Follow up questions regarding my hsv infection

[bobdoll]

I originally posted in this thread: http://www.medhelp.org/posts/STDs/questions-regarding-likely-genital-herpes-infection/show/1208428?personal_page_id=1333862#post_5524586
I've had some developments that I need an opinion on.  

I've had two recurrences of hsv around the abdomen, but nothing below that.  All the recurrences have been much smaller (less than a dime) compared to the initial infection.  Although there was some debate in my initial thread, I still believe that the first outbreak I had on my stomach was the result of my initial infection.

In the last few months, I have gotten shooting pain as well as dull aches in the penis.  It has been pretty much daily, but I've had no visible symptoms.  Complicating matters, I have developed a severe case of thrombosis from excessive sex/masturbation.  I've had this before, but never for this long.  It goes away if I don't do anything sexual for a while, but then comes back when I do.

I went to see a specialist when I had both the thrombosis and an abdominal hsv outbreak.  He told me that he did not think that herpes would cause these kinds of regular symptoms in a location so distant from any outbreaks.  He said thrombosis could cause pain, but usually not the type of pain I described.  He said I may eventually need surgery for the thrombosis if it keeps coming back.  He couldn't really explain the shooting and aching pain.

I don't expect you to be an expert in thrombosis, but I am have some herpes questions:

1) How likely is it that the hsv on my abdomen is causing my penis symptoms without penis lesions?  I have taken 1g of valtrex per day with no effect on these symptoms.  

2) I am afraid to have sex with my negative partner because I am having constant penis pain.  Does that mean the virus is always active, even with the 1g per day of valtrex?

3) If the herpes is causing my penis pain without lesions, is there anything besides valtrex I can do to treat it?  Maybe see a neurologist?  

[H. Hunter Handsfield, M.D.]

Don't assume the diagnosis on your own; see a health care provider (perhaps a urologist) if the symptoms continue.  In any case, it's clear you have no STD, so that will be all for this thread.  Take care.

[bobdoll]

Thanks Doctor, this was very helpful.  I was not familiar with CPPS or prostatitis before, but I believe it may explain my symptoms.  I have read that it can be caused or exacerbated by long periods of sitting, high stress, high caffeine intake, and lack of exercise.  Because of a new job, I have been sitting for extremely long periods and drinking copious amounts of caffeine the last few months.  I had not made the connection, but now that I think about it, it had gotten to the point where it was so uncomfortable to sit through a meal at a restaurant that I would have to get up and walk around five or more times.

I took a vacation last week where there was little sitting, stress, or caffeine, and my symptoms all but disappeared.  I have since returned to work, and my symptoms returned within a few days.  

I am now researching possible treatment strategies for this condition, but would be happy to take any suggestions you might have.  I hope you are right that it is not serious because I have read about several people that were forced to quit their office job to alleviate their symptoms.  

Thanks!

[H. Hunter Handsfield, M.D.]

Welcome back to the forum.  I doubt either the penile pain or the thrombosis have anything to do with your herpes.

Actual thrombosis of the penis is less common than sclerosing lymphangitis, which sometimes follows vigorous sexual activity and presents as a firm, mobile, painless, elongated, subcutatneous mass typically in the coronal sulcus -- i.e. between the head and the shaft. Some cases may be slightly painful. It is not serious and clears up on its own in a few weeks.  Up to 25% of patients are said to have gonorrhea, chlamydia, NGU, herpes or other STDs, but that means 75% do not -- and for a variety of reasons the 25% is probably an overestimate anyway.  And just like the specialist you saw, I have difficulty understanding why such distant herpes outbreaks could cause such a thing, especially while taking valacyclovir.

Similarly, recurrent or persistent pain distant from herpes oubreaks is not generally a symptom of herpes -- and again, its continuation while on anti-herpetic suppressive treatment with valacyclovir is additional strong evidence against herpes as the cause.  So here too I agree with your specialist.  I see no reason for you to be avoiding sex with your partner.  The pain undoubtedly is unrelated to herpes; and even if somehow it were related to your HSV infection, it doesn't mean you are shedding the virus.  As long as you take valacyclovir and also avoid sex when having an obvious HSV outbreak, it is very unlikely she will be infected.

Not knowing the cause of your penile pain, I cannot suggest any treatment.  As I said, it surely is unrelated to your herpes (unless possibly a psychological effect resulting from anxiety or stress over the herpes).  But if it continues, you might see a urologist and ask him/her about the chronic pelvic pain syndrome.  Formerly considered a form of prostatitis, CPPS may not involve the prostate at all -- but is among the most common causes of unexplained pain in the penis, testicles, or lower abdomen.  Google CPPS (spell it out) and read about it and see if it matches some of what you are experiencing.  Start reading with the excellent Wikipedia article, which will be near the top of the google hits, and also the information from the Stanford University dept of urology.  As you will see, at least some (most? all?) CPPS may be due to pelvic muscel tension of psychological origin.

Perhaps most important, almost certainly your pain is nothing serious, either for you or for a sex partner.  Sometimes knowing that is the first step in either the problem clearing up or learning to live with it without difficulty.

Regards--  HHH, MD