TWICE MONTHLY RECURRENCE OF ORAL HSV1

[balzac1000]

Hello Terri. You have helped me in the past with questions of transmission of oral HSV especially to my young son... I test positive for HSV1 in blood testing. My problem is I am having monthly to twice monthly breakouts of hsv sores on the margin of my lip. I have taken 1000mg Valtrex daily for a few months now and I am still getting very frequent outbreaks. This is becoming mentally and physically taxing. Anxiety levels never get a chance to subside which creates a viscous cycle I am sure. Do you have any thoughts for me? Do I bump up to 2000mg Valtrex daily to get this under control? IS this normal? Is there any hope of this subsiding with time? The outbreaks are never really bad, just very very frequent. Any help would be greatly appreciated.

[Terri Warren, RN, Adult Nurse Practitioner]

I can understand that this is concerning for you.  A person doesn't have to have a deadly disease to be concerned about their medical conditions.  

Has your wife actually had an antibody test recently to determine if she has HSV 1 or HSV 2?

Terri

[balzac1000]

Sounds like a great plan. Thank you so much for your genuine concern. I know I don't have some life threatening disease but the frequency of this is enough to make anyone's nerves shot. I of course worry about passing along to my wife and son. I am extra careful, but when I cant kiss my wife two weeks out of every month, that gets old too. I had a PCR swab test done today which is day one of the latest outbreak. The Dr's visual analysis was uncertain but said did resemble possible herpetic lesion. He agreed with the PCR test. Lets assume all of these outbreaks are herpetic. I don't understand the frequency and I don't understand why Valtrex doesn't seem to help. Kind of leaves me with a hopeless feeling that I am going to have to go through this for the rest of my life in this manner. I am healthy guy. I probably drink too much liquor and Im sure that isn't helping.  

[Terri Warren, RN, Adult Nurse Practitioner]

I see that you have also posted this for Dr. Handsfield.  I actually completely agree with his post response to you.  I saw in your response that you did have a swab test from a lesion on the mouth that was HSV 1, but you also mentioned that all of the presentations don't necessarily look alike.   This leads me to wonder if some of what you are experiencing are HSV 1 outbreaks and some are not.  I think if you were our patient, we would send you home with PCR swab kits and let you swab whatever lesions come up, return the gathered swabs to our office and we would send them to the lab. We would likely also ask you to keep a detailed diary of how the lesions look and then compare that to the results you obtain to determine which are really herpes and which are not.  

It may also be that Famvir would work for you while Valtrex does not, if, indeed, all these lesions do turn out to be herpes.  We rarely use Famvir, but every now and then, we find a patient who does a little better on Famvir than Valtrex.  

I personally would not recommend bumping your Valtrex to 2 grams a day.  That's a pretty hefty dose, and if 1 gram isn't doing suppression well, then I kind of doubt that 2 grams would do better.  However, you might try dividing the 1 gram dose into 2 500 mg doses, taking one in the AM and one in the PM to see if that helps.  But honestly, first I think you should sort out if everything you are experiencing is really herpes.  

If your clinician cannot and will not give you PCR swabs to take home, our clinic can send you swabs to gather and you can ship them back to us.  Let's try to sort out what is really going on here before intervening too much more.  Does that sound like a plan?

Terri