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What are the symptoms of herpes virus infection ?

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General & Family Physician
Practicing since : 2010
Answered : 157 Questions
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History - I am age 48. Dated this lady for 3 years and she found out she had hsv2 all along. She had an outbreak and was tested pos by culture. I have been on a roller coaster ever since. I read that where people who are having an outbreak have the virus present 20% of the time and asymptomatic people have the virus present 10% of the time. Also, the symptomatic and asymptomatic people shed the same amount of the virus. This was published by the University of Washington this week.

Next, I got tested for HSV2 at 3 wks, 6 wks and 10 wks via the Herpeselect IGG Elisa test. Each of those came back negative. Like a dumbass, I had a test done via an online outfit, using Quest labs, and it came back a low positive 2.0. It, too, was an IGG Elisa. I asked a renowned expert - Hunter Handsfield, MD, and he says the low positive is likely a false positive since it was 6 months post exposure and] the values were so low. He went on to say that about 70 to 80 pct of the low positives in this range are actuallly false - especially given I've had the 3 previous negatives. The lady and I used condoms approximately 75 percent of the time we had sex.

I am on anxiety medicine, and drinking heavily and am freaked out. I take Lysine, Olive Leaf Extract, Indole 3 carbinol, resveratrol and licorice root extract. All of these are supposed to have inhibitory effects on herpes and have some science to back them up.

It has been almost a year since I was with the lady. I have had NO outbreaks, but occassionally my scrotum will get hot and a little redder than normal and stay that way for a few days. It seems to be worse in some attire than it is in others.

Otherwise, I am in good overall health. I exercise 3 or 4 times per week and eat fairly healthy.

1. Do you think I have hsv 2 in light of all the above?
2. Would hsv2 cause my scrotum to get red and hot? I read that it rarely affects the scrotal area.
3. Am I doing myself any harm in taking the supplements above or am I helping myself?
4. I am not crazy about continued blood testing, and realize it isn't perfectly reliable so I don't know if I will pursue it. Would you or wait and see if you get lesions?
5. Given there is no cure for hsv, and I am not having active outbreaks, is there any real benefit (personally) in knowing I have it - if I do?

6. Ignoring the stigma, is hsv2 a big deal from a health perspective?

7. How does hsv2 usually manifest itself in a heterosexual male and over what course of time? For example, usually an outbreak on the penis - 75% of time, etc.

All other advice is appreciated.
Posted Wed, 2 May 2012 in Sexually Transmitted Diseases
 
 
Answered by Dr. Sunil.N 1 hour later
Hi ,

Thanks for your query.

After analyzing your history the answers to your questions are :
1. Do you think I have hsv 2 in light of all the above? - Considering the tests and the duration after exposure it is Unlikely to have HSV 2.

2.Would hsv2 cause my scrotum to get red and hot? I read that it rarely affects the scrotal area? - Yes it is unlikely of HSV 2 affecting the scortum, the redness and uneasiness may because of the undergarments.

3.Am I doing myself any harm in taking the supplements above or am I helping myself? -As there is no therapeutic claims for any Dietary Supplements i don't believe it is of much help to you.

4.I am not crazy about continued blood testing, and realize it isn't perfectly reliable so I don't know if I will pursue it. Would you or wait and see if you get lesions? - Since the Previous test are negative there is no need for the Retest. If you notice any lesions suggestive of Herpes(vesicles) then you can get it tested.

5.Given there is no cure for hsv, and I am not having active outbreaks, is there any real benefit (personally) in knowing I have it - if I do?
If there is history of positive for HSV 2 you can prevent it spreading by using condoms during sexual intercourse.It can re activate during Immunosuppression time by knowing your HSV status you can avoid or take prevention of certain things which causes Immunosuppression.

6. Ignoring the stigma, is hsv2 a big deal from a health perspective?
Some people may develop severe herpes infections that involve the brain, eyes, esophagus, liver, spinal cord, or lungs. These complications often develop in people who have a weakened immune system, AIDS, are undergoing chemotherapy or radiation therapy, or who take high doses of cortisone.


7. How does hsv2 usually manifest itself in a heterosexual male and over what course of time? For example, usually an outbreak on the penis - 75% of time, etc.
This first outbreak usually happens within 2 weeks of being infected.
Genital symptoms include the appearance of small, painful blisters filled with clear or straw-colored fluid. They are usually found:
A)on the penis, scrotum, on the thighs or buttocks
B)Before the blisters appear, the person may feel the skin tingling, burning, itching, or have pain at the site where the blisters will appear.
C)When the blisters break, they leave shallow ulcers that are very painful. These ulcers eventually crust over and slowly heal over 7 - 14 days or more
D)Enlarged and tender lymph nodes in the groin during an outbreak.
E)Painful urination

The best way to avoid getting genital herpes is to avoid multiple sexual contact.
Next best is being in a long-term, mutually monogamous relationship with someone who has been tested and is not, and never has been, infected with herpes.
Using a condom correctly and consistently will help prevent the spread of the disease.

Hope I have answered your query. If you have any follow up queries I will be available to answer them.

Regards.
Above answer was peer-reviewed by
 
Follow-up: What are the symptoms of herpes virus infection ? 37 hours later
1. How much experience do you have with and in the diagnosis of std's, particularly herpes?

2. I had the one blood test that was a low positive. Did you take that into consideration in your reply back to me?

3. There is much debate among the medical community regarding what constitutes herpes symptoms and what does not. Many experts in the US say that burning, unless followed by outbreaks, is not symptomatic of herpes. Others say burning by itself can be herpes. What is the right answer?

4. Do you see a cure for herpes on the horizon in the next 10 years?
 
 
Answered by Dr. Sunil.N 15 hours later
Hi again,

Thanks for following me up,

I shall answer ,

1)How much experience do you have with and in the diagnosis of std's, particularly herpes?
I do have working experience in HIV and STDs diagnosis and management for more than year in a community care center.

2) I had the one blood test that was a low positive. Did you take that into consideration in your reply back to me?
Yes, i did consider the weakly negative test and then concluded you to be negative for HSV.I agree with Dr Handsfield's comment on the same.

3)There is much debate among the medical community regarding what constitutes herpes symptoms and what does not. Many experts in the US say that burning, unless followed by outbreaks, is not symptomatic of herpes. Others say burning by itself can be herpes. What is the right answer?
My knowledge and experience says HSV infection do not produce isolated symptoms , like burning .Its always the package of symptoms at a time hence called out break.

4)Do you see a cure for herpes on the horizon in the next 10 years?
Well there is cure available , its only the prevention recurrences which is at research and there will be light on this soon.

Hope you got your query answered completely.
Above answer was peer-reviewed by
 
Follow-up: What are the symptoms of herpes virus infection ? 22 hours later
1. Per your statement, "Well there is cure available , its only the prevention recurrences which is at research and there will be light on this soon." Can you elaborate on the term "soon"? Is this 5 years, 2 years or less?

2. Is this complete suppression in terms of shedding, etc?

3. Is this a daily medication or vaccine?

4. There was a recent report indicating 50 to 75% of women in my age group have hsv2. Would you date a woman if you knew she had it?

5. If I were to get it, how would it most likely manifest itself?

Thanks and you've done me well

 
 
Answered by Dr. Sunil.N 1 hour later
Hi Again,

Thanks for the follow up query.

The term soon is used because the research programme takes its own time to finish and it has to get approved by the authority(like FDA) before it becomes available to everyone.

Once a person get infected the virus stays in the body dormantly without causing any problem.Treatment available to prevent the complications.The dormant stage virus stays long time in the body and may resurfaces once the body immune strength decreases.

There are no licensed vaccines currently available, AlphaVax(vaccine under trail for HSV2) is still in the research stage,once its safety is confirmed it will be released to the market.
Medications are given in the intial stage to prevent copmlications from herpes.Antiviral comes in IV preparation,they are not meant for daily administration.

The symptoms of HSV
small, painful blisters filled with clear or straw-colored fluid. They are usually found:on the penis, scrotum, on the thighs or buttocks.When the blisters break, they leave shallow ulcers that are very painful, and other features we had discussed earlier.
These symptoms varies not all the symptoms have to present in the particular episode.

Herpes is better prevented than cured.

Hope you got your query answered completely.

Regards.
Above answer was peer-reviewed by
 
Follow-up: What are the symptoms of herpes virus infection ? 20 days later
Doc, thanks... I noticed last week, I went jogging, and immediately after my scrotum was cherry red and and on a small part of the penis that immediatey connect to the scrotum was red. It stayed that way and felt hot Monday-Friday of last week. I started putting Lamisil on the scrotal area on Thursday and it began to do better and now is back to it's normal color. I am scared to death this is herpes as this keeps happening about every month or so.

If one has hsv2 does it get better as time passes?

No lesions though... Any ideas? Also, I read in a recent report on NPR (Dr. Leone at UNC School of Medicine) that between 50 and 75% of all unwed women between 40 and 50 have hsv2. Have you read and do you believe this?

Thanks
 
 
Answered by Dr. Sunil.N 7 hours later
Hi and thanks again,

The redness which occurred a week ago was probably due to irritation / reaction causes secondary to sweat - contact dermatitis. Fungal infection or folliculitis secondary to other infection are my second condition likely responsible. It is extremely unlikely to be associated with HSV 2 and I do not consider this symptom as an outbreak.

As far as the statistical analysis, yes it is common that one out of every five women have proved to be infected with HSV ( around 30% - according to 'Centre of Disease Control' reports). The rates increases proportionally to the number of sexual partner one has.

I wish not to comment on Dr. Leone's reports as I am not aware of the source of its reports.

Both CDC reports as well as Dr. Leone's reports highlights to point that HSV infections are much common in women involved in multiple partners.

Hope I have answered your query.

Regards
Above answer was peer-reviewed by
 
Follow-up: What are the symptoms of herpes virus infection ? 9 hours later
Per your comment, " It is extremely unlikely to be associated with HSV 2 and I do not consider this symptom as an outbreak", what percent chance would you give this as being an outbreak? Next, if it is one of the things you cited, am I ok to treat it with Lamisil? Do they go away on their on and do they come back on their own?

Do men my age (49) start to have fungal infections/jock itch more as they get older? Is it common for these to turn the scrotum red and burn? Most US doctors say herpes affects only a small portion of skin, say the size of a dime and therefore that is another reason it is unlikely to be the cause of my red scrotum. Do you agree?

Next, the report to which I am referring can be read at:
WWW.WWWW.WW

Please read, as it is short and let me know if you agree with the assessment that between 50 and 75% of unwed women from 40 to 50 have hsv2.

Lastly, I have read that hsv2 is typically the most active in it's first year. Is this true and it becomes more and more dormant, typically, over time? When do you think there will be a complete suppressant or cure?

Are you aware of any supplements that help treat herpes symptoms? I have heard all of the following help:
Lysine,
Olive Leaf Extract,
Indole 3 Carbinol,
Licorice Root, and
Zinc

Your thoughts?
 
 
Answered by Dr. Sunil.N 14 hours later
Hi and welcome again,

I can understand that you are anxious and want to get over this current event soon. I hope my answers help you in alleviating all your anxiety.

A typical herpes outbreak comprises off localised soreness-blistering-ulceration-crusting-scab that peels off. Though localised areas of redness are considered sometimes as warning signs of an outbreak, considering in your case the symptoms was more generalised to the entire scrotum and you have been tested negative recently prompted me to my opinion. The redness that you mentioned in your previous query is extremely unlikely to be an outbreak. Though I cannot specify a percentage, I would give your chances as less than 2%.

Fungal infection is an opportunistic infection. They grow and infect us humans when the condition is favouring - moist and dampness of the scrotal region is a favourable condition; and when body resistance is compromised. Increase risk of fungal infections in elderly, diabetic, malnourished, HIV infected individuals and other chronic debilitation medical conditions are evidence to my last statement.

Yes, herpes lesions are often grouped or localised to a particular area of skin. Generalised symptoms often aren't significantly considered as symptoms of herpes infection.

When I said, I am not aware of the source; I meant, I am not sure of the source of Dr. Loene's information. Hence wish not to comment on Dr. Loene's report. CDC reports have mentioned the prevalence of Herpes in above 40years individual as 30%

The primary symptoms of HIV often occur within the first 6 months of exposure. Again these symptoms are most often occur within the first few weeks of exposure. The virus becomes dormant and secondary outbreaks whenever body resistance reduce. The time when they become dormant varies among individuals depending on host immune factors. However it remains incurable yet.

Finally the herbs and supplements that you have reported have no clear evidence in the treating / curing Herpes. I do agree that the can help you in keeping body resistance fit, thus may play a role in suppressing the outbreaks.

Hope it is clear to you. I am available to answer any other follow up questions.

Best wishes
Above answer was peer-reviewed by
 
Follow-up: What are the symptoms of herpes virus infection ? 18 hours later
So, if I were to have herpes and have an outbreak, you expect I would have painful ulcerating blisters, right?

Next, why then is there so much disagreement, even among experts, on how herpes presents itself? I see pictures on the Famvir site that shows someone with red testicles and they say this is a mild outbreak...

I am ok to treat this redness with Lamisil?

 
 
Answered by Dr. Sunil.N 2 hours later
Hi again,

Symptoms of herpes vary among individuals. Yes, the typical symptoms are most often seen in individuals who have never been exposed to herpes in the past, such as in you. Statistically this is often seen in about 80 to 90% of times. Rarely in about 10% individuals, milder symptoms such as itching, localized soreness and even asymptomatic presentation occur.

Expert's opinion vary as the initial presenting symptom (primary out breaks) has been varied.

However with the evidence of negative Herpeselect tests (which are expected to be accurate in 95 to 97% of times), the scrotal redness which you had described are chanced remotely to be HSV 2 infection.

I would hence answer your first question this way.

It is not right to say absence of painful ulcerating blistering are against feature of Herpes. Since the symptoms got better with use of antifungal cream it may not be herpes and you have been tested negative; I agree with you here. It is not 'herpes outbreak'.

'Lamisil' is an antifungal cream. It is effective in treating fungal infections. You could use them after a physical examination to confirm fungal (Tinea) infection. Use measures strictly to prevent scrotal dampness such as use of loose, sweat absorbing undergarments.

Hope this answer reassures you.

Wish you good health!!!

Regards
Above answer was peer-reviewed by
 
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