[Question #5736] Follow up HSV1 ?

21 months ago
Teri I inquired a couple of weeks ago about a sore rash on the head of my penis that has is mostly bright red , burns/ stings and some spots are slightly raised but has not had any spots that present as pimple looking blisters.  I'm married and haven't had anyone perform oral on me in 10+ years.  You said that the symptoms did not present as HSV1, however, I cant seem to get it to go away.  Some days it's worse than others and last night I had back pain and it seemed to get worse again ( burning and stinging with a couple of new spots) This morning it is a little better, still no raised pimple like bumps.  I want to my family practitioner almost 2 weeks ago and and also showed him a rash in my groin area that has been present for several months that doesn't itch or burn.  He seemed to think it was jock itch and also caused my rash on my penis.  He prescribed Terbinafine 250mg which I have now been taking for 11 days but still have the same rashes ( penis and groin).  I had an IgG positive HSV1 (47.4) test a few weeks ago so I obviously have HSV1.  However, I am trying to determine if the penis rash could possibly be HSV1 without the classic symptoms ( raised blisters , puss filled , crust over after a couple of weeks). Is there such thing as chronic HSV1 rash that just won't go away? I started on Acyclovir yesterday just to see if that would get rid of it.  Please let me know your expert opinion.  Thanks!
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
21 months ago
No, there is no such thing as HSV 1 rash on your penis head that 1) sounds like yours and 2) doesn't go away.  I think it is an error to start herpes medicine as it could resolve on it's own or with the help of the antifungal and because it went away, you will think it was treated by the antiviral and thus you have herpes.  Right?  Have you tried topical medicine on it that is antifungal?  Is not, you could try that.  I would also suggest that you go to see a dermatologist for a more definitive diagnosis.

Terri
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21 months ago
So Teri, just a quick follow up.  Does genital HSV1 always present as sores or pimple like bumps that have clear liquid or are puss filled or can it also present as just a red rash that burns?  The reason I ask is because Some of my pain is from small raised bumps but there is never any liquid in them and they do not crust over.  They just kind of stop hurting after several days.  The other part of my penis is basically as I described before, just a red rash that sometimes feels like a burn. Again, this has been going on for over 4 weeks now.  
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
21 months ago
No, HSV 1 does not present as a simply a diffuse red rash.  Again, something that goes on for four weeks as yours has is not consistent with a herpes infection.  Please take my advice and see a dermatologist

Terri
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21 months ago
Teri so I am getting conflicting information from another site called Doctor Spring.  They tell me that herpes can present as a red rash and not fluid filled and last for several months if not treated and they recommend I start Acyclovir immediately.   They also said my viral load is very high. I am not questioning your answer or advice but It increases my anxiety when I receive conflicting opinions and you seem to be much more credentialed than the person ( dermatologist) on their site.  Can you provide me with some reassurance that what they are saying is inaccurate? I plan to see my Dr. again or a dermatologist but that could take weeks to get an appointment. Thanks for your help!
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
21 months ago
I do not agree with Dr. Spring and I wonder who their herpes expert is, if the have one.  Did you ask? 
Obviously they don't know how to interpret an IgG test is they tell you that your viral load is very high - this test does not measure viral load, it measures antibody.  You simply have a high level of HSV 1 antibody because you've been infected for a while. 

Terri
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