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Herpes/Chancroid No response to Valtrex
Oct 24, 2012

`Thank you for taking the time to read my question. I have been HIV positive for four years. All of my current labs regarding my HIV status are good/ WNL. About three months ago I developed a red round shaped ulcer just below the gland of my penis. It scabbed over, then I developed two more area that presented in the same manner. There was some tingling with the first area none with the other two areas. All three areas have formed a scab that fell off but then reformed another scab within days. This has occurred four time. Every time the scab fell off the reddened area and the new forming scab became bigger. I saw my NP who manages my HIV and she diagnosed it as HSV 2 and prescribed Valtrex for future incidents. The first time the scabbed area fell off and the red area was still present I took the Valtrex 500mg BID. However the areas never healed. Then my NP and another DR looked at the sites and prescribed the med as 500mg BID for 10 days for HSV 2 . With no response. She took two swaps of the areas one for syphilis/chancroid and HSV 1&2 all three were negative( The second swap was for Acyclovir resistance which is still pending). She has since decided to treat it as a Chancroid with Cipro 500 mg BID since I have recently been to Asia and South America and had protected sex in those areas. The scabbed areas are hard yellow in color with no bleeding, drainage, pain or elevation in my WBC. So I guess my question is do you think the prescribed treatment/diagnosis is correct? I have an appointment with an infectious disease doctor. Do you think that is the best specialist to see or should I see Dermatology, or both?

Thanks again for your time,

Ben

Response from Dr. McGowan

Ben,

Sorry to hear about your problem.

Both herpes and chancroid can cause painful, tender ulcers on the genitals. Generally with swollen glands as well. If they are recurrent (come and go) it would make herpes more likely. Syphilis may sometimes cause more than one ulcer, but it is usually painless. Other possibilties may include Behcet's Disease (often with mouth sores too), or apthous ulcers (which are caused by imbalance in the immune system). Granuloma inguinale is another possibility...here the sores start as nodules and can form ulcers. Treatment of chancroid is generally with azithomycin or ceftriaxone. Cipro may be effective for both chancroid and granuloma inguinale.

An ID expert (really an STD specialist would be best). If you are in the New York area Dr Jeff Gilbert in the Bronx (718) 882-5482) is the person to see

Hope things clear up soon.

Joe



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