Post Herpetic Neuralgia?

[Snowbound]

I was showering one morning and felt a burn on the underside of my penis, I assumed that I had cut myself shaving and thought little else of it.  The area was red, and seemed almost to look like a raised vein running the length of the shaft in a straight line.  I felt no pain, no itching, no papules or blisters noted, just the red raised line for lack of a better word.  It healed in about a week, with  shiny dry skin looking scabs and to this day (4 months later) has left a scar and is visible.  I have herpes 1 (oral cold sores) for about 8 years now.  I had no other symptoms until after about 2 weeks after the wound healed, then had pain shooting down the back of my legs, fatigue, and pain in my buttocks and perineum.  

I was tested for everything.  Herpes I 8.79, Herpes II 0.68, (HSV Type 1/2 combined Ab, IgM 1.09). I am going on 3 months now with pain everday either in my legs, buttock and lower back, and hands (alternating location)  Not excessive pain but a definitive burn and general just not feeling right kind of pain.  I have had no other blisters or outbreak. My questions are

1.  Could this have been an initial HSV I outbreak, even if I have had oral Herpes for years?

2.  What are your thoughts on Post Herpetic Neuralgia?  On other forums many complain of the same type of long lasting pain.  It seems rare but I am definitely feeling a burn.

3.  I know you speak of trusting the test results and ignoring IgM results, should I ignore the type 1/2 combined Ab. IgM of 1.09 (equivocal) or retest to rule out Herpes II.

4.(lastly) I have since joined the "I look at my penis 20 times a day crowd) almost hoping to see a definitive blister so I can know whats going on and move on. Outside of an outbreak is there no other way to know if I have herpes 1 genitally, since of course Im positive due to the cold sores? Sorry for the long post. my wife is negative for herpes 1, I'd like to avoid giving it to her but this crazy prodrome or PHN thing is making it hard to determine if I am "shedding" or not.  Help?

[H. Hunter Handsfield, M.D.]

1) No, you cannot have a new HSV-1 infection.  Your chronic oral infecttion protects you from a new HSV-1 infection of any part of your body.



2) Post-herpetic neuralgia is not generally associated with HSV-1 or HSV-2 infections, but with herpes zoster (shingles).  An exception if tic doloreaux, an excrutiating facial pain due to HSV-1.  But if PHN occurs as a result of genital HSV infection, it is uncommon.  This is an area of uncertainty, however.  In any case, the symptoms you describe are not suggestive of neuralgia as an explanation of the burning sensation of your penis.



3) You do not need further testing; you can be 100% confident you do not have HSV-2 and that you do not have a genital area infection with either HSV type.  Ignore the IgM result.



4) You can be 100% confident you don't have a genital HSV infection you can transmit to your wife.  Your symptoms are not either prodrome of herpes or PHN.



Best wishes--  HHH, MD

[ameba]

I have a question I hope someone can answere.

I was diagnosed with genital herpes about 6 moths ago and have had two outbreaks. Right after the second outbreak I started to get burning sensations on my inner thighs, the arches of my feet, the front of my legs and near the shoulder of my left arm. I have severe burning pain in my buttcks muscles and a prickly sensation around the anus but there is nothing there. All other tests for std's show negative. The doctor I am seeing right now thinks that I have post herpedic neuralgia and said that about 10 percent of people that have genital herpes may get it. The pain at times is unbearable and I have been on neuroton for a month with no change. How long will this last and is there anything else that can be done to help me. This has been going on now for 4 months and I am getting physically and mentally wore down.

Thank you

[H. Hunter Handsfield, M.D.]

Your symptoms to not suggest neuralgia due to genital herpes.  You need to request referral to a neurologist.  I will be happy to respond in more detail if you will post your question in a new thread.



HHH, MD

[calc]

I was recently diagnosed with genital herpes. Oct. 05.  I had a pretty significant response (negative for Herpes 1 and 2 up till then)...flu like...aches...fever...started Valtrex, (but  late maybe 4 days after initial outbreak.)  The ulcer healed and now there is no ulcers or any indication of the lesion.  My problem is that i continue to have an aching in that area of my labia where the ulcer was, and deep into that area, itching as well, but no sign of any skin ulcer.  Could this be a neuralgia?  If so, since is am recently infected, will this eventually end? should i maybe take the valtrex daily?

Also, now that i am infected (I knew by patner was positive, and we did use condoms), do we have to continue to use condoms, and can we now pass this orally to each other, or does the antibodies i have from the originaly infection protect me from this specfic virus if i am with the guy who infected me