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HSV-1 on Buttocks

Dear Doctor,

I'm a 26 year old male, and my question is about my 23 year old fiance.  About 2 months ago, she developed a small cluster of fluid filled bumps on reddened skin on her left buttock (about 3 inches below her waistline).  They appeared in one spot, and after a day or so, another smaller cluster appeared slightly below that one.  There was no pain, but they were quite itchy.  At the same time, the lymph gland in her groin, on the same side of her body, became swollen and a little tender.  She had just come off a week of night shift at her job, which is something she doesn't handle well.  Ever since she was young, she seemed to need a lot of sleep.  Anyway, she also had a cold at the time, and was quite stressed out at work.

Of course, we thought it was best to go see a Doctor.  A scraping of the bumps was taken, and she was given a weeks prescription for Valtrex (3 pills per day).  A couple days later, the nurse phoned her and said the test was positive for HSV-1, and negative for HSV-2 and Zoster.  The nurse said if it ever happened again, she could go back and get another prescription for the Valtrex, and that was it.  After the week of Valtrex, the bumps crusted over and healed.  When I say healed, I mean they were gone, but there is still light pinkish spots where the bumps were.

My questions are these:
1. Could the combination of her stress/cold/being run down from the night shift have contributed to, or been the main cause of, the HSV-1 popping up?
2. I have never had anything like this anywhere but my mouth.  I have had cold sores in the past, but I can't ever recall putting my mouth anywhere close to her buttock when I had a cold sore.  That being said, is it still possible that I did somehow pass HSV-1 on to her?
3. Will those pinkish spots where the sores were ever go away?  Or are they "scars" now?  Like I said, it's been about 2 months.

It should also be noted that when she was 16 (about 7 years ago) she developed something similar on the right side of her body (below the armpit and down the ribcage), which the Doctor at the time told her was shingles (no test was done though).  She can't recall if they looked the same as what she had this time, but she seems to remember that they were also quite itchy.

Thanks in advance for any answers/comments.

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If she had a viral test on the lesion scraping (culture, PCR, etc--that is a test to detect the virus itself) that was positive for HSV-1, then that's what she had.  However, if it was a blood test, then it could be she in fact has HSV-2 or conceivably herpes zoster (shingles).

But on balance, it sounds most likely that she indeed has genital (or genital-area) herpes due to HSV-1.  Most likely it is a recurrent infection, not the initial one; initial genital HSV infections (whether HSV-1 or HSV-2) just about always involve the genitals or anus.  However, an initial infection (perhaps months or years previously) can be asymptomatic and still have symptomatic recurrent outbreaks on the buttocks, upper thighs, etc.

To answer your specific questions:

1) Contrary to popular beliefs, the available research suggests that recurrent genital herpes is not triggered by stress.  Lots of people, like your partner, report stress as an apparent trigger; but it's important to remember all the times we are stressed but DON'T get a herpes outbreak.  Her cold is a more likely trigger than the stress,but even that might just be coincidental.  On the other hand, there never has been a well designed resarch study to address these issues.  On balance, I would describe stress as a possible but unproved trigger; and if it occurs, it's the exception, not the rule.

2) As suggested above, it is likely your partner has been infected for a long time, i.e. months or years.  Whether or not she caught it from you is impossible to say.  You could have an HSV-1 antibody test.  It probably will be positive, which would only mean you could have transmitted it to her (or caught it from her), but nothing more.  However, if your HSV-1 test is negative, it will prove you were not the source of her infection.  The other advantage of testing is that it will tell you whether you are susceptible.  If postive for HSV-1, you are not at risk of re-catching the infection from your partner.

3) Recurrent herpes rarely leaves permanent scars.  The pinkness probably will fade over a few more weeks.

Finally, she probably can expect to have few if any similar recurrences.  Over 80% of people with genital HSV-1 infection have outbreaks less than once or twice a year; and over time, they become even less frequent than that.

Good luck-- HHH, MD
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