Herpes or Herpes Zoster

[flyer8080]

Dear Drs.,

     Thank you for your wonderful service. My question is somewhat specific. I am in Germany and was recently diagnosed with Herpes Zoster (Shingles). The affected area is on my left side on my upper groin area almost where my leg meets the groin. There are two hive like areas one right above the other. The doctor seemed good and basically diagnosed it by looking at it. He mentioned something about blisters, but I did not see any. The hive like areas were raised like a regular hive (not bumpy). At any rate he gave me Alcivir (an antiviral at 400 mg 3 times a day) and a cream, and now less than three days later they are fading and smaller. My concern is the hive like areas never hurt (they did itch a bit) and I have seen that Herpes Zoster should hurt. Also they seem to be healing pretty quickly. He said it would take a week, but that seems quick for Herpes Zoster as well. I asked him about regular herpes and he said it is not that and when I asked he said I could have sex with my girlfriend as long as she has had the chicken pox or the vaccine. I have been with her for a year and have not cheated and while it is a long distance relationship I don't think she cheated either. Moreover, while based on the posts I have seen here herpes I or II is not always symptomatic she had no apparent herpes sores and does not have it as far as I know. My question is whether this could have been genital herpes and I was just misdiagnosed. I am probably being stupid and neurotic, but I am out of the country and figured you might be able to clarify given the above symptoms and information. Thank you again and I apologize for such a specific query as it may not be as helpful to others. Best wishes,

[Edward W Hook, MD]

Since your "last questions" are not, this will be the final answer.

Neither drying nor antiviral therapy are known to have any effect on the likelihooe of recurrence, if this rash was HSV.

That will be it for this thread.  EWH

[flyer8080]

Thanks! Is the same true for the dryness and the effect of acute antiviral treatment for recurrance? Thanks again and sorry to be a pain. As mentioned above I will not keep asking questions after the ones above.

[Edward W Hook, MD]

If anythng that rash yoiu had previously souns less like HSV than this one.  It does not change y opinion or advice. EWH

[flyer8080]

Sorry to bother you again, but I remembered something that I don't think makes a difference, but did start me worrying again. Last summer I had a very tiny red area with no blisters or crust or anything and another even smaller right below it. This too was under a lot of pubic hair (as the zoster one is) and about an inch and a half above the base of the penis. I was in Japan and went to a doc and it was diagnosed as a bug bite. He gave me some cream and it faded and went away in a few days. That one was about two inches to the right of the recent one diagnosed as zoster. I started freaking after looking on line that maybe that was a first breakout of HSV and now a year later this bigger one is a second. I am terrified that if that is the case maybe I could have exposed my girlfriend. On the other hand that was one tenth the size of this, and again this one was diagnosed as zoster. This one is by my leg as I mentioned and I forgot to mention is covered by a lot of pubic hair. Does the experience lastyear make a difference to the likelihood of the new one pobably being herpes zoster? Also my whole groin area is dry and itchy. I have had that before, but it is on both sides and zoster is usually one. I think the general itchiness means nothing since its summer and dry irritated skin is common, but could it point against it being zoster, and finally (and I won't ask you any more questions after this one). Since I am on antiviral to treat the zoster, if it were actually HSV, would it comeback quicker after going off the antiviral. If its zoster no big deal (I confirmed my girlfriend had the chicken pox), but we have only 8 more weeks together before I go back to the US and we don't see each other for three months after that so if it were HSV it would limit our already time limited sex life. Again, if its zoster no problem. I am so sorry to bug you again, but after remembering this I started freaking out and figured better to get an expert opinion and nip in the bud. Maybe I really just need xanax (joking).

[Edward W Hook, MD]

I'm glad I could help.  That's our goal.  EWH

[flyer8080]

Thank you. That is very helpful. I think I just freaked. It has been only three days and the hives are almost gone (they never really crusted much if at all) and as long as I apply the cream they don't hurt or itch. Part of me wonders if it was just jock itch anyway. At any rate your post was helpful and I am sorry for getting so hysterical. It does sound based on your reply like it was most likely zoster like my doctor said. I will calm down and try to stop worrying. It is helpful to know it does not mean she was unfaithful and I couldn't give it to her. It just scares me if things didn't work out between us that there is a chance it could be herpes, but it sounds like the odds are pretty low of that. Thanks again and I know you have to deal with people who get hysterical on here a lot so I apologize if I added to that. You guys are great and do a great service.

[Edward W Hook, MD]

I wish I could provide you with absolutes but without definitive testing (i.e. a culture or PCR), that cannot be done.  the odds are low that this is HSV- how low is difficult to quantify and, in my opinion, your anxiety is misplaced.  Similarly, you should not be doubting your GF.  Even if this were HSV, it would in NO WAY mean that she had been unfaithful.  Further, since in the unlikely circumstance that this could be HSV, if you had gotten HSV form her you could not give it back to her- once a person has HSV they cannot be infected again, even at another location.

I hope you can put this aside.  My sincere advice is to assume this was zoster and move forward.  EWH

[flyer8080]

Thank you. I am a little worried as I have never had HSV and therefore if that is what it is I would have had to have gotten it from her. I don't want to live in fear that any day another outbreak could occur and then I have HSV or that anytime I get itching in that area (which can often itch when it is warm out) I could realize the next day I had HSV. I just woke up one morning and there were these hive like things. I had itching a day or two before, but no sores. We have been monogomous for a year (or so I thought). You mentioned it is an "outside chance," does that mean the odds are pretty low it is HSV? I am sorry to be a pain I am just freaking out a bit. I don't mind a minor case of the shingles, but HSV is a different story, especially because of the implications wirh my girlfriend and the fact that we only see each other every other month or so, so if I had an outbreak we could not be physical and hat ould hurt he relationship.

[Edward W Hook, MD]

Welcome to the Forum. Your question is a good one.  Unfortunately, when HSV infection occurs at none genital sites such as the leg or abdomen, the appearance of the HSV lesions can closely resemble the lesions of Herpes Zoster and either infection can occur  without lesion pain.  As a result the only way to be completely sure is to have a culture of PCR test done on material from the lesion.  I have not examined you or seen the lesions and your doctor sounds pretty sure of himself so I suspect he is correct however, there is an outside chance that this might have been HSV.  At this time, being on treatment, there is little benefit of doing a culture or PCR (the treatment would make the tests negative) and there is really no role of blood tests in this situation.  As a result, my advice would be to complete your therapy.  Should the lesions recur, this increases the chance that this is HSV (zoster rarely recurs) and at that time a culture or PCR will be quite helpful  In the meantime however, my advice would be not to worry.  There is no reason to worry about sex with your GF if your relationship has been monogamous for more than a month, either way.

I hope this is helpful.  EWH