Chronic HSV 1? Please help

[trs10]

About 10 years ago, I had a couple severe outbreaks on the tip and just under the penis head. No blisters, but it was extremely swollen and raw. For about a 3 years now, after sex with my wife or after masturbation, I get 'severe chaffing' on the tip and just under the tip of my penis.  It looks like a partial red ring under the head of the penis. After lots of sex, I would get a fissure on the head, it would bleed then scab. Sometimes my penis head would turn to a purplish color. This has not fully healed for about 3 to 4 years now.

I do know now that 10 years ago, I had Oral Lichen Planus (didn't know then, but have known for about 5 years now and this is confirmed clinically by biopsy). This has been chronic for about 10 years and has never fully gone away.

I went to Urology, ID, IM and Derm. 3 herpes select tests over 2 years: All tests HSV 2 negative HSV 1 positive. ID physician then swabbed the red ring around my penis. The ID doctor said the swab was very sensitive and would pick up herpes if it was there. Test negative. I have had a slew of blood tests (hep C, syphilis, HIV, etc). All is fine. The only time my penis has healed was about 9 months ago when I took Acyclovir at 400mg 3 times a day for a month. However, I had sex one time with my wife with insufficient lubrication, and the symptoms returned. I have tried Acyclivor again for 3 months, no luck (very confusing, since it worked the first time). Everyone now thinks that I have genital lichen planus.

When I don't have activity on my penis, it gets better, but never fully heals. Could this be (and is there such thing as) chronic HSV 1 (I am very healthy and not immuocompromised)? Am I allergic to my wife's vagina or have problems with her PH levels? She has not presented with anything ever.

[H. Hunter Handsfield, M.D.]

I have no advice about treatment, especially for a non-STD problem.

[trs10]

Thanks for the reply.  What do you think about a higher dose of Prednisone to stop the inflammation?  Maybe 20mg?  Furthermore, how high of a dose can you go before you have to very careful?  I have seen a couple studies that I found on the internet with men having the same issue as myself.  In 2 cases, 50mg of prednisone was given for 6 to 8 weeks with success.  Also, with no recurrence.  I was thinking about talking to my family doctor and trying at least 20mg for 4 to 8 weeks.  What do you think?  Again, thanks for the reply.  

[H. Hunter Handsfield, M.D.]

Let me enumerate the overwhelming evidence that you do not have genital herpes.  1) The symptoms you describe do not suggest genital herpes.  Recurrent herpes ONLY causes periodic outbreaks that do not last more than 1-2 weeks at a time, with localized sores that heal; and in between, things look and feel totally normal.  Something that "never fully heals" simply cannot be herpes.  2) Even HSV-2 never recurs more often than once every 4-6 weeks, and genital HSV-1 usually recurs only once or twice over the first 1-2 years, then never again.  3) Genital herpes outbreaks are not consistently triggered by sex, or by anything else that is clearly understood (despite beliefs about sex, stress, diet, etc).  4) If your genital lesions were due to herpes, the acyclovir would have prevented it--and I'm sure the fact that it "worked" the first time was a coincidence.  5) Multiple health care providers have reassured you, and they even have provided an alternate diagnosis that sounds far more likely.

You need to put herpes out of your mind.  There is simply no chance it explains your symptoms.

Good luck-- HHH, MD