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Atypical Coldsores - Urgent help
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The STD Forum is intended only for questions and support pertaining to sexually transmitted diseases other than HIV/AIDS, including chlamydia, gonorrhea, syphilis, human papillomavirus, genital warts, trichomonas, other vaginal infections, nongonoccal urethritis (NGU), cervicitis, molluscum contagiosum, chancroid, and pelvic inflammatory disease (PID). All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.

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Atypical Coldsores - Urgent help

Hi, I am getting married in four days and need advice as I am extremely upset. I have had Cold sores for about 20 years, I am 31, (was tested as HSV1 positive) I get about 5 or6 OB per year. They usually take the typical form and are gone in 4 days to a week depending if I nip it in the bud with Valtrex

I started taking one a day 1g of Valtrex a day as suppressive therapy in fear of getting a CS on my wedding day, and my nightmare has come true. I started getting a litttle bump in each corner of my lower lip which has spread over the past few days to cover my complete inner rim (where my lips press together of my top lip) and my entire bottom lip. This outbreak is 'atypical' for me. The top lip is basically red, raw and has peeling skin, my lower lip has ulcers forming but not fully going through the stages. My bottom lip literally has two clusters of a bunch of bumps that are red but not 'fully forming'. I took 2g and 12 hrs later 2g of Valtrex yesterday and woke up with a worse bottom lip then i went to bed with. As the day progresses it is getting more red and bumpy. Top inner rim of lip is still red and raw but not lumps. I am using nothing else by my usual aquaphor applied w a q-tip. I dont know if i should still take the valtrx? I took another 1g when I woke up today.....I have taken 1g per day for almost a week and the additional 2g and 2g 12 hrs later last night. Im afraid if I stop the valtrex they will get worse. But it seems they are so 'angry' and still getting worse even on the V.... Im so upset over this and have only 4 days till my wedding. I feel as if the valtrex triggered an atypical outbreak that is fighting the medicine. Could I have trigged an outbreak by taking the V without an actual CS?
Or maybe im immune to Valtrex since I have been taking it on and off for the past 8 years?
Can coldsores get worse over the years or change the way they present themselves as mine seem to have done? Could the strain I have become more powerful? THANKS
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Welcome to the Forum.  I'm sure this is most concerning.  Several comments which might be helpful but really what I would urge you to do ASAP is to go and see a dermatologist for evaluation.  My suspicion is that what you are experiencing is not a cold sore but some other dermatological process- perhaps an allergy to something else )a new lipstick or lotion, other medications, etc.) or perhaps a fungal infection.  There are a very small proportion of herpes strains which become resistant to valacyclovir but this is very rare and most often occur in persons who are otherwise immunosuppressed such as cancer patients or persons with advanced HIV, neither if which I suspect that you have.  

At the moment and given your need for a quick answer, my suggestions are:
1.  Stop taking the valacyclovir.  Clearly it is not helping.
2.  don't put other things on your lip in the hopes of helping them.
3.  See a dermatologist for evaluation. I suspect if you explain your situation they will find a way to work you in quickly.

I hope this comment is helpful.  Please let us know what the dermatologist says.  EWH
8 Comments
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I was able to get an apt asap. Should I request a specific type of herpes test? If it is indeed a atypical outbreak do you think I should still stop the Valtrex? I will let you know how it goes :( thanks
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300980_tn?1194933000
I would let the dermatologist decide of testing for HSV is needed at all.  Most importantly however is to stop the valacyclovir now.  EWH
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Hi Dr Hook
I just got back from the Derm, he said it is def an outbreak of coldsores and he gave me Topicort Desoximetasone 0.05% ointment for the peeling, redness and irratation. He told me that I should continue to take 1G of Valtrex in the am and 1G in the PM daily and told me that this is just a bad outbreak with a large viral load prob. due to stress and the Valtrex can only help not hurt. Does this make sense to you re: the Valtrex? If i was resistant to the Valtrex which is rare, it wouldn't do more harm, correct? wouldn't it kind of be like taking a placebo? And Valtrex has worked in the past at stopping the full blister from forming, could this just be a very big viral load coming to the surface hence the spread out outbreak?
Thanks for all your help, I feel a bit better and hope that by Sunday for my wedding I can at least wear lipstick without it being so noticable - fingers crossed

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PS I just read up on Topicort and it says to not use it on a coldsore...should I not be using this med?
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300980_tn?1194933000
How interesting. If this is HSV, it certainly is unusual.  You have been examined by a trained specialist and I will defer to him as he had the chance to observe you and your lesions.  If this is HSV, takeing the valacyclovir would not hurt.  EWH
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Hi Dr Hook,
I had a few more questions I was hoping you can clarify. After the last outbreak healed, I have had two new ones, one right by my nostril a week later and two new bumps on my lips a week after that. It seems to be a weekly event. I have been taking 2 valacycovirs 12 hrs apart for the last for the last two outbreaks and they haven't become to bad.

Here is my concerns... my husband has never had a coldsore but also has never been tested for HSV... we have been together for 14 years - so I cant imagine he hasn't accidently come into contact w mine, esp bc they have been frequent in the past few yrs and atypical so it is hard for me to know when one is coming.

he has had a few minor sympotms on his penis a itchy area here and there over the years that have gone away in a day or two but again (nothing that looked like a typical sore) he never was tested. I have been numerous times and only test positvie for HSV1...my HSV2 IGG came back as 0.23 Index (not sure what this means) I was told it is negative.

My questions are can I catch HSV1 twice? or if he has it on his genitals and caught it from me can I catch a worse outbreak and pass it back and fourth? Can I get it on my hand if he sheds on his genitals? Can I get it on my hand from my own oral herpes by accidently touching it?
Im afraid of passing it back and fourth? and I am worried that my more frequent outbreaks in the past few years and their atypical nature could be bc my infection has gotton worse or i caught a new strain?

Thanks



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300980_tn?1194933000
These will be my final commetns.  I remain skeptical that this is HSV-1 and suspect it is some other dermatological process in you, a person who has HSV-1.  

A person cannot catch HSV twice.  If you have HSV of one type or another, you cannot let it in another location.  Further you cannot transmit it from one part of your body to another by touching yourself at one location and then another.  

That will be all.  You need to work through this problem with a doctor (a dermiatologist might be best) who you fel good about.  it may take some tiral and error.  EWH
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