HSV 1 & 2 with bladder and bowel problems

[marriedwith2girls]

Dear Dr. HH,

Thanks for your help in advance.

6 weeks ago I was diagnosed by a dermotologist with Herpes in my buttocks and between the scrotum and anus area (from an oral episode with a lady who also sat naked on my buttocks, no intercourse involved), after a week of pain and was put on a week of valtrex 500mg twice a day, the lessions resolved completely in the follow-up visit.

I then started feeling pain in the muscles and nerves as well as some bowel and bladder issues, and went to a neurologist as well as my family physician a week ago a did a complete pannel blood tests (over 7 weeks after the incident) all other std's came back negative as well as other tests, copper, lymes etc.  I also did a complete MRI from my brain to the lumbar noting significant was found (I have scoliosis one mildly herniated disc in L5 as well as one small insignificant perineural cyst in the sacral area.)

The blood tests however came back positive for HSV 1 and HSV 2.  HSV 1 IGM 1:160 titer HSV 2 IGM 1:80.

Anyways I was put again on Valtrex for 2 weeks this time from the neurologist 1 500gm 3 times a day this time.  my nerves and sensations are much better I think they are all residing, however by bladder problems, as well as my bowels to a lesser extent persist.  I am unable to urinate except at night lying at strange positions after taking the night does, I belive I will need catherization soon from this urine retention, the neurologist said it is a neurogenc bladder related to the herpes did not give me anything for it.

My question is how long will this last as its been 12 days?  Will it last forever? If not will it happen again in future outbreaks?  Is there any medicine I can take?

Thanks again for your help and sorry for my confusing email.

[Terri Warren, RN, Adult Nurse Practitioner]

Yes, Valtrex can impact antibody testing. Both tests.

Teri

[marriedwith2girls]

Thanks, but I have two issues if I stop the Valtrex.

1) I am married.

2) I do not want to experience the same effects of the initial episode and am scared of the recurrance.

For my knowledge, how will the Valtrex effect the WB?  Will it effect the IgG, maybe it did?

Thanks again.

[Terri Warren, RN, Adult Nurse Practitioner]

Your HSV 1 test is in the low positive range, which means it needs confirmation to know that it is correct.  When you come to the states, I would recommend that you get a western blot for confirmation.  But if you stay on Valtrex, it may change the results and I think you should stop it.  If you get an outbreak, you can then have it swab tested to determine if it is herpes.  

Terri

[marriedwith2girls]

I really appreciate your support, it means a lot,  the IGG for hsv 1 was 1.69 7 weeks post oral exposure and hsv 2 was negative.  so knowing what we know on IGM tests, in reliability, cross reaction etc, is this most likely a double infection or just an hsv 1 one?

my bowels now are better at 70 percent. getting better bit by bit.  my doctor said use valtrex once a day for the first year, nothing else I am using.

Should I get to 100 percent?  should I be terrified of a recurrence or will it be better?

By the way I am in Dubai but will be visiting the States in August.  thanks for all your help.

[Terri Warren, RN, Adult Nurse Practitioner]

How long after the encounter that you describe was the IgG test done?  The CDC recommends that a lab test always be used to diagnose herpes, and it should be a swab test if lesions are present.  A clinical impression alone should not be used.  But that opportunity is passed.  Do you have the values of the IgG test for HSV 1?  There is most often a number associated with that result.  

Glad to hear your bladder symptoms are improved now.  
You are very far out from the contact now, so I honestly can't tell you how long that might persist or even if it is due to the herpes.  It is unlikely to recur with future episodes

Terri

[marriedwith2girls]

Hi Terri,

Thanks for your help.

I was diagnosed by a dermatologist who looked at my buttocks and anus/scrotum area (one was on my anus) with a magnifying glass with light (I dont know what you call it). This was also thought of by my primary health doctor.  No tests were done at that point.  The herpes disappeared but the muscle/nerve symptoms and then latter bowel/bladder symptoms were still present.

Regarding the IGG it was positive for the HSV1 but non present for HSV 2.

I am happy to say that my bladder as well as my muscle/nerve symptoms now have all but disappeared.

I still have one more week of Valtrex and thats it (I have stopped Neurotin a few days ago).  

The only thing that remains is the constipation and bowel issues (3 weeks now) this may be due to the one herpes pimple on the anus, as there was oral and alot of saliva in that area too during the episode. According to your knoweldge will this persist for a long time? will it recurr with all future episodes?

Thanks alot for your help and support.

[Terri Warren, RN, Adult Nurse Practitioner]

So let me see if I have this straight:

You received oral sex from a woman who also sat naked on your buttocks?  And you were diagnosed with herpes by what method? Swab test?  Was it positive for HSV 1 or 2?  I'm guessing you might not live in the US because you are presenting test results showing titers which really aren't used any more here, is that correct?  The IGM test is not useful is the vast majority of cases. Was an IgG test done?  If yes, could you give me those results?  

It is really unusual for the neurogenic bladder symptoms from herpes to persist like this.  We have had a few patients who have needed catheterizing for the first 2-4 days of infection, but afterwards were able to urinate on their own.  You are several weeks out and this seems unusual to me, to say the least.  

In terms of treatment, if this is caused by herpes, which would be highly unusual in my experience, the antiherpes medicines would be best, I would think, the reduce the amount of virus present.  I'm not sure if something like neurontin would be useful in this situation.  You are now a bit out of my realm of expertise.  

Please write me back about how you were diagnosed in the first place.

Terri

[marriedwith2girls]

I am a 38 year old male