[Question #5134] HSV-2 Complications, Treatment, Risks

25 months ago
I first got sick on 3/5/19 with fever, aches, diarrhea, and flu like symptoms which improved around 3/8/19.  Rectum and anus became very sore and inflamed.  Also a lot of prostate pain and difficulty urinating, so went to clinic on 3/8/19 and they performed panel of tests including a swab of ulcer that they saw in my anus.  They gave me prescription for cipro and valtrex for 10 days as well as lidocaine ointment for anorectal pain.  Suggested that I had prostatitis.  While waiting for test results from clinic, I had a followup appointment with my doctor on 3/11.  Suggested I finish my course of cipro and valtrex and monitor.  I felt like I was on the mend by then so didn't pursue further treatment.  Dr. also did some tests.  Later in week I got test results back from clinic, all were negative except for PCR test from swab which returned positive result for HSV-2.  Tests dr. did also came back negative.  I completed course of cipro and valtrex on 3/18 but began to have issues urinating, prostate pain/enlargement, not having bowel movement, significant lower back and leg pain (everything from waist down).  Also experienced anal discharge with pus tainted with light blood.  Went back to Dr. on 3/18 with lab work results from clinic.  Doctor thinks issues were complications from HSV-2.  Gave me antibiotic injection, 1G zithromax oral, and flomax to help with inflamed prostate.  Prostate and urination improved this week, however I was unable to produce a bowel movement until yesterday 3/21 after taking laxative.  Back pain and leg pain still there and anal discharge and lots of anal/rectal pain/inflammation.  Are these complications of HSV-2?  Should I go back on valtrex until symptoms improve?  Is HSV-2 causing nerve pain and GI issues?  Once I heal is it possible for me to transmit HSV-2 from other places besides my anus where original ulcer occurred?  What is benefit to taking valtrex on continued regular basis?
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
25 months ago
They are not really complications from herpes, at least I wouldn't use that term, but these things most definitely can happen with a new herpes infection.  The irus causes some nerve dysfunction that prevents some people from peeing or having a bowel movement and pain down the leg.  the antibody test would be negative with a new infection - virus present on the skin but not enough time has passed to make an antibody response.  Valtrex is definitely our friend here and you should be taking 1 gram twice a day.  Once you heal up, yes, you can transmit herpes from the penis as well as the infection is in the entire nerve group that supplies that area.  Daily medication will reduce the frequency of recurrences and reduce transmission to future sex partners. 

Terri
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25 months ago
Hi Terri,

I feel like I'm putting a whole lot of trust in one single test.  Hard for me to completely rethink my life based on one test result.  Is there any means of monitoring level of viral activity?  Should I baseline test for antibodies and test again in x amount of time?  What does this tell me?  My Dr indicates no benefit to continuing antiviral.  What do I say?
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
25 months ago
By that, do you mean the positive swab test from an ulcer by your anus?  Yes, you should put trust in this swab test!  While there have been documented cases of false positive swab test results, I know of three in 35 years of practice.  You should trust this 1) because you had an ulcer in the skin 2) the swab test was positive and 3) not only was it positive, but also able to be typed (HSV 2).  You also had symptoms completely consistent with new infection - difficult urinating and defecating,  and pain down the leg.  You can certainly do an HSV 2 antibody test at some point in the future but remember if you continue to take the antiviral medicine, it will most certainly slow the development of antibody and as long as you take daily Valtrex, you cannot trust a negative antibody test.  If you are going to do an antibody test after coming off Valtrex, you should wait 12 weeks for greatest accuracy.  Frankly, I don't think that's necessary, given the positive typed swab test, but for you, it may be necessary for you to fully accept this diagnosis. 
The benefit to daily suppression is 1) fewer recurrences and 2) less viral shedding thus reducing transmission risk.

Terri
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25 months ago
Thank you Terry.  Yes, I was referring to the swab test.  In addition to daily suppression therapy with Valtrex, I just want to understand if there's any way to monitor my risk of transmission and/or level of HSV in my body.  How much does daily suppression therapy with Valtrex reduce my chances of transmission to a partner?  I fully realize condom use is a requisite, as well as obligation to notify partners.  Do you have any transmission rate statistics for gay men?  Very disappointing to learn how few clinics even test for HSV.  People who try to do the right thing by getting tested regularly aren't even tested for HSV antibodies.  So many people out there who may not know they are carriers.  Appreciate your efforts and am thankful for this channel.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
25 months ago
The only other way to test for the presence of virus on your skin would be to do daily home swabbing of the genitals.  However, that isn't perfect either because shedding episodes can be very short so if you swabbed in the morning, for example, you could be shedding in the afternoon.  And results aren't immediate - they come days or even weeks later.  And they are expensive - about $100 or more per swab.  Valtrex reduces transmission by almost 50% and condoms reduce transmission by 96% so with both, you are pretty darn safe.  There are gay men in our studies of shedding, yes, but not of transmission.

Terri
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