[Question #2483] HSV-2 and neurological symptoms

43 months ago
I, a 50 YO homosexual male, presented 8 weeks ago with fever, weight loss, urinary retention, addtl symptoms c/w proctitis, pain in glans, and an anal fissure.  Several days later, I had a couple of viral plaques on my lower back and hip.  10 days after presentation, I started acyclovir.  All STD tests were negative except for an eventual IgM pos for herpes (new) and eventually IgG pos for HSV-2 (new).   HSV-1 serology is negative.  Still recovering from surgical hemorrhoidectomy & fissure repair.  Urinary retention problems have resolved (never required cath), glans hurts less, but urination still feels "odd."  There was never burning w urination.  Orgasms have become painful, not burning, but painful -- hard to localize pelvic discomfort and pain.  Could this be Elsberg Syndrome, some form of herpes-induced myelitis, some form of pudendal nerve issue?  Infex DZ doc stumped.  GI surgeon stumped.  Both want to refer me to a urologist -- who you know will treat me w antibiotics for prostatitis.  Better to see a neurologist?
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
43 months ago
You mention an eventual positive IgG for HSV 2 - does that mean that you did have a recent negative IgG for HSV 2? was any swab testing done? 
Normally first infection will not appear on the buttocks or back  but recurrences can. I have not ever heard of herpes causing pain with ejaculation.
You mention taking acyclovir 10 days after the presentation of symptoms - are you still taking it and if so, how much and how frequently?
Have you had prostatitis before, is that why you think he will diagnose you with this?

Terri

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43 months ago
Hi Terri.  Thanks so much for the reply.  HSV-1 and HSV-2 IgG testing in January and March 2017 was negative.  First visit to local clinic resulted in an IM injection plus 7 days of oral antbx.  There were no visible viral lesions.  The following week, a visit to GI doc for discharge, extreme pain, and blood per rectum resulted in identification of viral lesions (as described) but GI doc thought it was shingles.  He put me on acyclovir plus another round of oral antbx.  Following week, Infectious Disease doc disagreed with viral impression (but he drew serology).  Regardless, he switched me to valcyclovir (2 gm BID x 10 days, then maintenance of 1 gm QD), and he repeated all STD tests.  All repeats came back negative except for herpes IgM -- which had converted to IgG pos 3 weeks later upon retesting.  He agreed w you that viral lesions were atypical in appearance and location, but to be fair, he saw the lesions 2 weeks into it, and they were already resolving.  Nevertheless, I think the serology is fairly convincing (Yes?).   I became sexually active for the first time in Jan 2017.  I've never had an STD nor anything like proctitis or prostatitis.  I probably shouldn't glean info from the Internet, but all case reports I could find of men complaining of painful orgasms included treatment for many weeks with oral antibiotics.  Many of these men ended up having odd neurological diagnoses (e.g.  Elsberg, transverse myelitis, or some kind of chronic pelvic pain syndrome).  My symptoms started very acutely w fever,  urinary retention, glans pain, painful orgasms, weight loss (I eventually  lost 15 pounds), proctitis symptoms and signs, an anal fissure, apparent viral lesions (although uncharacteristic), and a serological switch from HSV-2 neg to pos.  Thanks again for your reply.  
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
43 months ago
So you started out IgG negative and then became positive?  At what index level? 
What kind of sexual contact had you had prior to these symptoms?  Unprotected anal sex? 
And no one did a viral culture of these lesions, is that right? 

Terri
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43 months ago
Yes.  I was IgG neg and converted to IgG pos.  The testing was performed at LabCorp, and HSV-2 results were reported as High (3.21; index range for pos >1.09).  Yes, it was unprotected anal sex.  Correct; no one cultured the lesions.  Probably didn't occur to the GI surgeon to do it.  By the time the ID doc saw me, the lesions were healed, and there were no vesicles to unroof and swab.  
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
43 months ago
OK, given all of that information, it does appear that you have new herpes anally.  I think it is entirely possible that you are having some remaining symptoms from your first infection.  The immune system has lots to do to get this virus under control and it is likely a bit more difficult as we get older.  Are you currently taking antiviral medicine?  If not, you might want to try that and see if it helps your symptoms.  I'm so sorry that this all came about just when you became sexually active.  I think it is important since you had unprotected anal sex and acquired herpes, that you also get checked for other STI's anally and certainly have an HIV test.  All this may have already been done but if not, please do it.  If you have more questions, please feel free to renew here on the ASHA website.

Terri
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