[Question #2271] HSV SYMPTOMS WONT GO AWAY

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99 months ago
THIS QUESTION IS FOR DR. HANDSFELD. I HAD A PAST QUESTION ANSWERED BY SOMEONE ELSE AND WOULD LIKE A NEW PERSPECTIVE.

6 months ago I came down the a primary hsv-1 infection genitally. It was undiagnosed for 3 weeks so by the time I got on anti virals it had taken over everywhere. I take 500 mg of famvir twice a day (valtrex didnt help much) and it seems every couple of days i get terrible terrible itching usually accompanied by cervical mucus. I then double the meds and and the itching goes away a day or so later. No blisters have formed since the primary infection and I've gotten re swabbed with negative HSV results. I have gotten tested for everything (clamydia, rich, pap smear, etc) and everything is negative although the cervical mucus always has a lot of white blood cells in it. I am going insane with all this itching and I'm convinced that its the HSV prodrome symptoms since the medication helps. Could this be possible and is there anything else I can take or do? Is there a lesser known anti viral medication I should be trying? Something else I should maybe get tested for? Any any itch medications that would help? My quality of life has gone downhill and I have 2 babies at home to care for.

Thank you
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H. Hunter Handsfield, MD
99 months ago
We generally recommend our forum users not seek second opinions from other moderators, indeed usually refuse such requests. When it comes to herpes, Terri Warren, Dr. Hook and always have more or less identical knowledge and experience, and give identical advice, despite differences in our online styles. However, in this case Terri asked me to respond to this repeat question.

I read your previous discussion with Terri and, as predicted by the comment above, agree with all she said. Like Terri, I am confident herpes is not the cause of your continuing symptoms, for several reasons. 1) Not only are the symptoms not typical for herpes, but genital HSV1 recurrences typically are rare, if there are recurrences at all. 2) HSV infections do not cause persistent longstanding symptoms; periodic outbreaks occur no more often than about once a month (usually less) and between them, there are no symptoms at all. 3) The negative tests for the virus during your symptoms are strong evidence against herpes as the cause. 4) I'm not convinced that famciclovir is really helping. It is not possible for famciclovir to help if valacyclovir does not; they are minor chemical variations of one another and pretty much equally effective by all known measures. And if it really were helping, symptoms would be reduced for a lot longer than a day or two. 5) As for prodrome, it's nothing like you are experiencing. Prodomal symptoms occur because of nerve irritation, typically with tingling, numbness, pain, and related sensations, but without itching, which implies an irritation in the involved tissues themselves.

Don't get me wrong. I have no doubt you're having real and distressing symptoms, and I believe you should keep working with your doctors on potential causes and their management. I'm confident no other STD is involved, because the symptoms also are wrong for all other STDs, because of the source of your infection (no reason to suspect your husband of having other STDs), and the negative tests you have had. I would ask whether you have been treated for possible yeast infection. Yeast can be difficult to diagnose by exam or lab testing, yet marked relief can be achived with appropriate treatment -- maybe worth a try.

So I'm afraid there's nothing more this forum can do, except to encourage you to continue to work with your doctor. Referral to a gynecologist who specializes in infectious diseases and/or vulvar disorders might be a logical step.  

Good luck and best wishes--  HHH, MD
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99 months ago
Thank you for reply and I apologize if I have violated any protocols. 

I have been treated for yeast and it did not help. Could it be post heretic itch? (Terri had never heard of it but i have read about it). 
Do you know what sort of doctor I should see? My OBGYN is at a loss and I'm not sure what kind of Dr. I should head to next to get this resolved.

Thank you 
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99 months ago
sorry I missed the bottom of your email where you told me what Dr. to go to. Thanks
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H. Hunter Handsfield, MD
99 months ago
Thanks for the thanks. You didn't run afoul of any forum policies.

I also am unaware of "post herpetic itch". I suspect you saw that some such patients have had such complaints, but this is not a phenomenon recognized by experts in herpes or STDs.

A condition not mentioned so far is idiopathic vulvodynia. (The fancy looking term doesn't say much. It's just Latin for vulvar pain of unknown cause.) Your symptoms don't seem typical -- usually burning, not itching, and without redness or other visible abnormalities. But your ObG will know about it, and likely is aware of other ObGs with special interest in this and other unexplaind or inflammatory vulvar pain or itching (that's what I meant by suggesting someone with special interest in vulvar disorders). Or a dermatologist might be helpful.
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