How to manage recurrent herpes genitalis outbreaks?

Question

Hello Doctor,

For the past six months, I have been experiencing small red bumps on my penis, which appear and disappear in the same area. There have been four episodes during this period. I tested negative for HSV with a PCR test after the first outbreak (I have not had sex since), but my HSV-1 and HSV-2 antibodies were positive. Since I had no major symptoms, I assumed it was not herpes.

Two months ago, I noticed vesicle-like bumps in my pubic area, which were not painful or itchy and resolved on their own after 10-12 days, leaving a mark. This occurred again two days ago. About a week ago, I developed pimples on my penis and two small, itchy pimples between my penis and pubic area. These healed and scabbed over. The bump on my penis was in its usual location but was itchy this time.

Currently, the bumps are in different stages of healing—some are new, and some are healing. I had a swab test for herpes on the pimples between my penis and pubic area, which was negative. However, I am unsure what this could be, given the recurrence and worsening of symptoms, and I am still considering herpes despite the negative lab results. I have attached pictures for your review.

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I have seen the pictures. (attachment removed to protect patient identity).

This is a classical herpes genitalis. A positive antibody test for HSV 1 and 2 substantiates that. The virus causing herpes stays dormant in the nerve cells, causing no symptoms. In most people, the virus becomes active from time to time, traveling from the nerve cells to the skin and causing repeated blisters and sores (recurrent outbreaks). Negative blood, PCR (polymerase chain reaction), HSV (herpes simplex virus) tests do not rule out herpes. The gold standard for diagnosing herpes is a test done on a sore (either a viral culture or PCR testing), and not a blood test.

I would suggest an oral antiviral Acyclovir or Famciclovir for the episodes of herpes. However, if you are having frequent recurrences, you may be a candidate for suppressive treatment.

I hope this answers your query.

Please let me know if I can assist you further.

Thank you.