I'm a middle-aged male who just came off of long-term benzodiazepine use, lorazepam 2mg daily, for a period of around 3-4 years. I have been fully off of benzodiazepines for about 3 months, but about 6 months ago or so (as I was doing a thing called 'tapering' off the medication) I acquired some kind of recurrent herpes infection. I have also had candida infections, and I suspect UTIs as well (see Heather Ashton's work re infections during withdrawal from benzos).

There are only a few days per month in which I am not having an outbreak, and new blisters often show up before the old ones have healed fully. My doctor has looked at it once as it was almost healed, and he gave me a very strong antibiotic (moxifloxacin) that did not make it better. He will not prescribe me valacyclovir or acyclovir because he says it is harmful to the kidneys. Additionally, they have said they cannot have a culture done because this would require "cutting it off." Because of this, I have waited months now hoping that it would go away on its own, given that herpes infections tend to get better over time. They have done many blood tests (not for herpes): HIV, blood sugar, etc., and found nothing significant.

Given my proclivity to new infections at this time (via benzo withdrawal and recurrent HSV2), how safe/dangerous is it to sleep with CSWs in Thailand? My main concern is HIV, and if having any kind of infection raises CD4 count, I am concerned this may increase my HIV risk.

P.S. I have not had a confirmed herpes diagnosis, but a sexual partner complained to me that she got herpes (confirmed by a doctor) about the same time as I did.

Something doesn't compute. Herpes does not respond to antibiotics like moxifloxacin, which is never used for herpes treatment. And genital herpes never keeps recurring with the frequency you describe ("only a few days per month in which I am not having an outbreak"). Every case of recurrent genital herpes (or oral herpes) recurs no more often than once a month, usually once every 2-6 months; each outbreak lasts 1-2 weeks; and there are no symptoms at all between outbreaks. So my first advice is to see a provider who understands genital herpes and have the diagnosis confirmed, and properly treated if indeed you have genital herpes. It seems you either have a misunderstanding of your doctor's diagnosis, or s/he isn't very knowledgeable in this area, or you have. Valacycvlovir or acyclovir do not cause kidney harm. It also is nonsense that a culture for HSV would require an amputation of some sort ("cutting off" what???).

And of course a partner's complaint that she got herpes "about the same time" as your symptoms began is not serious evidence that herpes explains your symptoms; there are plenty of other causes of genital area skin problems. So my guess is you do not have genital herpes at all, but perhaps some other condition. There are excellent STD specialists in Bangkok; with a bit of online investigation and phone calls, you should be able to find a knowledgeable physician or clinic.

You also have other misunderstandings. Benzodiazepines or withdrawal from them do not increase the risk of any infection. (I've never heard or Dr. Ashton, but a quick look at the medical literature indicates she used to publish articles on benzos and their use, but I see nothing about increased infection risk.) And while having HSV2, if you have it, would increase your risk of HIV if sexually exposed, it does not raise the risk of any other infection; and the magnitude of increased risk of HIV is not great. All things considered, there is no reason to suspect you are at increased risk of anything. I would suggest you just follow standard safe sex methods if you continue your CSW contacts, and periodically (e.g. every few months) be tested for HIV, syphilis, gonorrhea and chlamydia.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

In the Ashton Manual, a guidebook for overcoming benzo withdrawal, she mentions anecdotally that many of her patients had various infections. She did not claim to know why this was the case, and thought it needed further study. But the logic is that if one is more vulnerable to infections during benzo withdrawal, then one might also be more vulnerable to HIV, etc. There's probably no way to know this for sure, but you seem confident that this is unsound. Given my near-constant outbreaks, I thought this made sense.

I suppose I'll wait for another outbreak-type event again and see a specialist.

Any localized inflammation can cause lymph node enlargement and tenderness. That aspect has no bearing on whether you have a bacterial or viral infection. Either you are misinterpreting or misunderstanding your doctor; or he is a rank amateur when it comes to infections. Maybe some of each.

The kind of "evidence" you attributed to Ashton is BS, completely unreliable in my view. There is no science behind the sorts of statements you say she has made. In my 40+ years as an infection specialist, this is the very first I've ever heard about any hint of benzo drugs or withdrawal increasing susceptibility to infections, and I've also checked with some colleagues. All agree this is BS.

I don't know what is causing your "outbreaks", but I would be very surprised if it is herpes. You don't need to wait for another outbreak to be tested for HSV infection. But so far, you have been far off base in all aspects. I hope you are able to find a qualified ID or STD expert to guide you. Good luck.