dull pain in penis / pelvis area- is it herpes? Am I contagious?

[qwerty123525]

I have had HSV2 for 12 yrs.  Take 1000mg valtrex daily (2000mg/day w/ symptoms or OB).  Visible OBs have been seldom over past 5 yrs (less than 1 per yr), although I just had 1 that lasted about 3 wks (this is longer than usual).  Since the last OB "cleared up" (there is still slight redness, but no blister) over a month ago, I have been experiencing sharp pain in my tailbone (this pain I have had before, but it went away before...it has been more present over the past 6 mos) and a dull pain or ache (sometimes could describe as numbness)  that is in the shaft/base of my penis (mainly here), testes, hips, buttocks, pelvis (noticeable in different places at different times).  What is this?  Am I contagious now or is this just nerves?  The back pain I am fairly certain is from the HSV, but the other pain I dont know.  I have experienced the other dull pains many times in the past they come and stay for days-weeks at a time and then go away...they do not accompany visible OB.  Am I contagious when the back pain is present?  Contagious with the dull pain??  I understand shedding, but I mean contagious like if I was having an OB or is this an idicator that I am shedding?

[Edward W Hook, MD]

I think you need to talk with an infectious diseases specialist.  For a HSV recurrence to last more than three weeks is virtually unheard of unless you have other, underlying disease.  Similarly, the severity of the pain is out of line with typical HSV. I would suggest that you have this re-evaluated.  You may have HSV but it may not be caussing all of the symptoms that you attribute to the infection.  EWH

[qwerty123525]

Thank you for your quick answer.  As I said the tailbone pain is almost unbearable during OB and just present other times, so I am fairly confident I can attribute it to the HSV. Is the other pain possibly Chronic Pelvis Syndrome?  The pain episodes often will follow lack of sleep/ drinking excess alcohol and stick around for days or weeks.  Is there any method  of testing one can do at home to see if there is shedding present?    I have been refraining from sex for awhile as I am unsure about contagiousness, but this has been awhile.  My last OB went from 11-15-09 - 12-10-09 and these pains have come and gone since then...

[Edward W Hook, MD]

There are two questions here, only one of which I can answer with factual data.  I’ll do that one first.  Your valacyclovir suppressive therapy will dramatically reduce both the frequency of viral shedding (either in outbreaks or asymptomatically) and the quantity of virus present when shedding is occurring.  Thus, while it is typically impossible to be absolutely sure when a person has asymptomatic viral shedding and when they do not, you should have confidence in your therapy and that it reduces your risk of transmission of infection to others (but does not completely eliminate it).  Without suppressive therapy when studied in couples, valacyclovir reduced a baseline transmission rate from about 6-8% per year by over 50%.  Thus this addresses your questions about shedding.  

Now about your pain.  Persons with HSV including those taking suppressive therapy may have "prodromes" in which they experience tingling for up to several hours before an outbreak in the location of an outbreak OR "false prodromes" in which they experience the sensations but do not go on to have a recurrence.  In these situations viral shedding at the site of the sensation is more likely.  On the other hand, we get many questions about more long lasting pains and discomforts related to HSV infections and these are harder for us to deal with.  Neither of us, nor any of our expert colleagues (and we have asked many times) has seen or is aware of patients in whom it is definite that the sorts of more long lasting pains in the back, genitals or down the legs (neuropathic pains) they describe are due to HSV.  If they are, it is absolutely clear that they do not respond to antiviral therapy.  Thus I cannot say with any degree of confidence that the discomforts you describe are due to HSV or comment on the possibility that you might be infectious during these times.  In my opinion it is unlikely that you are infectious since neuropathic pain, if it is due to HSV,  is typically not due to ongoing infection/inflammation but is a lasting effect of damage to the nerve.

I realize this does not fully answer your concerns about your pain.  Sorry.  EWH