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Herpes Lymph node pain

Background: 30 year old male. About a year & half ago I had a very bad rash in pubic area (above penis).  It formed into circular scabs.  I went to two doctors and a dermatologist all saying I had folliculitis (given antibiotics).  My lymph nodes became severely swollen...it hurt to walk. After about two three weeks, finally a new doctor said I had herpes.  Culture was negative, but blood antibody test was postive for HSV2.  Doctor gave me acyclovir.  For months I kept having outbreaks so he put me on suppressive therapy (acyclovir twice day/400mg).  The outbreaks are always in the pubic hair region above the penis.  Sometimes barely on the base of the penis.  A year later I stopped and within a week I had an outbreak, so doctor put me back on for another year.

Questions:

1)  My inguinal lymph nodes never went fully down.  I am lean so I can easily feel them.  They don't stick out, but I can feel them easily when laying down.  I don't remember being able to feel them before all of this.  They are still a little swollen.  They are not hot or painful to the touch, but I do have a aching feeling in or around them. Some are the size of a pea, two the size of a marble.  They do not feel hard.  Not a day goes by that I do not notice this feeling.  It is not very painful, but I kinda feel an aching in my stomach all the time.  I had physicals since this time and the doctor says I look healthy. Is this sometimes experienced with herpes?

2)  My doctor didn't say much about it other than sometimes they never go down and some people have to get them removed.  If this is related to the initial outbreak I had over a year ago, would they go down with time?  Would the aching go away with time?

3)  Would you recommend seeing a specialist?  Again it is not very painful.  I do feel it every day so it is more annoying than anything.  Also, I do not know if I am focusing on the lymph nodes.  I realize every day aches/pains happen and maybe I am focusing on the lymph nodes.

4)  I'm in sports and take supplements with high arginine.  Do you believe in the lysine/arginine ratio and herpes?

Thanks in advance for the help!
2 Responses
239123 tn?1267651214
MEDICAL PROFESSIONAL
I'm not convinced your pubic area lesions were herpetic.  The blood test shows you have HSV-2, but you might have asymptomatic herpes plus folliculitis unrelated to HSV.  The way to know is a culture for HSV when you have a new outbreak.

1) At least half of all normal people have easily felt small lymph nodes in the groin.  Regardless of the cause of the original inflammation, repeated inflammation is common, because minor trauma and/or infections of the legs and feet are virtually a daily or weekly occurrence in most people (e.g., every stub of a a toe, pimples, nicks the skin when cutting toenails, etc).  The nodes gradually become scarred and stay slightly enlarged.  Whether your residual nodes are due specifically to herpes or folliculitis, I cannot say.  But nontender, pea-sized nodes definitely do not suggest active infection of any kind.  The aching probably is more psychogenic than anythings else, not evidence of active inflammation.  In other words, this sounds entirely normal.

2,3) Your doc is right.  You don't need a specialist.  It would be malpractice to remove them surgically.

4) Quackery.  I know of no traditionally trained virologist, STD expert, or infectious disease specialist who believe in it.

Bottom line:  If/when the pubic lesions reappear, get examined within a day or two for a herpes culture.  Also keep a lookout for more typical herpes recurrences, e.g. on the penis.  Be sure you inform all your sex partners that you have genital herpes and take precautions to protect them.

Happy holidays--  HHH, MD
Avatar universal
A related discussion, herpes lymph node in neck was started.
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