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Avatar universal

Swollen, painful gums and HSV1

hello, I contracted HSV1 about 5 months ago.  I've been on suppressive therapy with Valtrex since then because I believe (but don't know for sure) that my current partner is HSV1 negative.  From time to time I try stopping the Valtrex for a few days and the virus seems to come back in the form of swollen, painful gums (it's not terrible pain but annoying, especially when brushing or flossing).  Each time I stop Valtrex, it seems to take longer for the virus to reappear but it almost always reappears in the form of swollen and painful gums.  I had this same symptom (although much more severe) when I initially contracted the infection together lesions on the penis and testicles and one strange lesion on my lower stomach.  At the time of initial infection, I also ran a fever for a couple days.  Prior to contracting HSV1, I never had problems with my gums.  

My questions are: (1) is it likely that my infection is now limited to recurring in my gums? (2) How easy is it to transmit the infection through kissing or oral sex when my gums are swollen?; (3) Do I need to take Valtrex indefinately or can I stop at some point (i.e., will the risk of transmission decline appreciably at some point making it reasonable to stop taking Valtrex?); (4) Are there any health risks from taking Valtrex on a long term basis?

Thanks for your help
4 Responses
239123 tn?1267651214
MEDICAL PROFESSIONAL
Welcome to the STD forum.

It might be posssible that iyour HSV-1 is reactivating each time you stop treatment, but I am skeptical.  Although the intitial oral infection with HSV-1 often includes gingivitis (gum inflammation) in addition to multiple oral sores, sore throat, etc, recurrent oral herpes almost always is limited to a few blister-like lesions that recur on the outside of the lips, nearly every time in more or less the same spot.  I recommend you say off Valtrex for several weeks, and the next time you get apparent gum inflammation, see your primary care provider (or your dentis) for HSV testing from the inflamed gums.  If postive for HSV-1, you will have proved me wrong -- but I would be very surprised.

In general, suppressive therapy is not commonly used for HSV-1.  The main reason is to prevent symtomatic outbreaks, when those outbreaks are particularly severe or frequent.  There are no data on its benefit in preventing transmission.  And you can't safely transpose the data on prevention of genital HSV-2 to oral HSV-1.  HSV-1 is less susceptible to Valtrex and related drugs, so the necessary dose is unknown and might be higher than for HSV-2.  Also, asymptomatic shedding is less common with oral HSV-1 than genital HSV-2.  Finally, the main strategy for protecting your partner probably should be for him or her to be tested for HSV-1.  There is a 50-50 chance of a positive result, in which case s/he is not susceptible and you need take no precautions at all.

To the specific questions:

1,3) Answered above.  In summary, I doubt your gum symptoms are due to herpes.  But I certainly will be interested to hear if or when that diagnosis is confirmed.  And I do recommend you stop Valtrex and see what happens.

2) If the apparent gingivitis really is herpetic, I imagine the transmission risk would be very high -- but only if your partner is susceptible.

4) Long term valacyclovir treatment appears to be very safe, with few if any side effects.

Going back to my advice about stopping treatment:  No distant online forum gives official medical advice.  You should discuss my opinion with the doctor or clinic that prescribed Valtrex and then follow their advice.

Feel free to report back after you have been reevaluated as suggested.  I'll be interested to know the outcome.

Best wishes--  HHH, MD
239123 tn?1267651214
MEDICAL PROFESSIONAL
To clarify one point:  I'm not saying suppressive treatment would not be effective in prevention transmission or oral HSV-1.  Most likely it would reduce the risk, but it is difficult to know by how much.  Or, as I said above, to know what dose to use.
Avatar universal
Dr. H, I've done some more research and heard from someone else in the forum.  I believe what I'm experiencing is primary herpetic gingivostomatitis.  The picture of this matches what my gums look like when I have an outbreak.  I will take your advice, stop the Valtrex and see if I get another recurrence at which time I'll try to get a culture to confirm.  I'm 90% sure this is what I have.

During the initial outbreak I had lesions on my lower stomach, penis and testicles; they were fairly minor; no pain and little discomfort.  Do you think I have to worry about a recurrence of this as well as in my mouth?  It only occurred with the initial outbreak.
239123 tn?1267651214
MEDICAL PROFESSIONAL
All gingivitis looks pretty much the same; photos of herpes don't look any different than gingivitis of any case.  Primary herpetic gingivostomatitis is the initial oral HSV infection and it always clears up within 3-4 weeks, with or without treatment.  It cannot last 5 months, and recurrent lesion are not primary (by definition).  HSV does not cause widespread lesions like you desctive; the ones on your abdoman, penis and testicles were not herpesr.  As I said above, I continue to be skeptical your gum problem is due to herpes.

It is time to stop trying to figure out the diagnosis by online research.  Return to the provider who prescribed the Valtrex.  Or see your dentist, for the most expert evaluation of gingivitis.  Or ask your dentist to refer you to a dentist who specializes in oral medicine -- a dental specialty.

Feel free to post another comment after the problem has been professionally reevaluated and the diagnosis, herpes or otherwise, is confirmed -- but until then I won't have any other comments or advice.
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