Anti-viral resistant herpes

I contracted oral herpes a few years ago from my present wife. For most of that period the outbreaks were infrequent and mild (a single small lesion that would heal in  few days without cratering).

A few months I ago I also began having symptoms of genital herpes, though the presentation has not been of the "classic" variety, and the diagnosis has yet to be confirmed (I have only had one lesion on my genitals, and that on my scrotum.The others have been on my legs, buttocks and torso, if that's possible). I have also had recurrent irritation, itching, and prodromal symptoms (neuralgia, burning) on my penis, scrotum, and legs, accompanied by flu-like symtoms (symptoms), which has mostly resolved at this point. In spite of the diagnosis not being confirmed (the doctor took a viral culture from penis which came out negative; there were no visible lesions anywhere at the time), my dermatologist put me on suppressive acyclovir, which provided some benefit, but did not keep me completely symptom free.

I stayed on the acyclovir for about two months, until I started having frequent flank pain and headaches, which I took as indicative of nephrotoxicity from the acyclovir, particularly because I am on continuous mesalamine -- a drug that also can be nephrotoxic -- for ulcerative colitis.

Shortly after I went off the acyclovir, which was about 10 weeks ago, I started having outbreaks of oral herpes that have progressed in frequency, scope, and severity, and have been continuous for about the last 6 weeks. I attempted to go back on suppresive acylovir, but to no avail whatsoever. I then tried a one-week course of Famvir (500 mg twice daily) that also had no impact. And by no impact I mean not that the existing lesions didn't immediately disappear -- which I didn't expect-- but that I continued to get new lesions throughout the course of treatment. I also have been taking l-lysine, vitamins (including high doses of vitamin C), minerals (including zinc), and various herbal remedies. I also took a week off of work to limit my stress level, and all but quit drinking in order to bolster my immune system.

Not only has nothing has helped, but the lesions have been spreading and now cover about a 1'' x 1.5'' area between my upper lip and my nose. Each individual lesion does not last very long, but new ones appear about every other day. I have not been able to get in to see the dermatologist who prescribed the acyclovir (the Famvir I actually got from my sister), because he has no appointments available for the next several weeks.

My questions are:

1. Have you ever heard of such a recalcitrant case of herpes, either oral or genital in an otherwise healthy individual?

2. Is it possible for immunocompetent individuals (I do not have any immune-defenciency disease that I am aware of, and have had a negative HIV test within the last two years, for what it's worth) to develop anti-viral resistant herpes or, alternatively, to contract it? If so, what sort of treatment is usually prescribed? I read that Foscarnet is prescribed for immunocompromised patients with anti-viral resistant herpes,but not recommended for others.
3. If the answer to either of the above questions is "no," is it likely that I am suffering from an underlying problem that is impairing my immune system?

4. Would most internists and/or dermatolologists (e.g. those that are available to me through my HMO) know how to diagnose and/or treat anti-viral resistant herpes? Are testing facilities for it available through most commercial labs?

5. My wife had a cold sore toward the beginning of this year, and I didn't make any effort to avoid oral contact (e.g. kissing) with her during that time, because I figured I already had the virus, and could get "reinfected." Is it possible that I could have, and that this could be causing or contributing he burgeoning severity and tenacity of my current disease? I am at loss to explain why, after almost four years of having oral herpes, It has all of the sudden become so severe and tenacious.

6. I have been applying anti-microbals and various over-the-counter topical treatments to the lesions and inflamed tissue around them (it's actually hard to differentiate the two at times, as the entire area between my upper lip and nose is virtually covered in lesions) to prevent infection, ease pain, and hopefully speed healing. Is this a good idea, or is it possible that it could be contributing to the spread of infection to the surrounding tissue, or causing the infection of new nerve ganglia in the presently infected area?

[auntiejessi]

I answered this on the STD forum, and will just copy and paste what I wrote there.  We should keep this here, as it is a more appropriate forum.

This is my reply -

Hi there -

You ask several good questions.  Forgive me, but I can never remember if its .2 or .02% that are actually resistant to antivirals.  Either way, its low.

You tried famvir for a week.  Suppressive therapy takes about 5 days to kick in, so its possible you didn't take it long enough to see any results.  Also, you continued to have sores, possibly because you weren't on a treatment dose of the antivirals.  The treatment dose for famvir is 1000 mg twice a day for one day for genital herpes, and for cold sores, take a single dose of three 500-mg tablets at the first sign or symptom of an outbreak (within 1 hour).  After that, you could go right into the suppression dose, which is 250 mg twice a day.

That said, I wonder if this is all herpes.  You wouldn't get herpes on your torso.  Its been 3 months - that's about enough time to get a type specific IgG blood test and at least find out if you have either type of herpes.  That won't tell you if all of these are herpes related, but if you have no antibodies, then you know this can't be herpes, and therefore, aren't responding to antivirals.

I personally wouldn't use anything on them at this point that your doctor didn't tell you to use.  A lot of those treatments can cause irritation, and you might be preventing it from healing.  

The other thing that makes me wonder about this is that if you got herpes from your wife, and she has a strain that isn't resistant to antivirals, the strain you have would not be resistant.  

Since you can't get into a derm for several weeks, your regular doctor should culture any new sores you get for herpes, bacteria, etc.  It would really be a lousy deal for you if this was a bacterial infection that was only treated as herpes because everyone just assumed, ya know?

I hope this helps.

Aj