Shingles on genital area

Edited , 5 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.

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  • 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

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  • 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 of Herpes 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%

    1. It is available in the US at age 50 with insurance
    2. If you have had Shingles, and are in the US, Shingrix is covered by your insurance. Have your physician write a note stating you have had Shingles.
    3. In the UK, it is not available until age 70.

      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

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    • 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?

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  • 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

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  • 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!

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