[Question #1577] Question

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90 months ago

After a primary HSV 1 herpes episode on the eyelid (not eye), how frequent is shedding in the first year versus future years?  Does the virus shed equally in the mouth as well as the eye?  

What is the average recurrence rate for herpes in this location? If this was an initial episode, does it make sense to take suppressive therapy due to the likelihood of recurrence? Does reoccurrence generally reoccur in the same place?

How quickly will Valtrex suppressive therapy begin to work? How long does it take for shedding to begin decreasing as it relates to transmitting HSV 1 to my partner (ie: hours, days, weeks)?

Is it hard to differentiate between herpes and shingles on the eyelid absent a culture?

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Terri Warren, RN, Nurse Practitioner
90 months ago
We don't have data on how frequently virus is shed from the eye specifically.  It does appear from a recent article by Dr. Wald that shedding in tears is quite infrequent.  We also don't have specific data about how common recurrences are on the eyelid.  The mouth, however, does shed quite a lot - about 27% of days sampled.  Recurrences often come in the same place but you may expect to see them orally or in the nose or on the chin as well. 
Suppression starts to work fully in about 5 days from initiating therapy.  If your partner is negative (remembering that the standard IgG test for HSV 1 misses 30% of infections) then taking daily therapy should reduce your infectiousness to that partner. 
So if you didn't have any testing done, how do you know it is HSV 1?  I don't think shingles and HSV 1 on the eyelid would look much the same, no, especially if it recurs. 
If you had HSV 1 on your eyelid, I think a consult with an eye doctor might not be a bad idea.  Likely they would approve of you taking suppression also to protect the eye itself.