4 genital herpes out breaks with negative tests

[mikeconfused]

Hi,

I am a 33 year and very sexually active male. I have had oral herpes (HSV-1) which was diagnosed about 5 years ago. Since then I have had only 3 episodes of the oral herpes/cold sore outbreak on my lips.

However 2 months ago I noticed typical herpes like symptoms of the upper shaft of my penis. There were a cluster of blisters and I thought great now I have HSV-2 as well. So off to the doctor I went to reconfirm my doubt and he looked at the blisters and said well yes this looked like classical herpes. Nevertheless did the blood test for type specific herpes and the test came back that I was positive for HSV-1 (Igm) only. The rest of HSV-1 (igg) and HSV-2 (igg & igm) were negative. The VDRL, TPHA were also non-reactive (negative).

Well this was the first time I had genital herpes and it did not burn or hurt in any way. They started healing as i was taking Zovirax and applying the zovirax cream as well to the affected area. They completely healed within 10 days from the date of the first symptoms. After 4 days of healing another group of blisters popped up not exactly in the same place but right next to it. This was again classical looking herpes they stay for 10 days and dissapear and then again after 5-7 days they pop up again not exactly in the same place but within very close proximity.

It has been 2 months since my first initial outbreak in the genital region and I have already had 4 reoccurences. It breaks out and then heals after 5-7 days breaks out again heals and then after 5-7 days breaks out again and so on and so forth.

The mystery is I have been to different doctors and they have all advised me that this is herpes when they look at it and send me for blood test confirmation. I have done 3 blood tests in the span of 2 months and they have all come back negative for HSV-2 (both IGG and IGM) and only positive for HSV-1 (IGM). All of these 3 times I have been tested for VDRL, TPHA as well and every time these have been negative as well.

Can someone please advise me what is happening? DO I really have herpes or something much more serious? Could it be something different that looks like herpes but is another STD. I am a very sexually active person so I have a felling that it is a STD but I am at a loss why is it happening so quickly. I have read on the internet that reoccurences happen 4-6 times in a year. I have had 4 re-occurences in teh genital area in the span of 60 days (2 months) - keeping in mind that they healed first and then I was ok for 5-7 days and then happened again.

Should i be testing for something else as well? Please help as i am totally confused and lossed and cannot find answers to this anywhere on the internet.

Thanks.

[Bhupinder Kaur, MD]

Hello,
Generally genital herpes is caused by HSV 2 but it is not a thumb rule and in some cases, genital herpes can be caused by HSV 1 also. So if the blood tests are showing HSV 1, then you should start with the antiviral treatment for this. Alternately you can get a biopsy skin also.

I sincerely hope that helps. Take care and please do keep me posted on how you are doing.

[ExcelGuy09]

You can get HSV1 in the genitals, I would have a culture swab done on an open sore to confirm you that you do/do not have genital HSV1 herpes, although not typical, but it does happen, HSV1 prefers oral, HSV2 prefers genital, but both can occur in either region and HSV1 genitally will give you initial bad outbreaks, but less frequent recurrences and severity.

The + blood test for HSV1 just tells you it is in your body and doesn't specify the region.  If it is negative for a culture swab, then you don't have it in the genitals.  You need to have the swab done as soon as you have an apparent outbreak.  

HOWEVER, what I think you most likely have it Lichen Planus which can easily be confused as genital herpes.  Lichen Planus which is a skin condition that is not contagious and caused by other issues – skin irritation, stress, immune system issues, etc and occurs in middle age men, yes 30 is middle age my friend :-).  It can cause blisters that ulcerate and heal very similar to how herpes act and can occur and heal with another outcrop occurring soon afterwards (persistence).   The lesions are typically not itchy or painful like herpes outbreaks.   Yes, I experienced the same exact thing you are going through.  

Woke up one morning with lesions on my penis, thought it was herpes went to doctor’s he said it was herpes and then I had negative tests results at 8 and 31 days post-exposure, plus partners were negative as well and I have a history of skin conditions on my penis.  Doctor evaluated and said it was Lichen Planus.  The first outbreak healed after 7 days and then about 7 days later another crop of lesions occurred, but these ones are taking a bit longer to heal.  

Get a culture swab, if negative ask your doctor about Lichen Planus.
Check out http://www.ihmf.org/OnlineLearningZone/DiagnosticAtlas.asp