[Question #3953] 4 repeated her pes breakouts on lips

31 months ago
Dear Doctor
This is a follow up question to my previous one. I understand that no more repeated questions about the risk of HIV as mentioned by you in my second post. My question is about why iv had 4 repeated herpes breakouts and if it is something i need to worry about.

Just a repeat of the incident. I went for a massage and it resulted in one minute of a handjob. Nothing else - no kissing, vaginal, anal. Nothing else. Iv been very stressed out and iv gotten 4 tests 
1. 4th gen lab test on day 21
2. 4th gen lab test on day 26
3. Determine ag ab rapid alere test on day 51
4. 4th gen lab test on day 60 post incident 

I UNDERSTAND THAT THESE TESTS RULE OUT HIV and that my exposure was zero.  What i cannot understand is how iv had 5 breakouts of herpes simplex since then. Iv had herpes simplex blisters on my lips for the last 5 yeasr but never 4 times in two months.

The first time was 10 days after the incident - very small blister , not sure if its herpes 
The second time was 55 days after the incident - definately herpes ( seen after long flight which i did not sleep on )
Third time was 62 days later - small blisters 
Fourth time was at 65 days and 5th time was 70 days later . 

In the last two weeks (days 55 -70 )  every three days iv gotten a small blister somewhere. My questions are 

1. Could this be something serious ?
2. Has this ever happened to anyone before ? Is it because of the stress  
3. Iv started acyclovir cream. Should i take oral medication
4. Do i need any other tests ? 

FYI - Iv had herpes simplex for the last 5 years so its recurrent and not inital. 

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
31 months ago
Welcome back, but I'm sorry you found it necessary.

"I UNDERSTAND THAT THESE TESTS RULE OUT HIV and that my exposure was zero. That's exactly right. The HIV blood tests are among the most accurate diagnostic tests ever developed, for any medical condition. The results overrule all other considerations:  no matter how high the risk of HIV at the time of exposure (your risk was nil) and no matter how typical symptoms or other considerations might be for a new HIV infection, the test result ALWAYS RULES. Your result proves you did not catch HIV. If you are having increased herpes recurrences, it isn't because of HIV. And anyway, increased frequency of herpes recurrences is not a common a symptom of HIV infection. (Advanced HIV, i.e. overt AIDS, can result in longstanding, non-healing herpes outbreaks. But that's a different issue than increased outbreak frequency.)

My first advice is that if similar apparent episodes occur in the future, you get professionally checked to confirm the diagnosis. There are three main reasons I doubt herpes. First, true herpes outbreaks never occur more often than once a month, and anything occurring "every 3 days" cannot be herpes. Second, recurrent oral herpes almost always is in pretty much the same spot every time. If someone usually has outbreaks on, say, the left upper lip, future outbreaks will also be there. But your statement "I've gotten a small blister somewhere" suggests they are in different locations each time. Third, no herpes outbreak can clear entirely in a day or two; herpes outbreaks last a minimum of 7 days and usually 10-14 days until complete healing. I don't know enough about each of these several episodes to say that none were herpes outbreaks, but I'm confident that not all of them were herpes and perhaps none were.

To your specific questions:

1) Almost certainly this is nothing serious, and for sure it has nothing to do with HIV or the non-risky sexual event you have described.

2) Contrary to popular belief, stress has never been proved to trigger herpes outbreaks. This is a controversial issue and I'm not saying it can't happen, but it's probably uncommon. In any case, for the reasons above, I doubt these are recurrent herpes outbreaks.

3) Acyclovir cream is useless for herpes outbreaks, with little if any benefit in speeding healing. The accepted and recommended treatment for recurrent oral herpes is a single large dose (2 grams) of valacyclovir (Valtrex) by mouth at the earliest sign of an outbreak.

4) I see no need for further testing at this time. As suggested above, you should see a doctor immediately (within a day or two) if and when another of these episodes occurs to either confirm herpes or advise you about other possible causes.

31 months ago
Hi Doctor 
Thank you for your answers . After this incident ( handjob ) I had several meltdowns . Went to a therapist and she put me on anti depressants - 
Maxgalon , Sizdon and Stablon 
Long story short - I was told to take 10 days off and I went on a hike . That’s where I am now and I can’t show a doctor till next Tuesday. 
I started Valacyclovir the day you said I should but today I have another blister . I’ve taken a picture of it - 
My follow up questions are 
1. Does it look like a herpes lesion ?
2. Can anything apart from herpes cause blisters on lips
3. I only got a handjob . Nothing else really - am I at risk of hepatitis c or syphillis . I read if the body is fighting another virus or infection it could also cause herpes outbreaks. I’m most worried about that
I wish these “blisters “ would go away

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
31 months ago
Sorry, but we do not examine clinical photos. This is not a clinical service -- we don't diagnose problems or provide specific treatment.

As discussed in your previous thread, no STDs are transmitted by hand-genital contact. That event did not put you at risk of any form of hepatitis or syphilis.

Herpes outbreaks can be triggered by other infections -- that's why they're sometimes called cold sores or fever blisters. 

You give even more evidence that your current problem isn't herpes. If it were, they would have started to clear up within 2-3 days of starting valacyclovir treatment and would have cleared entirely within 5-7 days. That they are persisting on valacyclovir means herpes isn't the cause.