Post-Herpetic Neuralgia from Genital Herpes


Persistent Nerve Pain as a Result of Herpes

Neuralgia is pain that occurs along the path of the nerves.  Postherpetic Neuralgia is best known in relation to Shingles (Varicella Zoster Virus).  Although it has been little studied in connection with genital Herpes infection, the incidence of this condition is much more common that is normally reported.  This type of neuralgia is the result of the virus irritating the nerves and neural pathways.  The symptoms are similar to Prodrome, including tingling, twitching, burning sensations, shooting pains, numbness, and/or aches in the area of infection, and also particularly in the buttocks, legs, and thighs.  (*Experts advise that patients experiencing prodromal symptoms or PHN consider the virus to be active, and to take precautions against transmission.)

The pain can be intermittent, and in some people it can be chronic, lasting for weeks and months at a time.  This kind of chronic HSV-PHN is considered to be rare, although anecdotal evidence suggests that it occurs much more frequently than has been documented.  HSV can also cause a “sciatica syndrome” – pain the sciatic nerve in the back of the thigh.  Many women have found that PHN intensifies prior to menstruation.


Possible Solutions for Post-Herpetic Neuralgia

Anti-Viral Drug Therapy for PHN

Some people have found a course of suppressive anti-viral medication to be helpful, particularly when accompanied by very frequent or severe outbreaks.  Acyclovir and other anti- herpes medications work by interrupting the new viral replication.  By keeping the virus in check, theoretically the nerves are able to calm down and rest after having been irritated for so long.

There is some conflicting advice on the effectiveness of suppressive therapy with acyclovir (Zovirax).  Some research from the mid-90s indicated that it either has no effect, or that it may worsen “unexplained nonlesional HSV episodes.”  However, other research and anecdotal reports from Herpesite correspondents found that daily suppressive therapy with acyclovir brings relief from PHN, possibly by decreasing the irritation to the nerves caused by frequent outbreaks.  Relief may take weeks or even months to achieve, depending on various factors including the severity and duration of the irritation, and it’s effectiveness appears to increase dramatically by being very regular in the timing of the dosage.


Topical Anti-Pain Creams with Capsaicin for Post Herpetic Neuralgia

Another treatment that has been shown to be very effective in many cases of neuralgic pain are topical creams containing Capsaicin.  Capsaicin is derived from chile peppers, and works by inhibiting accumulation of “substance P,” which sends pain signals from the nerves to the brain.  Studies have been done with shingles PHN that have shown Capsaicin’s effectiveness.  HerpeSite correspondents have found this to be a very effective treatment.  One brand that was designed originally and specifically for shingles PHN is “Zostrix” (named after Varicella Zoster Virus, the herpesvirus that causes chicken pox and shingles!).

The main things to remember if choosing to use one of these pain relief creams are: 1) Wash hands immediately after applying, 2) Rub it in gently or it will burn worse than an outbreak, 3) never put it on mucous membranes, 4) heat and warm water will intensify the effects (so no sunbathing, showering, or hot baths afterward!), and 5) Capsaicin’s benefits are cumulative, so it may take up to several weeks to achieve full pain-relieving benefits.


Low-Level AntiDepressant Medications as Therapy for PHN

Elavil, as well as certain other tricyclic antidepressant medications, have pain reduction properties that appear to be independent of their antidepressant actions, and have been recommended and used for PHN associated with Shingles.  The pain alleviation effect can be reached at doses much smaller than those normally required for the antidepressant value.  Several medical reference books mention these drugs for “post-herpetic neuralgia” specifically.  The drugs mentioned as being possibly effective in relieving neurogenic pain are: imipramine (Tofranil), nortriptyline (Aventyl), amitriptyline (Elavil), clomipramine, desipramine, doxepin, and trimipramine.  Especially the first three.  However, there are many possible side effects to consider when investigating the use of these drugs.  Also, if a person is already taking another type of anti-depressant or any other drug, they may have to go off it for quite a while before starting a new one, or they could have serious complications.

As always, discuss every aspect of possible treatments and their side effects with your health care provider and do not attempt this type of treatment without medical supervision.


Lifestyle and Nutritional Support for PHN

Some people have found that eliminating coffee and other acidic and neuro-stimulant foods, beverages, and medications has helped in both decreasing PHN and outbreaks.  Other lifestyle modifications, including meditation, guided imagery, yoga, breathing exercises, and moderate aerobic exercise can help.  Better nutrition can also help people manage their overall health, deal with infection and other physical stresses, and just feel better.  Proper and sufficient hydration, increased intake of essential fatty acids and “good oils,” and consuming fruits and vegetables with anti-oxidant properties can lead to a stronger immune system and better overall health.

The healthier a person’s mind and body, the better they are able to cope with infections, and other physical issues.  This seems obvious, but it’s one of those things that we sometimes need to remind ourselves.  There are also some experts who say that the neuralgia, like many other aspects of herpesvirus infections, gets better by itself with time.

The good news is that with time and taking good care of yourself, most people find that neuralgia, like other aspects of Herpes infections, gets better, with fewer and milder occurrences.  So that’s something to look forward to!  More tips on how to improve your physical and emotional well-being to support a healthy and strong immune system can be found on the Living With Herpes and Health & Wellness pages of HerpeSite.