Recurring Symptomatic GHSV-1

[s_0654]

Doctor Handsfield,

I am a 23 y/o male that was diagnosed with GHS via visual inspection in early September 2010; the diagnosis came following a sexual encounter with my girlfriend. We were both tested; she tested negative for HSV-1 and HSV-2, and I tested positive for HSV-1 and negative for HSV-2. I am quite confident that I have GHSV-1 as my most recent sexual encouter prior to this episode was in April 2010, and my girlfriend's was in May 2010.

I had a moderately-severe initial outbreak, with very clear blisters on the base of my penis and continuing sores popping up for an additional 3-4 weeks.; I took 1 g of Valtrex daily for four weeks After this outbreak passed, the skin at the base of my penis was still quite sore and red; however, shortly thereafter (1 week) I began taking 500 mg of Valtrex daily and this cleared up all remaining redness.

On November the 18th (after a night of very heavy drinking and little sleep) I began experiencing my second outbreak. It was quite similar to the first, with classic sores on the lower left side of my penis (at the base), and several additional 'after-shock' sores that occured up to this week in my general pubic area. The sores healed more quickly, and were a lot more mild; however, the outbreak duration still lasted 3-4 weeks.

I am quite concerned that I've experienced a second outbreak so close to my primary episode given that I have GHSV-1. I am wondering if I've gone on anti-viral therapy to soon after my initial oubtreak and not allowed my body to develop sufficient immunity to the virus.

Questions:

1) Should I stop using Valtrex in order to let my body develop a stronger immune response to the virus on its own?

2) Does the recurrence of my GHSV-1 outbreak so soon after my primary epsiode mean that I am doomed to face outbreaks every 2 months for the rest of my life? Is there still a chance that I will never experience another outbreak, like others diagnosed with GHSV-1?

[Edward W Hook, MD]

Welcome to the Forum.  I think you need a more definitive diagnosis and would suggest that you cease taking valacyclovir and, should a recurrence occur, you have it tested for herpes by culture or PCR as soon as possible after the recurrence begins.  Experts are wrong in their diagnosis of genital herpes about 25% of the time and there are other recurring genital rashes that can mimic herpes.

There are several atypical aspects to your story including that your recurrence lasted 3+ weeks. Typically recurrent HSV outbreaks last only a few days and are fully healed after a week.  

There is some, limited data that starting valacyclovir or other antiviral therapy soon after acquiring HSV can delay development of a positive antibody test.  Whether or not this impacts the tendency for the infection to recur is unknown but I doubt that this would be the case.  

If you do have genital HSV-1, it is typical for recurrences to occur relatively soon after the first outbreak and then, with time, for the recurrences to become less frequent.  EWH

[Edward W Hook, MD]

I hope that you did as suggested and got your OB tested with PCR or culture.  As I said, you still do not know that this is HSV for sure.  EWH

[s_0654]

To anyone interested. I've come down with another mild OB 3 weeks later. Unfortunately, I don't know what to make of all this........ praying that this virus will finally leave me alone!!!!

[Edward W Hook, MD]

Thx.  EWH

[s_0654]

Many thanks Doctor.

I will be sure to update this post over the coming months to let anyone interested in GHSV1 know if I have experienced additional outbreaks.

[Edward W Hook, MD]

Thi sis still not the typical recurrence pattern of genital HSV.  Typically recurrences do not follow one another so quickly.  

It is too early to establish a clear pattern of recurrences, if you have herpes, particularly given the atypical features thus far.  EWH

[s_0654]

Thank you very much for your prompt reply Doctor.

I will certainly take your advice and get a second opinion *IF* I ever experience a recurrence, and I will cease taking Valtrex once this recurrence is fully cleared.

I should clarify that the individual sores themselves seem to heal in approximately one week, but that additional sores popped up over the course of the 3 week period.

Does this initial recurrence pattern suggest that I am likely to experience additional recurrences in the future? Have you ever encountered a patient that ceased having recurrences after their second episode being so soon after the first outbreak?

Many Thanks.