whats wrong?

I have had HSV 2 since 1999 never had more than 2 or 3 outbreaks a year sometimes none. since may 05 to present i have had 7. each  lasting 3-5 days. this month i had 3 tiny blisters that go away overnight i started valtrax 500mg 1x day in july didnt have anything for 2 months then had an overnight blister in sept. then swithched to zorivax 800mg 3x for 7 days in oct.  but uneffective.  is there something more serious wrong? like hiv?  most hsv info i've read said outbreaks lessen over time but mine are doing the opposite.

[H. Hunter Handsfield, M.D.]

I'll try to help.  The first thing you need to do is see a health care provider exerienced in herpes, when you are having an outbreak, to confirm it really is herpes.  If your symptoms are identical to those you always have had with recurrences, presumably you are correct in your current self-diagnosis.  The 3-5 day outbreaks sound typical, but herpes lesions never go away "overnight".  So perhaps you have something else going on.  Also, it is very rare for herpes to persist while on valacyclovor (Valtrex) or acyclovir (Zovirax), especially at the large dose of acyclovir you are taking.  It is possible your HSV-2 strain has become resistant to the drugs, but that is unusual.

So stop all treatment and see a herpes-knowledgeable provider immediately (within 24 hours) of onset of your next outbreak.  If indeed it looks like herpes, ask your provider not only to culture to detect the virus, but to tell the lab to save the virus; it can then be sent to a reference lab to see if it is resistant to acyclovir and valacyclovir.

In the meantime, don't worry about dire things.  Even if it is herpes and the frequency of recurrences has increased, it rarely indicates HIV or any other serious health problem.

Good luck--  HHH, MD