[Question #1230] Constant prodrome with no outbreak

48 months ago
I'm Female who has had hsv2 for 30 years. I've had outbreaks 2-6 times a year that all followed a normal pattern of brief prodrome, outbreak of lesions and healing. Only once before during my pregnancy 20 years ago I felt prodrome with no outbreak. Now I have a terrible new problem which I've read about online so I know I'm not unique.  For at least six weeks I've had same sensations as with any prodrome in the exact spot of any prior outbreak: pain, tingling sensation. I saw my NP who confirmed no lesions. Some days are worse than others in intensity but feeling never goes away. I took acyclovir 10 days at higher dose and switched to suppression dose after that. I've been on it at least a month total. I need to know if I am shedding virus and  putting partner at greater risk while I have these constant prodrome sensations . Is there any use for him to take valtrex/acyclovir in addition to me taking it? He had blood test and is negative for hsv1 &2. Also I requested swab test from Gyn. Normally they only do with active lesions. They will do one but asked me what I would do if it's + or -. If it's + should I abstain for months  while this lasts if this sensation doesn't go away? Given I'm on acyclovir and use condoms should I just abstain maybe indefinitely because I am putting partner at some level of additional risk? Thank you 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
48 months ago
Hi Dorothy,
I'm sorry you're having this problem, it sounds really annoying!
The only way to know if these symptoms represent viral activity is to swab test you in the area where you are having these symptoms.  It's a bit odd that things are changing at this point in the game but also possible.  Did the increased dose and daily dosing with antivirals make any difference?  If not, then I think it is less likely that this is due to prodrome with herpes but can't be certain without a swab test of the area.  It should be aggressive rubbing.  If it is positive, then yes, I think you should abstain while you have it. 
What does your partner think about the possibility of getting HSV 2 from you?

Terri
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48 months ago
Hello Terri can you please answer my question of whether my partner should take antiviral med at same time I am taking it and if that would give him additional protection? To answer your questions no the antiviral a haven't helped me at all with these sensations of constant  prodrome. I am also using Zovirax cream which hasn't helped either and which in past outbreaks helped me tremendously. My partner says in general it's a risk he is willing to take but this special situation of the constant prodrome has caused me a huge amount of worry and anxiety.  I am so scared of this feeling not going away and don't know what more I can do.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
48 months ago
Sorry.  No, there has never been any benefit shown for a partner taking antivirals to avoid infection. 
I would again encourage you to get swab tested.  However, if this was prodrome, I think the medicine would have really helped by now.  
And also, I know it is difficult but your partner knows what is going on and has made this decision to take a small risk.  I would encourage you to get swabbed but then try to let this go as you are doing all you can now about this.

Terri
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48 months ago
Hi Terri an update: I went for swab testing and  iit came back negative for HSV 1&2.  Testing type was listed as "DNA PCR."  I definitely had the prodrome sensations at time of the testing but no outbreak as has now been the case for at least two months.  My questions now pertain to what can I do if this pain/ tingling keeps persisting with no idea what other things might be causing it? Anything else I can ask health provider to do?

 Also the pain really varies in intensity day by day. Should I be abstaining on days when prodrome sensations are more
noticeable or severe- again with no outbreak and  over a month of acyclovir on board.  I am so worried about my partner and this is stressing me out so much. Thank you.
48 months ago
Addendum to last question  since it wasn't answered yet. Can it be post herpetic neuralgia pain? I know that occurs after shingles but what about HSV 2? I haven't had an actual outbreak that I can remember for over a year. That wouldn't be contagious right ? Thank you
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
48 months ago
Its very good that your PCR swab was negative.  This strongly suggests that even when your discomfort is at it's worst, no virus can be recovered from the troubling area.  Have you tried increasing your dose when you have these feelings?  If increasing the dose does nothing to relieve the symptoms, again, I doubt that they are herpes related.  As to abstaining with these symptoms:  I don't have a magic answer for you because even though your swab test was negative, I cannot say for certain that you aren't shedding virus because you can shed virus with absolutely NO symptoms at all. 

A few people do have post herpetic neuralgia with herpes, yes, but many time people complain about these symptoms and NEVER test positive for herpes at all.

Another thing is this:  if the tingling and pain is pretty constant, that is also a sign AGAINST it being herpes as herpes doesn't behave in an "every day" sort of way, the vast majority of the time.

Best
Terri
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