Recurrent oral herpes

[balzac100]

Dr. H... i am 32 year old male.  I posted here this time last year having been diagnosed with oral HSV1. I had a severe initial outbreak of herpetic gingivostomatitis. Since then I have had on average 1 to 2 outbreaks per month. Sometimes overlapping. One time may be a small blister on lip other time may be swelling and inflammation on gum, usually in the same spot. The outbreaks arent severe but they are all the time. I feel like i'm going crazy. My doctor put me on valtrex 1 gram a day for three months then said to taper down to 500mg day in hopes to eventually taper down to none. Outbreaks still occurred. I have been instructed this week to take 1 gram Valtrex twice a day for 45 days. Then go back to once a day for 45 days. Is this normal? Is this safe? Am I the only one this happens to? I keep reading how rare it is to have recurrent outbreaks on gums. But it is happening. Is so much valtrex safe? Will my body become resistant to the Valtrex? Am I a rare case? Should I see an infectious disease specialist? Should I be put on other medication? Do you think this will subside with time? I feel like I am a walking infectious being. The mental strain has become extremely unbearable. My everyday motivation is gone. I worry about infecting my girlfriend. It seems I am telling her 3 out of 4 weeks I cant kiss her,.... Any help in explanation and answers would be greatly appreciated.  HELP!

[balzac100]

Also, if what I am experiencing is a papilloma... why does it go away on its own in less than 12 days. I thought a papilloma would remain until it was removed. Plus small area on lip is firm raised bump. No fluid and no scabbing. Just forms and regresses. Also the number of recurrences is really troubling me. Area on hard pallet is never raised. It is flat, painful, and usually is affected by hydrogen peroxide.

[balzac100]

Dr. After numerous "outbreaks" of bump on my lip and area on hard pallet. I went to an oral surgeon who looked at the lesion on my hard pallet and biopsied it. The results came back as benign pappiloma? I was actually given this news by a secretary and my follow up with surgeon is not till end of next week. I dont know what to think. Secretary said biopsy was not herpetic.  Can you give me our thoughts? I am very concerned at this point.

[Edward W Hook, MD]

I'm not sure why your case is so severe either. One possibility it that there is something other than HSV going on, mimicing HSV which you have but is not causing problems.  Canker sores can do this as can other dermatological problems.  My advice would be to seek the advice of a dermatologist who has experience looking at oral lesions.  Alternately, perhaps a good dentist.  EWH

[balzac100]

Dr. Hook, Just a side note. I finally had a blister on my lip swabbed last month. Probably 3 to 4 days into outbreak. Test came back positive as I suspected. But... I got a call yesterday from my doctor. They had been contacted by the testing center that my results were a mistake. Test was NEGATIVE. I received all paperwork and even called testing center. They apologized saying it was clerical error. Not sure what to think? I just dont know if I didnt swab at the right time or what else this may be. My immune system has always been golden, I havent been understanding why this HSV has been so hard on me.

[Edward W Hook, MD]

Thanks for the confirmation.

The severity of your outbreaks is rather atypical.  Over time there frequency should decline but unfortunaely this may take quite a while (i.e months to years).  EWH

[balzac100]

Yes sir, I have had a swab of lip blister but never had swabbed the gums. Result from lip was positive. I have also retested IGG by blood. My titer level was escalated to over 6 for hsv1 , negative hsv2. Is this typical to have continuous overlapping outbreaks on lips and gums? Will they subside with time?

[Edward W Hook, MD]

Welcome back to the site.  In preparing to address your questions I re-read your initial interaction with Dr. Handsfield, as well as our exchange last September.  I still think that you need more information.  As Dr. Handsfield and I have pointed out to you, your blood test result was on the low side to be confident in the diagnosis.  We both suggested you get a culture of PCR test from an outbreak when it occurs.  Have you done this.  I would hate to think that you have suffered and taken all of this valacyclovir for something that was not HSV and there are other problems which can cause sores resembling HSV.  My primary advice for you is that you need a culture or PCR from a lesion and if nothing else, a repeat blood test.  Now on to the questions that you asked:

Typically oral HSV-1 infections require higher doses of valacyclovir than genital HSV.  The reason for this are unclear but those are the data.  I would not however worry about valacyclovir toxicity unless you have kidney problems (the drug is excreted by the kidneys and persons with abnormal kidney function tend to have higher blood levels than persons whose kidneys are normal).  Acyclovir and valacyclovir (VCV) however are amongst the safest drugs we use, causing few side effects.  Thus, if your renal function is normal and you really do have HSV, there is no reason to be concerned about the dose of valacyclovir your doctor has suggested.  

Resistance to VCV is uncommon but does occur, typically after a person has taken the drug for a long time.  

Hope these comments are helpful to you. Please make sure this is HSV.  EWH