Tingling and HSV1 Genital

[Marco7]

Hello H,

Thank you for your help.

I contracted HSV 1 from an old girlfriend that had both HSV1 and HSV2 (igg test). We kissed 5/09 & had close skin to skin contact but no form of sex.  A few weeks later she called me to show me clusters of ulcers on her bottom. Then, she told me it was herpes and she wanted me to know.
Before I found out about my old girlfriend, my new girlfriend (now fiancé)  had unprotected oral and sexually intercourse.

Ok. I got tested for HSV on 7/09: LabCorp HSV 1 Igg 3.80 –Positive, HSV 2 Igg, Herpeselect 0.19 – Negative. HSV Igm 1 & 2 Combination 1.44 Positive.

My PCP said this infection is new & I may have received it from my old girlfriend because of the Igm results.

I did a different test on 10/09 to be clear. Immunoblot test(LabCorp). HSV 1 Igg Positive. HSV 2 Negative.
Currently, here is what I am going through:

Tingling (everyday) in the following areas:  tip of penis, below my waist, on my face(I had my 1st cold sores on my lips after this), and sometimes the bottom of my feet.

Patches of small bumps with white fluid on 3-4 of the same places on my penis and then they leave my skin very dry and look like cluster of rashes healing. Sometimes a little stinging on my penis. Most of all, the tingling feels like something crawling/popping on and around my genital, it is very annoying.

Also, I have had swollen lymph nodes on my neck & groin pains. Sores in bottom after tingling. Headaches after tingling.

I did get Valtrex but these symptoms have not stop.

1. Do I have genital HSV 1?
2. Can you recommend an ID doctor in my area? I am very unclear
3. Should I get a PCR test on my genital?
4. Can you have tingling from herpes without an outbreak/ulcer?
5. If this is not HSV what do you think it is?

Thanks,
Marco

[H. Hunter Handsfield, M.D.]

"...if I had HSV 1 and/or 2 I would have ulcers/sores after the tingling in clusters mostly on one side of my body":  Correct.  In addition, every occurrence of sores/ulcers would appear within an inch of the same spot every time.

"...my test results shows HSV genital is out of picture":  Not quite.  You have HSV-1.  There is no way to know how long you have been infected or where on your body the infection started.  Statistically, it is most likely a longstanding oral infection.  Whenever and wherever it started, it does not explain the symptoms you have described.

"When is HSV shedding?"  In people wiith genital HSV-2, the virus can be detected in the genital area 10-20% of the time.  For HSV-1, whether oral or genital, it is quite a bit less frequent.  In both cases, the timing is random and not predictable.  "Skin to skin" is how all HSV infections are transmitted.  However, not through casual contact, like shaking hands, and rarely if ever by "social" kissing.  Most cases are transmitted by kissing, oral sex, or genital intercourse.

Here are some websites with excellent information about HSV infections. You should be able to find the answers there to any additional questions you might have: www.cdc.gov/std; www.ashastd.org; and www.westoverheights.com.

[H. Hunter Handsfield, M.D.]

I forgot to provide the link about HSV IgM tests.  Here it is:  

http://www.medhelp.org/posts/show/541451

[H. Hunter Handsfield, M.D.]

Welcome to the STD forum.  Starting out with the title you chose for your question, before I read anything else:  Tingling, in the absence of overtly visible sores, is not a symptom of herpes.  If that's your main symptom, without blisters/sores, then you can be reasonably certain herpes isn't the cause.

Now I have read the question itself.  My intitial assumption seems correct.  You provide no evidence you have genital herpes.  Your blood test indeed shows you have HSV-1, but so does half the US population (lesser or greater proportions in other countries).

Your doctor probably believes your HSV-1 infection is new because the IgM test result was positive.  He apparently doesn't understand the nuances of HSV test results. In theory, a positive IgM test indicates a recent infection.  Unfortunately, it usually doesn't work that way with HSV.  It is conceivable you acquired HSV-1 from a sex partner, but it is more likely you have been infected for years (probably since childhood) with an oral, non-sexually acquired infection.  Below I will give you a link that explains the problems of the IgM herpes tests.

Second, if your old girlfriend had recurrent clusters of blister-like sores on her "bottom" (buttocks), it is more likely she had HSV-2 than HSV-1.  Luckily, your blood test shows you didn't catch HSV-2.

Third, as I already said above, tingling without lesions is not a symptom of herpes.  Let me also describe all the other reasons that your symptoms don't suggest herpes.  Herpes symptoms cannot continue daily. HSV outbreaks last no more than 10-14 days; cannot occur more often than every 4-6 weeks; and between outbreaks there are no symptoms at all.  And herpes symptoms cannot be so widespread as you describe.  Recurrent herpes symptoms are quite localized, always in more or less the same spot (give or take an inch), and always are limited to one side of the body.  Bilateral symptoms excludes herpes as a possibility.  Genital HSV-1 rarely causes frequent recurrent outbreaks. Only HSV-2 does that.  And finally, the capper:  lack of response to Valtrex more or less proves herpes isn't the cause.

To your specific questions:

1) Almost certainly you do not have genital HSV-1 (or HSV-2).

2) We don't make specific referrals.  Your county medical society can recommend an ID specialist.  But don't expect miracles.  You can expect that an ID specialist will confirm that herpes doesn't explain your symptoms.  A neurologist might be a better bet to explain your symptoms.

3) A PCR (or culture) for herpes can only be done if there is a blister or open sore to test.

4) Continuous tingling doesn't suggest herpes, as explained above.

5) I have no good explanation for your symptoms.  But the good news is this:  you did not catch herpes from your previous sex partner.  You probably have an old, longstanding HSV-1 infection that is not the cause of your symptoms.

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

[H. Hunter Handsfield, M.D.]

Don't hold your breath waiting for a herpes cure.  This isn't the first time we have seen hype from the same research group.  See http://www.medhelp.org/posts/STDs/Herpes-Cure-Research--To-Dr-HHH/show/1034001

[Marco7]

That is exactly what I had in mind.

Yes, after much searching I see that you (Dr. Handsfield), Dr. Wald, and Dr. Corey are the leading experts in this area.  Hopefully, this will give some incite to my ID doctor.  I really appreciate your help, effort, and time.  

Hopefully, one day you guys can/will find a cure for this thing..

I see you all "maybe" close:
http://www.redorbit.com/news/health/1460794/cure_for_herpes_may_be_coming_soon/

Cheers,

Marco

[H. Hunter Handsfield, M.D.]

I should have thought to add this to my closing comment:  If I were you, I would print out this entire thread, take it to your ID doc, and discuss it point by point.  Many trained ID specialists will recognize my name as a valid STD expert, and perhaps he will come to understand that herpes is not a likely explanation for your symptoms.  If you find he is defensive or becomes upset, that's a good indication of the need for another specialist's opinion.

Good luck.

[Marco7]

Thank you..

[H. Hunter Handsfield, M.D.]

The ID doctor has examined you and evaluated the situation in person, which I cannot.  Therefore, his opinion needs to be respect.  Nevertheless, I disagree with everything you report that he said; and certainly many ID specialists are not up to speed on the diagnosis and management of genital herpes.  I continue to see no evidence you have genital herpes.  And there is no such thing as herpes that responds to Famvir but not to Valtrex.  The drugs are chemically nearly identical and equally active against HSV.

That is all I can say.  You'll have to work this out with your ID doc, or continue to search for a physician who really understands HSV.  

[Marco7]

Hello Dr. Handsfield,

Sorry to ask you another question. I when to an ID doctor and he said I need to go on Famvir, since Valtrex did not work.  He said my body maybe rejecting the medication.

Also, he said I could have genital HSV 1 because some outbreaks can be mild like a rash that itches/stings and does not have to ulcerate like the pictures most people see online or in books. He stated those cases are not always the norm and each outbreak vary from person to person.  In my case, he said my symptoms may be overlooked.

I am confused now!!  I thought herpes type 1 or 2 does cause blisters or sores, etc.  In this case, if one does have a “herpes rash” on the male genital could it be in clusters on different parts of the genital? Have you ever seen HSV 1 or 2 cause this in any of your patients?

Thanks,
Marco

[Marco7]

Thank you Dr. Handsfield. Therefore, It is safe to say if I had HSV 1 and/or 2 I would have ulcers/sores after the tingling in clusters mostly on one side of my body. Sometimes it the information on the internet can be confusing, because some web sites say that stinging,headaches,and etc. is a symptom of herpes and others say another thing..

Also, my test results shows HSV genital is out of picture. I just wanted to make sure I did not have false negative results..Thanks..

Lastly, just for my education. When HSV is shedding what are the chances of it spreading through skin-to-skin contact.

Thank you,
Marco

Happy Holidays..