According to the Centers for Disease Control and Prevention (CDC), 45 million Americans are infected with herpes, although most have no idea that they are infected. In the May 2008 edition of the “Archives of Neurology,” Drs. Joseph R. Berger and Sidney Houff of the University of Kentucky College of Medicine reported that herpes virus was found in the spinal nerve roots of 40 percent of people on autopsy, although most had no documented history of herpes. Symptoms of herpes of the spine are different from the symptoms most people associate with herpes.
Skin lesions associated with spinal herpes can appear on the genitals or they may appear in places less commonly associated with herpes infections, such as the lower back, buttocks and thighs. The website Skinsight.com offers representative photos.
Typically, according to "Harrison's Principles of Internal Medicine," herpes lesions begin as painful, small red bumps or fluid-filled blisters. Over the course of a few days, the lesions usually break open and crust over. During this time they may be itchy, painful or both. First-time lesions may take as long as six weeks to heal. Recurrent lesions usually resolve within about a week. Often, lesions are mistaken for pimples, ingrown hairs, allergic reactions, jock itch or other kinds of rashes. Since they resolve on their own, people usually don't seek medical advice.
Radiculopathy is another symptom of spinal herpes. The term “radiculopathy” refers generally to problems with the nerves. The defining feature of radiculopathy is that symptoms track or “radiate” along the distribution of the affected nerve. Radiculopathy caused by herpes typically affects lumbar or sacral nerve roots. Symptoms of sacral and lumbar radiculopathy, as described in the "Archives of Neurology" article, include dull or tingling pain in the lower back, buttocks or anogenital area, shooting pain down the buttocks and thighs (sciatica), weakness of the leg muscles and inability to walk on the tip-toes. In severe cases, symptoms may cause urinary retention, constipation and transient paralysis.
According to "Harrison's Principles of Internal Medicine," spinal herpes can also lead to a condition known as aseptic meningitis. The term "aseptic" refers to the absence of bacteria, while meningitis means inflammation of the connective tissue lining the spinal cord and brain. Symptoms of meningitis include headache, stiff neck, fever and altered mental status. People with these symptoms need to seek medical care immediately, regardless of whether or not they have a history of herpes or other diseases. Meningitis due to spinal herpes may also be accompanied by back, buttock, perineal and lower extremity pain, urinary retention and constipation. Headaches occur in as many as 15 percent of patients with recurrent genital herpes and, according to the article in "Archives of Neurology," probably reflect subacute infection of the meninges by the herpes virus.