Dr. Cohen-I sincerely hope you can help me with my question. I am very upset currently because just the day before yesterday I started feeling a burning in a very small area about the size of a dime about an inch to one side of my rectum. The slight burning/itch now appears to have formed a whitish type of lesion again about the size of dime surrounded by red. I am not 100 positive but I am almost certain that this is an initial outbreak of HERPES that I am experiencing. I looked online and found some pictures that appear to resemble what I have although the pictures I saw were more blister-like whereas mine is just kind of a flat, whitish type lesion. Still, I really think this is probably Herpes. I am scared because I am concerned that a co-infection of both HIV and Herpes is going to make my life-expectancy/overall treatment success worse now. Is this the case? I am doubly worried because I was also diagnosed about 3 months ago with HPV after experiencing some anal warts (which now seem to have disappeared). I have been undetectable and relatively healthy up until now on Combiver and Viracept. Should I be prepared for the worse if this IS Herpes now that I am not only HIV+ but also have HPV AND now HERPES? Also, MUST I get treated for Herpes or can I just let it run its course and just try to take care of myself as the outbreaks heal? Thanks SO MUCH in advance for you help. I am highly anticipating your response!

There is no evidence that having HIV and HSV shortens life expectancy. Your choices for treatment-- if this indeed HSV-- are to use an antiherpes drug episodically for each new outbreak, or, if you are having multiple outbreaks (6 or more per year), you can try chronic suppressive therapy which can be accomplished with one pill twice a day. You can aslo chose just to live through each episode, but the time to stop shedding virus and the time to lesion healing will be shorter if you get treated.

The main thing is to find out if this is really HSV after all. Cultures are quick and easy and the results are generally available within 1-2 days.