hsv1

[peoplep]

one morning after having oral sex with my gf i woke up with crusting skin under the head of my penis which became very painful . I went to the doctor a few days later to get tested and he said he couldnt swab test because there were no blisters present only reddish cracked skin. I later had a blood test done for hsv1 and 2 which came back positive for hsv1 which i had expected because i used to get cold sores as a kid. I tested neg for hsv2. That was 3 years ago and i still have terrible reacurences of pain ,reddness, and maybe a very small bump on the head of penis every 5 months or so. I cant say if i ever had any blisters to speak of. Right around christmas i developed a cold sore on my lip which i havent had in 15 or so years and started taking acyclovir. three days later i developed a small reddish spot on the shaft of my penis and what could be a small bump on penis head. I am in terrible pain. Is it possible to be reinfected with hsv1 on you genitles after you already had it? If so why would it come up while i was already on the anti viral meds? IM planning on getting retested for hsv2 even though this acts more like hsv1.

[H. Hunter Handsfield, M.D.]

I meant to add that I hope you will return to the forum once you have seen a dermatologist and can tell us the diagnosis.

[H. Hunter Handsfield, M.D.]

I'll try to help.  I'm not sure what is going on here, but almost certainly it isn't herpes, for several reasons.  Your description of the rash doesn't sound like it.  Your oral herpes in childhood protects you from a new HSV-1 infection of the genitals or anywhere else.  In the extremely unlikely chance you caught genital HSV-1 despite that, it is rare that genital herpes due to HSV-1 recurs as often and for as long as you have had your problem.  (Most people with genital herpes due to HSV-1 have either no recurrent outbreaks or only 1 or 2 over a couple years, then no more.)  There is strong evidence you don't have HSV-2, so that's not it.  Finally, the continuation of your symptoms on acyclovir is further powerful evidence that something other than HSV (of either type) is responsible.

Frankly, I see no need for further testing for HSV-2.  I"m not sure what you mean by "this acts more like HSV-1"; it does not.  It doesn't act like any HSV infection.

So if not herpes, what might it be?  A fungal infection is an obvious possibility.  But there are many other skin conditions that can cause recurrent rashes of the penis, other than fungal infections, herpes, or STDs.  Since this obviously isn't an STD, however, I won't try to guess futher; this gets away from my expertise.

If you have not been under the care of a dermatologist, that is the obvious thing to do next.  My bet is that this will turn out to be something fairly easy to treat and not in the least dangerous, once adequate therapy is underway.

Best wishes--  HHH, MD