kissing them, with or without an obvious sore.

[grandmanow]

A related discussion, severe outbreaks was started.