Some Herpes Questions Experts

[james7767]

10 months ago 3 ulcers developed on my foreskin. I had enlarged groin glands and a 24hr fever. The ulcers tested pos for HSV2. Sound like a primary outbreak? During my 1st OB the ulcers were in contact with each other and the head of my penis. Why did the virus not spread there? The head does not stretch like the foreskin during sex so served as an in tact barrier? Or does the head have better inter intra cellular defences? Since my 1st outbreak I've had 12 much milder OBs. The OBs have been getting milder but the frequency has not decreased much, perhaps from 3 to 5 weeks. Do some men go from my number of OBs 1 a yr? Even after years? Is asymptomatic shedding simply a period in which virus particles exit the neuron but not in great enough concentrations to destroy noticeable numbers of skin cells? I read I can shed "anywhere in the boxer short area". I've had OBs no further than 2in from the head of my penis and never directly on the front. The OBs are localized. Is my asymptomatic shedding localized to the same area? During an OB, where do the virus particles come from? Is the virus already definite at the root of the boxer-short-area nerves in me? Has it perhaps only reached an intermediate point between my skin and the nerve root, hence why my OBs are localized? When the virus is reproducing how does it find the skin surface? Is it sophisticated enough to navigate? Or does the virus just reproduce in such numbers that particle density forces particles along the neurons to the surface? During my 1st OB I took acyclovir for 5 days. Once healed, I noticed the consistency of my semen had changed from cloudy white to clear. My doc assured me this was nothing to worry about and was a result of the infection. My semen returned to normal but during my 2nd OB I took acyclovir. My semen became clear again! I read a paper indicating the effect of acyclovir on sperm production in rats is negative. Have you heard of similar reports by men taking acyclovir?

[james7767]

Thank you for your response. Can you recommend any research level resources on HSV? I am interested in determining how likely it is that I pass it on beyond the blanket statistics.

I read several studies researching asymptomatic shedding but none state where swabs were taken from. For example if I were to take part in a study I assume they would swab the end of my penis. But this wouldn't say a lot about shedding from the base of the penis and legs which are the areas I would transmit the virus to another person if wearing a condom, I assume.

Just to confirm, you would expect me to shed virus from my legs and buttocks and base of penis in the future?

Would you say there is a kind of pattern in transmission, say a discordant couple only have sex in the missionary position, would you expect someone with herpes OBs only on there left leg to lead to a partner with OBs only on their right leg?

Finally is the main reason condoms do not work better at preventing HSV simply because they do not cover areas where the virus is shed from?

[Edward W Hook, MD]

Welcome to the Forum.  You ask a number of good and basic questions about herpes. The answers to some but not all of your questions are known. For some of your questions the answers are also complex and were I to answer all of them, I could write a book- something that space and time do not permit.  

I will do my best to answer your questions where answers are known.

1.  Why did your lesions occur on your foreskin and not the head of your penis.  I cannot answer this and the answer is not known.  HSV is spread through direct contact.  Friction and abrasion enhance transmission and perhaps the mobility of your foreskin made that localize your infection there.

2.  Outbreak frequency.  You have been having very frequent recurrences.  The average is 3-4 recurrences per year in the first 1-3 years after infection.  We note that recurrence frequency tends to decrease gradually over time (years).  Given the frequency of your recurrence, you may wish to consider taking suppressive therapy.

3.  Outbreak location.  Herpes is an infection of nerve roots.  Recurrences occur in the distribution of nerves supplied by those roots and the distribution of nerves is rather widespread, leading to the statement the both recurrences AND asymptomatic shedding can occur in the distribution of the nerves served by the nerve roots.  When reactivation occurs to lead to either asymptomatic shedding or a clinically apparent recurrence, the activation occurs in the nerve root and then the virus travels down the nerve to be present as the areas of skin supplied by those nerves.

4. Acyclovir impact on semen. There are no scientific data to suggest that taking acyclovir or other therapy causes changes in the quantity or quality of semen in infected persons.  The drugs for HSV treatment are amongst the safest medications used in all of medicine and, for that reason are commonly used even in pregnant women, the group most effected by drug side effects.

I hope these comments are helpful.  As I said, I have limited time/space for addressing so many broad questions.  Follow-up will be limited.  EWH