Shingles on genital area
Posted , 9 users are following.
My husband came down with a rash about 4 days ago and finally got into the doctor. The rash is unilateral, a couple lesions on penis, left-side groin, left upper inner thigh and some around buttocks. Initially, a doctor felt is was herpes. My husband and I have been married for 10 years. So understandably, this has caused some stress. As for myself, I have never had herpes. The first doctor then felt it looked "odd" so asked another physician to look who then said it was shingles. Testing was done, no results yet
He is in quite a bit of pain. Does anyone have experience with shingles in this area and how long does the pain typically last (without post-herpetic neuralgia) and when does it peak? Any recommendations for how to deal with it? He is using lyrica.
0 likes, 12 replies
Merry19451 cjj998877
Posted
Dear CJJ,
I am a retired FNP. I will send the answer to your questions in a lengthy post, but regarding your stress, Herpes Simplex vs Herpes Zoster-Shingles, the way it is diagnosed is the following:
Obviously, the scraping and having a PCR is definitive.
Simplex comes out in one wave, and that's it. The vesicles are uniform in size and shape. Simplex crosses the midline.
Zoster-Shingles comes out in waves or crops over a period of five days. The vesicles are not uniform in size or shape. Google dermatome and you will see your husband's dermatome in the S Sacrum distribution. Zoster usually does not cross the midline. Now, a few vesicles can definitely have strayed over to the other side. Zoster-Shingles does not obey the text books. It seems that your husband's distribution is in a dermatome, not in a pattern of Simplex.
The pain often peaks the second week, then by the fourth week starts to decrease.
Your husband needs to rest and sleep and sleep and rest. He should wear 100 % cotton underwear. Any activity will exacerbate the pain.
I strongly doubt that Lyrica alone will help with the pain. Obviously, the genital area is exquisitely sensitive, and I would have your husband ask for an Opioid, such as Oxycodone. Normally, I do not push opioids, but I have had Herpes Zoster-Shingles in my right ear, mouth, and throat every three weeks for the past 24 years, and twice in my right eye. I can empathize with your husband.
The first episode, I felt like I was giving birth via my ear canal while being tazed. My allergist and two ENTs could not diagnose it. A neuro-otologist diagnosed it after the vesicles showed on the outer ear. I had no an analgesics, and no antivirals. Hopefully, your husband was given either Valtrex or Famciclovir.
Ice or cold packs will help numb the pain. No hot showers, as it will increase the pain.
I also found when I had shingles on my right scalp,
I used Flonase Nasal Spray (cortisone anti-inflammatory fresh bottle 4x daily)
followed by Bactine, which has Lidocaine, to numb the area 4x daily.
The topical application, combined with the oral analgesics, plus rest gives your husband the best chance of coming through this terrible ordeal the least unscathed. I know the site of the lesions has tested the trust of your marriage. That is why I told you how it is diagnosed.
Physicians are reluctant to prescribe Opioids due to the overdoses, but it is their duty to treat acute pain. Shingles pain is one of the most painful conditions of mankind as it is nerve pain. Lyrica alone just won't be enough, especially in the genital area.
May I ask how old your husband is and which country you are located?
Best Regards
Merry Juliana
charles67842 Merry19451
Posted
It crosses the middle line with me. it’s funny it will hit me on one side then weeks later jump to the other side. this other guy went in to see the doctor with blisters on both sides of his butt he told the doctor he thinks it’s shingles the doctor says no it does not hit both side only one side. the doctor tested came back positive for shingles. The keyword that everybody misses is it Usually only one side. why haven’t you got the new vaccine shot? Soon as I get rid of my shingles this time around I’m going to get the vaccine shot.
Merry19451 cjj998877
Edited
Hi CJJ:
I am so sorry that your husband is suffering from this disease. Unfortunately, there is a lot of misinformation among health professionals. Many health care professionals are abysmally ignorant regarding the diagnosis, the signs and symptoms of the disease, and the treatment and management of the disease. They are loathe to prescribe opioids for the acute pain.
**** This letter contains different information than the first one. Warm hugs to you and your husband! With Shingles, your husband would feel much sicker than with Simplex.
My first episode of Shingles felt like I was giving birth via my ear canal while being tased!
I have had Herpes Zoster-Shingles in my right ear, mouth, and throat every three weeks for the past 24 years. For the past 2 years it has also spread to my entire right scalp. I have had it twice in my right eye.
The third ENT finally diagnosed it correctly.
Because I suffered so much with the disease, I am extremely active on this forum. My goals are to educate, support, and advise the people. I have learned so much from many wonderful individuals on this forum. I am a retired Nurse Practitioner in the States.
There are three stages to Herpes Zoster-Shingles.
THE FIRST STAGE-ACUTE STAGE PREERUPTION
PAIN, often burning or lancinating
Itching
Patchy redness
Swelling, in the dermatomal area of involvement
Swollen Lymph Nodes, either at this stage or subsequently
Constitutional Symptoms
Headache
Photophobia
Aches and Pains
Mild Fever
Chills
Fatigue
Exhaustion
THE SECOND STAGE-ERUPTION
Grouped herpetiform vesicles-blisters developing on the red base (the classic finding)
The vesicles come in crops or waves over a period of
usually 5 days
Skin findings that typically appear unilaterally, stopping abruptly at the midline
Vesicular involution: Vesicles initially are clear but eventually cloud, rupture, crust, and involute (shrink)
After vesicular involution, slow resolution of the remaining
red plaques, typically without visible sequelae
Scarring can occur if the skin has been compromised by
excoriation, secondary infection, or other complications
Almost all adults experience pain, typically severe
A few experience severe pain without a vesicular eruption (Zoster Sine Herpete)
Symptoms tend to resolve over 10-15 days,
but can last much longer
Complete healing of lesions may require up to a month
THE THIRD STAGE PHN
POST HERPETIC NEURALGIA
Persistent or recurring pain lasting 30 or more days
after the acute infection or after all lesions have crusted (9-45% of all cases)
Pain usually is confined to the area of original
dermatomal involvement
The pain can be severe and incapacitating
Pain can persist for weeks, months, or years
Slow resolution of pain is especially common in the
elderly
PHN is observed more frequently after cases ofHerpes Zoster-Shingles Ophthalmicus (HZO)
Herpes Zoster-Shingles Oticus
(Ramsay Hunt Syndrome)
and in instances of upper-body dermatomal involvement
TREATMENT & MANAGEMENT
Antivirals
The cornerstone of treatment
Should be started within three days of onset of
symptoms or rash
Famcyclovir 500 mg 3x daily 7-10 days
Most efficacious
Newest Antiviral
Valacyclovir 1000mg 3x daily 7-10 days
Less efficacious than Famcyclovir
Large pill
Based on Acyclovir
Acyclovir 500mg 5x daily 7-10 days
Most resistance to this Antiviral
Oldest Drug
Cheapest drug- Used in the UK
Difficult schedule of 5x daily
USE THE FOLLOWING: one of each class together
Anticonvulsants
Gabapentin-Neurontin
Dosages must be tapered up and down
Effective as adjunct in acute stage and PHN
Pregabalin-Lyrica
Dosages must be tapered up and down
Effective as adjunct in acute stage and PHN
Weight Gainer
Affects moods
Difficult to wean off due to withdrawal symptoms.
Antidepressants
Dosages must be tapered up and down
Effective as adjunct in acute stage and PHN
Can be difficult to wean off due to withdrawal symptoms.
Duloxetine-Cymbalta SNRI
Venlafaxine-Effexor SNRI
Amitriptyline-Elavil Tricyclic
ANALGESICS
OPIOIDS
Oxycodone
Codeine
Hydrocodone
IF YOUR PAIN IS NOT WELL CONTROLLED WITHIN THE FIRST TWO WEEKS, GET IT UNDER CONTROL BY DEMANDING OPIOIDS.
***The pain often increases markedly the second week of the disease.
HERPES ZOSTER SHINGLES IS ONE OF THE MOST PAINFUL AFFLICTIONS OF MANKIND SECOND TO CANCER AS IT INVOLVES NERVE PAIN.
IT IS THE PHYSICIAN'S DUTY TO HELP THE PATIENT IN PAIN. OPIOIDS STILL ARE THE BEST OPTION FOR ACUTE PAIN.
Gabapentin-Neurontin or Pregabalin-Lyrica can help decrease the neurogenic pain when used in conjunction with Opioids
Topicals
Lidocaine/Benzocaine
Found in Bactine, Solarcaine, Oragel, Salonpas
Auroguard for Ramsay Hunt Syndrome etc
Numbs the skin's nerve endings
Corticosteroid Sprays Creams OTC
Decreases inflammation, soothes topical
swelling, pain
Cool Compresses/ICE.
(DO NOT USE HEAT-CAUSES MORE PAIN AND INFLAMMATION)
100% COTTON CLOTHING soft & allows the skin to breathe!!!!!
SLEEP AND REST
You will experience fatigue and exhaustion and want to sleep. Obey your body. You cannot power through this. Take off from work. If you don't, it will only get worse.
CONTAGIOUS
Remember: your exposed rash is contagious to all individuals who have not as yet had chickenpox.
This list includes all pregnant women and their unborn fetuses. Many women do not know in the early stages if they are pregnant.
If someone has been fully vaccinated, they are protected. The unborn child is never protected.
Cover your rash with clothing or a dressing.
You are no longer infectious when every last vesicle-blister has scabbed over/ dried up.
PREVENTION of SHINGLES
Get the Shingrix Vaccine, a two part injection, taken 2-6 months apart.
The efficacy is 93%
ADDENDUM the Shingrex vaccine has helped decrease the intensity of pain of my episodes, but not decrease the frequency of episodes.
High Lysine Low Arginine Diet
Google High Lysine Low Arginine Diet and Herpes.
The amino acid Lysine helps decrease Herpes and Arginine triggers Herpes Zoster-Shingles.
If you binge on chocolate or nuts, and find yourself getting a horrible prolonged shingles episode after,
it is due to the high amino acid content of Arginine in chocolate and nuts.
You can take Lysine supplements, but there can always be issues with drug interactions, adverse reactions, and harm to the heart, liver, and kidneys.
It is my hope that this letter has helped you in understanding your disease and how to care for yourself.
Best Wishes,
Merry Juliana
cjj998877 Merry19451
Posted
Thank you so much for responding! That truly helped a lot and I appreciate the recommendations!
My husband is 36. His immune system has always been a bit shoddy...has hx of frequent sinus infections, frequent illnesses. So while I am surprised it is likely shingles (still waiting on labs of course), I am also not surprised. As stress levels have been up as well and I'm sure this likely contributed. We are in the U.S.
I have spoken with my husband about getting the Shingles vaccine in the future. So I appreciate you mentioning that with insurance coverage. I will make sure he follows up with his PCP on this. Do you happen to know when shingles vacc is recommended following an outbreak of shingles?
charles67842 Merry19451
Posted
how long ago did you get the vaccine shot?
charles67842
Edited
delete
tracey77598 Merry19451
Posted
Hi Merry,
I found this thread as I have been researching my really confusing symptoms, I think i either have genital herpes simplex or zoster. Please could you give me some advice?
About 4 weeks ago (24th Jan) I felt a sharp pain in my left labia, it was swollen and sore for about a week, then on 31st Jan I noticed several flat looking white pimples in that area. Then about 3 days after that the skin in my right groin went red raised and blotchy, within 24 hours small shiny looking blisters (about 10) appeared which again went white and flattened. They dried up and went red on the top then faded over about 3 weeks without ulcerating or any fluid coming out. I can still see the marks where they were. During this time i also got a couple of other blisters across the top of my pubic area which flattened and dried. There were also some random pimples on a red base on my vulva which came and went quickly.
I was examined at a local GUM clinic, the doctor saw the blisters in my groin and the resolving flat pimples in my labia. She said it did not look like herpes simplex and diagnosed Mollescum however I dont think its that. I took a weeks course of anti viral tablets (Acyclovir) which I finished on 14th Feb and all seemed fine, no more redness or blisters.
However today (23rd Feb) Ive started with yet another red blotchy area of skin just above the area of my right groin where I had it last time and about 4 blisters.
All of the pimples/blisters were in the same horizontal area - starting on my left labia, then directly opposite in my right groin and the few on my pubic area were also directly in line with the others.
Ive had some general body aches and pains, nothing severe. The red blotchy area of skin is very slightly tingly but again nothing severe.
Im a 49 year old female, in a relationship for nearly 2 years and was single for 3 years before that. I have been through a lot of stress in my personal life the last 18 months. I also eat a lot of chocolate which I know can start herpes episodes so im limiting it to small amounts at the weekends only from now on!
From what i have described could this be zoster? The doctor said it didnt look like simplex but had never heard of shingles in that area.
Thanks so much for any help you can give me, Im very confused and worried.
Tracey
GeekSauce Merry19451
Posted
Thank you for this. I finally found a forum that helps because I thought I was going crazy.
brenda69504 Merry19451
Posted
Hi, I've just read your reply and everything there is almost identical to my symptoms, when this started over two months ago now with severe pain all around my vaginal area, just a burning severe pain, no rash at the start, then a slight rash appeared but no sores, my doctor straight away said herpes and I was terrified, couldn't tell my partner or anyone, she said not to, she prescribed antiviral which didn't ease the pain, nothing helped, then after almost four weeks she gave me neurostil and that helped so much, she mentioned shingles but until I see a gynaecologist she can't give me a diagnosis, all swabs are clear but everything you've said in your answer is how I'm feeling and so like what's going on with me that I need to speak to my GP again, it hasn't left me and it's draining.
Merry19451 cjj998877
Edited
Dear CJJ
Usually, if he doesn't have a recurrent episode, the experts recommend waiting 6 months.
Shingrix is the vaccine to get as it is the most efficacious at 93% at all age groups.
The vaccine does cause an extremely painful arm at the injection site. Usually, individuals experience a low- grade fever, aches and pains, exhaustion and fatigue, and malaise for 3-5 days. These symptoms are nothing compared to Herpes Zoster-Shingles, however.
Best Wishes,
Merry Juliana
trish82895 cjj998877
Edited
So sorry to hear of your husband's diagnosis. I had Shingles in 2011 in the S3 Pudendal Nerve Distribution and still have PHN in the same area. It is excruciatingly painful. I suppose it's the female version of what your husband has! Merry always gives amazing advice. She is an authority for sure! The only thing I would add is that, although it gives only temporary relief, I have found the topical Rx cream " Lidocaine with Prilocaine" helpful. Most ointments used for Shingles cannot be applied to the hypersensitive
genital/peri-anal areas, so I was relieved to have this prescribed. I use it after taking an ice-cold Sitz bath (using the inexpensive plastic bowl version over the toilet. Surgical appliance stores sell them). Rest as much as possible - and though it sounds weird, take up yoga! It is a wonderful distraction. The pain is always worse when I'm under more stress than usual - and definitely exacerbated by fatigue. Good luck!
charles67842 cjj998877
Edited
I get shingles I can have it on one spot on my body and have a blister on my penis.
The second doctor was right it’s shingles . it can hit you up on both sides of the body there’s so many doctors that don’t know nothing about it. right now I’m battling it on my legs and crotch. what gets it going is stress heat and trauma.