Controlling herpes

Hi Doc,

I am a 28 y/o female diagnosed with GHSV1 last month. I posted and asked you a few questions then about transmission and other things.

Since my initial diagnoses, I have had two outbreaks of coldsores. One on my lower lip and now one on my little nose. It's outrageously embarrassing and really stressing me out.

My questions are as follows:

1. How impactful is diet to controlling herpes? Do you believe that a diet that is rich in Lysine helps to control herpes? Should I really be avoiding coffee, chocolate, nuts, etc.?

2. Will beginning hormonal birth control help to control my outbreaks? My OBs seem to be linked to my menstrual cycle. I have some pretty significant mood shifts associated with my menstrual cycle. ; ) I have read that hormonal birth contral can make OBs more frequent?

3. Would daily suppressive therapy work for me to control these OBs? What is a proper dosage?

4. I am asthmatic and take a daily steroid inhaler to control my asthma. Could this be contributing to lowering my immunity and increasing OBs?  

Your help is very much appreciated.

[H. Hunter Handsfield, M.D.]

1,2,4) Despite what you might have read, diet, lysine, and hormonal contraception have no known effects on herpes recurrence frequency or severity.  Most likely the inhaled steroid also has no effect either.  However, some of the steroid is deposited in the mouth, and conceivably could impair your immune response to HSV.  But to my knowledge this has never been studied and I cannot give a firm answer.

3) Daily suppression is effective against recurrent oral herpes.  HSV-1 is less susceptible than HSV-2, so that oral herpes typically requires higher doses of drug than genital herpes.  Valacyclovir 1.0 g twice daily or acyclovir 800 mg 3 times daily are often used to start, but the dose can then be reduced to see if a lower amount keeps outbreaks in check.  But follow your provider's advice for details.

Regards-  HHH, MD

[St.Bernadette]

thank you.