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Forum Name: Dermatology Topics

Question: recurrent issue - herpes or dermatits?


 veryunsure109 - Tue Jan 05, 2010 9:06 pm

I have been having recurrent issues for 2 years, first vaginally, which over the past year became a rectal problem. Dispute numerous HSV1 & HSV2 blood tests, I had/have remained convinced that what I have is herpes. I thought this because my partner, a female, has a history of cold sores, while I do not. She performed oral sex on me 6 days after having a cold sore. Issues (ALWAYS occuring on the right hand side) have occurred ever since. Over the past year, I get what feels like a cut/lesion/fissure on the right side inside my rectum. The cut is pre-ceding by itching, and sometimes local discomfort on the outside of my rectum (soreness). Also, I do get an enlarged lymph node on the right side too (down there). While having this “cut” I have had, over the course of 1 year, 2 negative cultures and 3 negative PCRs. I have been taking Valtrex on and off, but have not taken the Valtrex before I get the culture, but not sure if the Valtrex may still be in the system for some (?). Anyway, over the last 2 months, this issue has been coming and going approximately 1-2x a week (whereas it used to occur approx. 1 time a month-- lasts a few days and goes away). I've had doctors that say: it sounds like herpes so thats what it is, and other that believe my tests. I also have an autoimmune disorder and take hydrocortisone, which I fear may be clouding my IgG results.

In any event, with my last negative HSV PCR, I had a biopsy done. The biopsy diagnosis read –“Spongiotic Dermatitis, Subacute Type.” I want to know if I can really believe this. I perused an article that said that the “Spongiotic Diagnosis” is often a blanket diagnosis- and not specific. If I get a biopsy that says the Spongiotic Dermatitis, does that DEFINITELY mean that that is what it is, and not herpes?? I am very unconvinced. I don't see why dermatitis would have those other symptoms-- itching, swolen lymph nodes, and sometimes tailbone pain. Still seems like herpes to me. Are biopsies that say spongiotic dermaitits always correct??
 Dr.M.jagesh kamath - Sat Feb 06, 2010 5:46 am

User avatar Hello,The cold sores are caused in majority of cases by herpes type1.While it can indeed spread to different sites the virus generally prefers the nerve ganglion of the oral area rather than the genital.Also even if it does the disease is often muted.And then recurrences in the nonfavoured sites are extremely uncommon.So the chances of your recurrence due to oral type of herpes ie is type1 is not likely.Again type2 does not the favour oral area.
Spongiosis is indeed a nonspecific feature in dermatopathology.With your history of autoimmune disorder investigations to rule out localized crohns proctitis may be in order.Best wishes.
 veryunsure109 - Sun Feb 07, 2010 3:30 pm

Hi Doctor,

I'm confused. I don't have cold sores...but my partner does. And I was afraid I got genital hsv1 from my partner. I definitely don't have hsv2. I am unsure of what the spongiotic dermatitis means for me -- my question is: does this diagnosis rule out herpes or is it too non-specific to do that?

Can you elaborate on the crohns that you were talking about? Thank you!
 Dr.M.jagesh kamath - Mon Feb 08, 2010 12:21 pm

User avatar Hello,Spongiosis generally is indicative of a dermatitis.It could be allergic,drug induced,seborrheic,fungus induced etc.Herpes simplex would be different in causing baloon degeneration and vesiculation with inclusion bodies.
Crohns would have shown a granulomatous respose being an inflammatory disease of autoimmune aetiology.
So I feel it is more like a dermatitis and since the investigations have not in favour,and likeI mentioned cold sores if the affect the vaginal area it is always muted and rarely recurrent.I hope this helps to clarify.Best wishes.

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