frequent cold sores

[mq123456]

Nurse Warren,

I have been infected with HSV1 orally for about 2 years. At first I was getting cold sores about every 4 to 6 weeks. I then started taking 500 mg of Valtrex daily for suppression therapy. This seemed to reduce the frequency of my outbreaks to about once every 2 to 3 months. To save money, my insurance switched me to acyclovir (400 mg twice a day) with similar results as the Valtrex. Then starting about 3 months ago, I began to have outbreaks every two weeks even with the suppression therapy. My doctor changed me to famciclovir with no change in the frequency of the outbreaks.

In addition to the antiviral therapies I also receive hormonal replacement therapy (testosterone injections) every two weeks. I started this a little over a year ago. Could this be causing the frequency of my outbreaks? I receive my injections every other Friday and by the following Monday I have a cold sore. Have you heard of this happing in other patients. Is there anything else I can do to reduce the frequency of the outbreaks? Would higher dosages of medication be helpful?

[Terri Warren, RN, Adult Nurse Practitioner]

Good, that's great

[mq123456]

I was retested for HIV with the Uni-Gold test today and it was negative.

[mq123456]

Yes, two positive HSV 1 PCR tests

[mq123456]

I am currently taking 250 mg of Famvir twice daily. I was previously on acyclovir 400 mg twice daily and my PCP changed to the famivir to see if it would work better. Before the acyclovir I was on 500 mg of Valtrex once daily but my insurance made me change to acyclovir. So far it has not. The Valtrex was working well and so was the acyclovir (I was having outbreaks about every other month) until about 2 months ago. When you say HIV is a long shot risk (a very long shot) how concerned should I be? I assume you mean that it is unlikely that I have HIV? How reliable is the type of HIV test I took?

[Terri Warren, RN, Adult Nurse Practitioner]

So you've had two positive PCR tests from the cold sores for HSV 1?  
I think HIV is a long shot risk for you, very long shot, but you could retest if it would make you feel better.  
How high is your medicine dosing at this time?
Terri

[mq123456]

Thank you again for the response. I did have the frequent outbreaks confirmed with PCR swabs (well the first 2 anyway after that My PCP saw no point in continued swabbing.) I have tried your advice about taking more antiviral medication after my injections and that has not helped yet, I know it still is early. I have been searching posts about frequent cold sores and I keep coming across HIV/AIDS as a possible cause. This, of course, is disconcerting. It has been near two years since having any possible exposure and I tested negative (an in office test where they poked my finger and took a sample.) The results were read in the office after about 10 minutes. I took this a week or so after the recommended time period following exposure.

I guess my question is this. Is HIV a possibility? I know that I had the negative test but it took me longer than normal to seroconvert and show HSV1 in a IGG blood test. In fact this test was a low positive (3.1) and I had 3 western blots with the first negative and the next two indeterminate. Could the HIV test I took also be effected by a slower conversion rate.? I was having cold sores about every two months until a couple of months ago. Now I am barely over one before I get another. I am seeing my Doctor this week. Should I ask him any questions? Should he do any specific testing? We know that the sores I have are caused by HSV1 due to the swabs but why are they so frequent?

[Terri Warren, RN, Adult Nurse Practitioner]

My first strategy would be to prove that what you are having so frequently are actually PCR positive HSV  lesions, this is always the place to start.  And it could be due to your hormone levels, I've just not seen it in men, that doesn't mean it doesn't happen.

Terri

[mq123456]

Nurse Warren,

Thank you again for your response. If the fluctuations in my hormone levels aren’t contributing to my frequent outbreaks can you think of anything that might be? Should I be concerned about my health? I am generally in good health. Could my immune system be compromised in some way?

[Terri Warren, RN, Adult Nurse Practitioner]

It is uncommon for people on suppression to have frequent outbreaks, yes.
All the antivirals work pretty much equally when taken as directed.  Some do have different doses for oral vs. genital herpes

Terri

[mq123456]

Thank you Nurse Warren, I will give that a try. I do have just a couple of follow-up questions. Is it uncommon for people on suppressive therapy to have such frequent outbreaks? Also, are there any other explanations you can think of that could contribute to my frequent outbreaks, e.g., my health, diet, stress, etc. Finally, in your experience does any of the antivirals work better than the others and are the dosages the same for genital HSV as for oral (I ask because the dosage my PCP prescribed was based the dosage for genital HSV?) Thank yoy again.

[Terri Warren, RN, Adult Nurse Practitioner]

Hmmmm. I've not heard of that, but the timing is, of course, suggestive that the testosterone is related to the cold sores in a timing sort of way.  Here is what I would recommend if you were my patient.  IF this is happening most every time you get your injections, I would increase your suppressive dose of acyclovir to 3-4 times per day vs two for about 5 days starting on the day of your injection.  See how that works.  And don't just put them together but rather spread them out over the course of the five days.  Do you see what I mean?  You might want to run this by your health care provider, of course, but I think that might help.  Some women report outbreaks at some point related to their menstrual cycle, and that's what we do with them, so it might also work for you.  Hope so!

Terri