Very confused. Genital HSV-2 problem

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Hello and thanks for taking my question.

I have been having what I can only recognize as recurrent herpes outbreaks for the past two years. Below I will give you some reasons I believe I have it

1) They are recurrent, they happen on the shaft of the penis and they occur about 3-6 times a year.

2) They recur pretty much in the same spot everytime. Sometimes right below the head and sometimes on the head. All the previous recurrences occurred on the top side of my penis but this last recurrence happened on the bottom side.

3) All the recurrences pretty much look the same. I have occasionally seen bumps (although very slight) and these bumps sort of develop into these skin lesions that I do not know how to explain. They just look like dark spots which can be scabs but I have never surely been able to determine if they are scabs or not more like dried skin. However, a big area around these "bumps" shows obvious signs of skin irritation...Peeling dry skin. Again no real "open sores".

This is all very strange to me for the following reason:

Before I got into a relationship with my current girlfriend we BOTH got tested for all STDs and everything but HSV1 came positive for us. So I had assumed I was herpes free!!!!!! And my only contact before her was a single episode of condom protected sex with a CSW which happened about 8-9 months before my testing. That contact was the ONLY sexual contact I have ever had with any other person expect my current GF.

However, after reading these forums regularly for the past 2 years I KNOW KNOW what herpes is and I truly believe I have it. This is not an anxiety driven assesment. What do you think? Should I get tested again?

[Edward W Hook, MD]

Thanks for the clarification and follow-up.  The additional information makes it clear that this is not genital herpes but some other dermatological problem.  As to what that might be, it is difficult to say, both because I have not had the chance to examine you directly and also because there are so many possibilities within the large field of dermatology.  EWH

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Thank you for your answer doctor. I have a few updates but first to your question.

I do not see any blisters ever, I have looked hard but never any blisters. However, I do see these bumps that form. The most obvious part of these lesions is when they go away forming this irritated spot. Again, the whole area becomes very irritated looking with peeling skin all over.

Also, this last week I had taken another blood test (HerpesSelect) and the doctors office called me this morning and they told me my blood test was once again negative for HSV-2 and positive for HSV-1.

I can certainly rule out genital HSV-1 because I have get typical cold sores sometimes. I have even had that cultured positive for HSV1 once (just for curiosity).

So my questions is what on earth can I do now? Any other blood tests you recommend? This latest negative result did not come as a reassurance for me since I am beyond doubt convinced my consistently recurrent lesions are HSV-2.

[Edward W Hook, MD]

Welcome to the STD Forum.  I'll be happy to try to  help.  I agree with you that the pattern of a recurring rash at the location you describe is highly suggestive of genital herpes and that is amongst the first things I would consider in seeing a patient with your history, but not the only thing.  Several possibilities come to mind.

This may not be genital herpes but some other dermatological process.  The description of the lesions you have do not mention small blisters of vesicles - do these occur?  Also does the duration of the lesions you experience now last longer than your first episode?  The reason I ask is that there are a number of other recurring dermatological conditions which could be causing similar lesions.  It turns out that even when experts make a clinical diagnosis of genital herpes without the benefit of lab tests they are wrong about 25% of the time.  My advice would be to have a dermatologist see you and the lesions when they occur.  Testing may include a culture or PCR test which are the only way to make a definitive diagnosis of HSV or other testing by the dermatologist.  Making a proper diagnosis is important since treatment would be different depending in what is causing the problem.  If you see a dermatologist and the lesions are not present at the time you are seen, discuss how you can get tested, even without being seen by the doctor ASAP after the next time the lesions appear.

Alternatively, you may have genital HSV-1.  While genital HSV-1 typically does not recur, it can.  Again, the way to be sure is with a PCR or culture test taken from the lesions, not with blood tests which can tell you that you have HSV-1 but do not tell you the location (i.e. you could have an oral infection or at some other location).  

I hope these comments are helpful.  You really need testing of the lesion and to be examined by a knowledgeable clinician.  EWH

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"
Before I got into a relationship with my current girlfriend we BOTH got tested for all STDs and everything but HSV1 came positive for us"

Obviously,  I meant to say everything but HSV1 came negative for us.