Zoster and HSV-2

[POSGUY]

I am a 35-year-old male in otherwise fine health.  Approximately 4 months ago I was experiencing pain on my abdomen--right side only and exactly to the midline front and back. I also had swollen inguinal glands, etc. The skin was very sensitive to the touch, but I never got any rash or lesions. Nevertheless, I was diagnosed with zoster and put on the week-long course of Valtrex. It went away rather quickly.  Approximately two months later, I woke up with an itch on the center of my left eyelid. A tiny little red bump was there and was persistently itchy.  I mistook it for a bug bite for a day and it got worse, transforming into a series of tiny blisters and growing a bit.  I went to a different doctor, and was diagnosed again with zoster.  Valtrex again and everything was fine after about a week.  It never made it into my cornea.  Less than a month after that, I developed swollen glands (inguinal, I believe) and discovered a couple of little redish blisters in my pubic region (in the center).  Back to doctor number one who again diagnosed zoster (I also informed him about the eye thing I saw the other doctor for) and prescribed Valtrex.  All fine in just a few days.  Now, just about 3 weeks later I woke up with irritation on my (glans) penis and saw that there were about five tiny little bumps on the right side.  Not very painful but, then again, I've never had a tremendous amount of sensitivity there for whatever reason.  I immediately went back to the doctor who took a look and ordered an HSV-1 and HSV-2 test.  Back on Valtrex.  The bumps got redder but began to heal the next day.  Within a couple days, they are just tiny little scabs and few in number.  The doctor calls 3 days later and says that the genital herpes test is positive.  He based that on a negative IgG and a positive IgM.  His consluion was that the infection was recent.  Trouble is, I've had the same girlfriend for more than 1.5 years and we are both faithful.  She was tested for both of those things in February 2004, just after she broke up with the last boyfriend and before we met.  All negative.  She just went to get blood drawn yesterday, based on my results, and we expect those soon.  To her knowledge, she has never had a cold sore.  But, she questioned her mother yesterday who told her (my girlfriend) that she got them somewhat frequently as a child.  Her mother says that she (herself) gets them still, though my girlfriend says she hadn't noticed.  They often share utensils when eating together, etc.  My questions are these:  Is it possible that zoster caused my latest event rather than HSV-2?  Can active zoster cause the IgM test to yield a positive result? I have never had any such incidents before, so this is all very odd happening at the same time, although I have been experiencing abnormal stress.  HIV tests negative (both 4 mos. ago with 1st zoster and last week). Any thoughts on the recurring zoster at my age?  Any more specific tests that I should be getting? Thanks

[H. Hunter Handsfield, M.D.]

The IgM test for HSV-1 and HSV-2 is useless; see other threads on this subject (search the forum for "herpes diagnosis", "HerpeSelect test", and "IgM'.  It does not reliably indicate early HSV infection, regardless of what your doctor says.  And, in fact, it may cross-react with antibody to varicella zoster virus--so if you indeed have shingles, that could explain the positive HSV igM with negative IgG.  Conceivably you could have an HSV-2 infection, acquired too recently to show up on the standard (IgG) test.  But HSV-2 is only acquired sexually, so that possibility will be ruled out if your partner's HSV-2 test comes back negative.  If positive, you should be retested in a few weeks.  Stress isn't the cause of any of this, nor is sharing utensils.

As far as zoster goes, it's most common in persons older than you, but not rare at any age; my son had an episode of shingles at age 13.  But recurrent shingles can be a sign of underlying illnesses of various kinds.  But this is outside my expertise as an STD expert, and I'm not going to second guess the diagnosis of zoster, the cause of your repeated symptoms, etc.  It sounds like your doc is on top of it, though (except for his or her misunderstanding of IgM and HSV).  But if in doubt, ask for a second opinion, such as from a dermatologist or infectious diseases specialist.

Good luck-- HHH, MD

[bluebird05]

Doesn't sound like an initial outbreak????....Also, HSV-2 on the eyelid doesn't make sense????....let's see what the Doc. says.