Oral HSV-1 outbreaks

[Cubs69]

I have had oral hsv-1 for almost 30 years and was wondering why in the last few months I have had about three outbreaks. I typically have one a year if that. What could be causing the increase in outbreak frequency? I have not been under any stress other than normal and have not been sick. I visit a massage girl once in a while and during our session I perform oral sex on her. I have never seen any sores or lesions on her vagina during oral sex. Is it possible I aquired hsv-2 orally and could that be the reason I am getting more outbreaks. My outbreaks are not any different than normal and this might have happened in the past where I would get a cold sore and than a month later would get another, but never 3 within a three month period. I am concerned about my performing cunnilingus on the massage girl and whether this is the cause of my frequent outbreaks lately.  

[Edward W Hook, MD]

I wouldn't normally associate increased HSV with GERD meds.

Oral HSV-2, particularly after oral sex is rare but it is a possiblity.  I meant to suggest that an early step should be to be sure this is HSV and to find out what type.  I would expect it to turn out to be HSV-1 but it is a good idea to make sure.  The best time to get a culture or, better yet, a PCR test would be ASAP after the lesion appears.  EWH

[Cubs69]

Is hsv-2 orally still a possibility or is this just hsv-1. I have been taking a gerd medication for the past month and wonder if that's the cause

[Edward W Hook, MD]

Welcome to the Forum.  Your question is a wonderful one and, unfortunately one that I do not have great answers for.  I will make several suggestions/observations which occur to me but they are suggestions only.

Typically when people have HSV infections of any sort their patterns of recurrence tend to set themselves and then follow that pattern over time, perhaps becoming less common, if anything, over time.  When the pattern accelerates there is sometimes some other change in health status which can be related.  For instance, have you started taking any sorts of new medications over the past few months or perhaps started washing/cleansing your face differently.  Medications can have a variety of side effects and it turns out that different topical factors (like scrubbing) can elicit recurrences (the most extreme instance of this is that plastic surgeons state that dermabrasion can regularly increase the likelyhood of oral HSV recurrence).  The other possiblity is that there may have been some other change in your health. For instance, ould you have developed  a dermatitis/skin condition or diabetes or other heatlh issue.  If you have not had a recent check up, this might be a good time to do so.  

Finally, if none of these suggestions pan out, then I think you are going to need to attribute this to some sort of chance event.  I look forward to hearing if any of my suggestions resonate with you in any way.  EWH