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STDs (Expert Forum)
Genital Herpes and Numbness
Answered by
University of Washington
Seattle - WA
This forum is for questions and support regarding STD issues such as: Chlamydia, Crabs (pubic lice scabies), Gonorrhea, Hepatitis (viral), Herpes, HPV, Molluscum Contagiosum, PID, Rectal Infections, Syphilis, Trichomoniasis, Warts, Yeast Infection.All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.
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Genital Herpes and Numbness
by tammi66, Jun 08, 2007 12:00AM
I’m a 41 year old female. Tested positive for genital herpes in Dec.06 per a swab culture test. During and after taking the Valtrex, I noticed numbing on the left side only, of my buttocks, vagina, down the back of my leg and bottom of my foot (NO pain though). Could this be related to HSV. Now 6 months & 3 doctors later I think it's possible. I went to a Neurologist, had MRI’s, brain, cervical, thoracic, lumbar…etc, no slipped disc pressing on a nerve or sciatica. MS was ruled out at the Cleveland Clinic. Tested neg. for Lyme disease, Lupus, Syphillis, meningitis, vitamin B12 deficiency. Blood work all came back good. I was on Prednisone, Neurontin, Tizanidine and Trileptal, no change. Herpetic Neuralgia (herpes zoster only), or can you get it from HSV?. The virus travels up your Sacral Ganglia nerve and lays dormant until a reoccurrence. Did the virus get stuck somewhere in between its destination and is now wreaking havoc?). Since HSV is a neurotopic virus, isn’t it possible to have other neurological symptoms/problems? Transverse Myelitis, Sacral Paresthesia, Sacral Neuropathy/neuralgia? The Sacral area of the spine S1-S5 effects the lower extremities, exactly where my numbness is. I am now on Lyrica. Is this permanent nerve damage or will this go away over time? My bowels feel different when I go to the bathroom, sex is not good, I can’t seem to have an orgasm. I want to thank you for taking the time to read my question.
Doctor's Answer
by H. Hunter Handsfield, M.D., Jun 08, 2007 12:00AM
, Jun 08, 2007 12:00AM
First, I'm not a neurologist--so I cannot comment on any of the alternative diagnoses you mention or the treatments that have been tried. And I also cannot comment on the specific symptoms. My comments below accept the notion that you have a neuropathy, but only because of what you say (or apparently have been told); this definitely is not my area of expertise.
Second, my comments below assume the diagnosis of genital herpes is correct. If in fact you had a genital outbreak of herpes zoster (shingles), then I would assume your neurological problem is post-herpetic neuralgia (PHN). As you seem to know, PHN is a well recognized and quite common complication of that infection. However, if a culture test showed HSV, the diagnosis almost certainly is correct.
HSV indeed is neurotropic. However, the documented neuropathic effects of HSV-1 and HSV-2 are pretty much limited to recurrent symptoms that occur in association with (typically just before) herpes outbreaks, with localized numbness, tingling, etc. Some of those outbreaks can be asymptomatic, i.e. only the neuropathic symptoms occur. But either way, they usually are localized to the area where the outbreak itself will occur, although once in a while they can be more widespread--e.g., pain and tingling down the leg, even though the outbreak occurs on the labia, for example.
Whether HSV sometimes can cause more persistent neuropathic symptoms, such as what you are experiencing--that is, a syndrome comprable to PHN following shingles--really isn't known; the issue has never been studied in any systematic way. My guess is that it can and does, but is rare. For most people with your sort of problem, herpes probably is not the cause. However, most cases that come to my attention do not have the apparent direct sequence of events that you describe: the onset of symptoms while being treated for your apparently first genital herpes infection certainly suggests a possible link.
As for what to do about it, that's also outside my expertise. It would seem reasonable to try high dose suppressive therapy with valacyclovir or one of the other antiherpetic drugs. But don't get your hopes up; that doesn't help PHN due to shingles, even though that virus also is susceptible to the same drugs. You're going to have to rely on your neurologist or, if not certain s/he is on top of the problem, ask for referral for another opinion.
Best wishes--- HHH, MD
Second, my comments below assume the diagnosis of genital herpes is correct. If in fact you had a genital outbreak of herpes zoster (shingles), then I would assume your neurological problem is post-herpetic neuralgia (PHN). As you seem to know, PHN is a well recognized and quite common complication of that infection. However, if a culture test showed HSV, the diagnosis almost certainly is correct.
HSV indeed is neurotropic. However, the documented neuropathic effects of HSV-1 and HSV-2 are pretty much limited to recurrent symptoms that occur in association with (typically just before) herpes outbreaks, with localized numbness, tingling, etc. Some of those outbreaks can be asymptomatic, i.e. only the neuropathic symptoms occur. But either way, they usually are localized to the area where the outbreak itself will occur, although once in a while they can be more widespread--e.g., pain and tingling down the leg, even though the outbreak occurs on the labia, for example.
Whether HSV sometimes can cause more persistent neuropathic symptoms, such as what you are experiencing--that is, a syndrome comprable to PHN following shingles--really isn't known; the issue has never been studied in any systematic way. My guess is that it can and does, but is rare. For most people with your sort of problem, herpes probably is not the cause. However, most cases that come to my attention do not have the apparent direct sequence of events that you describe: the onset of symptoms while being treated for your apparently first genital herpes infection certainly suggests a possible link.
As for what to do about it, that's also outside my expertise. It would seem reasonable to try high dose suppressive therapy with valacyclovir or one of the other antiherpetic drugs. But don't get your hopes up; that doesn't help PHN due to shingles, even though that virus also is susceptible to the same drugs. You're going to have to rely on your neurologist or, if not certain s/he is on top of the problem, ask for referral for another opinion.
Best wishes--- HHH, MD
With everything I read on PHN, pain was the main symptom, why is it that I have no pain? Also My nuerologist said he didnt think I had it, but like you said I should get a second opinion.
You stated that maybe I should try high doses of suppressive therapy, no Dr. thus far has mentioned that to me, I will check into that.
Thank you again for you comments, much appreciated!!!!