I have had herpes for over 10 years with few breakouts. Now I am taking Zovirax for 10 days. To my surprise, the Zovirax seems to have helped restore the feeling and warmth I lacked in my legs and feet. I thought I had diabetic deterioration of the nerves in my legs and feet, but maybe that's not the case. Can herpes cause me to hurt all over? I have fibromyalgia, but could it maybe be the herpes? Does the virus do things to me when I am not having lesions? What are the other symptoms besides the lesions?

Lynn

I assume that you are talking about genital herpes, but much of what I say will also apply to oral herpes infections. Herpes simplex virus (HSV) type 2 (HSV-2) is the usual cause of genital herpes. Because it is never eradicated from the body, recurrences of herpes can occur, usually resulting in a painful, itching rash on the external genitals. Some people also have general symptoms as fever and malaise (feeling ill), while others can have neurologic problems such as headache, meningitis (inflammation of the membranes that cover the brain and spinal cord), and urinary retention (inability to urinate).

In an otherwise healthy person, HSV does not typically cause chronic illness. It has been implicated in fibromyalgia, but the association has not held up to scrutiny. It can leave long-term effects, such as scarring where the rash was, chronic pain or sensory loss. However, these occur more often after shingles, which is caused by the related varicella-zoster virus.

I have never heard of HSV leading to neuropathy (nerve damage) such as you describe. This stocking-glove (hands and feet) distribution of sensory changes is more commonly seen in diabetes or vitamin deficiencies, and some infections, such as syphilis, can lead to this form of neuropathy as well. I certainly cannot say that it never happens with HSV, but no definitive link has been described. Furthermore, chronic changes associated with HSV, such as scarring, bladder problems or neurologic problems such as numbness are not due to active viral infection. Since acyclovir (Zovirax) attacks the virus itself, it would not likely help such problems.

What could be happening in your case? Well, maybe acyclovir has some activity that could help whatever is causing your condition. There are other infections that can be treated with acyclovir -- but none of these commonly cause your type of neuropathy. Acyclovir also may have activity unrelated to its antiviral activity. This has been shown to occur with many antibiotics, including the tetracyclines and metronidazole (Flagyl), which are useful in some non-infectious inflammatory conditions. These additional activities are often discovered by chance.

However, in your case, I think the most likely explanation is coincidence. Your neuropathy may have gotten better for one of a number of reasons -- such as simple tolerance to the symptoms, abstinence from alcohol, or improvement in controlling your diabetes -- and you are just attributing the improvement to the acyclovir because you started taking it around the time your symptoms improved. It is this exact reason why we have to be very careful with case reports and anecdotes, where people mistake coincidence for cause and effect. I would not want anyone to think that acyclovir is acceptable therapy for neuropathy -- unless of course future study proves that it works.