[Question #4821] HSV1 question

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79 months ago
Hi Terri,

59 yo man, diagnosed  with oral HSV1 via a positive culture swab in September '18. Since I am immunocompromised due to lymphoma my oncologist started me on Valtrex (500 mg 2x/day) as a suppressive and I have been taking that everyday. My first outbreak was bad with 3-4 lesions that I unknowingly shaved over (lesions were above and to the sides of my upper lip) that resulted in a bacterial infection as well. Quite a mess. In any case, I have not had any outbreaks since the initial September '18 infection and I have also gone from shaving everyday to more of a stubble beard (trimming every 3-4 days) because I don't want to irritate the area via shaving and bring on an outbreak. However, fairly often I feel a tingling/pulling in one spot near my upper lip and I was wondering if that could be prodrome/shedding and that the virus is trying to come out but the Valtrex is suppressing it. I was also thinking that it could be whiskers growing in and irritating the area of the initial outbreak (I was left with some scarring). I guess that I could test the theory by going off the Valtrex for a couple of weeks and see if the tingling/pulling evolves into an actual sore but I would rather not for obvious reasons. So, to summarize, my questions are:

1. Could the dull tingling/pulling be prodrome suppressed by the Valtrex?

2. If so, could I pass oral HSV1 to someone else during this prodrome?

Thank you for your service to us!
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79 months ago

Hi Terri,



59 yo man, diagnosed  with oral HSV1 via a positive culture swab in September '18. Since I am immunocompromised due to lymphoma my oncologist started me on Valtrex (500 mg 2x/day) as a suppressive and I have been taking that everyday. My first outbreak was bad with 3-4 lesions that I unknowingly shaved over (lesions were above and to the sides of my upper lip) that resulted in a bacterial infection as well. Quite a mess. In any case, I have not had any outbreaks since the initial September '18 infection and I have also gone from shaving everyday to more of a stubble beard (trimming every 3-4 days) because I don't want to irritate the area via shaving and bring on an outbreak. However, fairly often I feel a tingling/pulling in one spot near my upper lip and I was wondering if that could be prodrome/shedding and that the virus is trying to come out but the Valtrex is suppressing it. I was also thinking that it could be whiskers growing in and irritating the area of the initial outbreak (I was left with some scarring). I guess that I could test the theory by going off the Valtrex for a couple of weeks and see if the tingling/pulling evolves into an actual sore but I would rather not for obvious reasons. So, to summarize, my questions are:



1. Could the dull tingling/pulling be prodrome suppressed by the Valtrex?


2. If so, could I pass oral HSV1 to someone else during this prodrome?



Thank you for your service to us!

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Terri Warren, RN, Nurse Practitioner
79 months ago
This could be prodrome  - it really isn't possible to know for certain without a swab test looking for virus.  If you want to know for certain,you could go see your provider and have a swab test, preferably PCR, done of the area that is tingling/pulling.  This would tell you if virus was present.
You can  pass HSV 1 to someone else even when you don't have symptoms, unfortunately.  But transmission happens with direct contact - kissing or giving oral sex to an uninfected person
I'm not clear that shaving is an issue for people with oral herpes but you are associating shaving with a bad primary which is understandable.  I doubt that shaving will trigger an outbreak, generally speaking.

Terri
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79 months ago
Hi Terri, thanks for your reply. I will see if I can get in to see my doctor for a swab test. My doctor doesn't do PCR tests, he says that he doesn't order the kits because he doesn't do the volume of tests that would make it worthwhile. Maybe I'll look for a herpes expert in my area who is familiar with the PCR test. I sure hope that it is not prodrome because it seems to be pulling/tingling/aching almost all the time and that would mean that I would be able to pass the virus to somebody almost at any time and I suppose that means that I could never kiss another person unless I was sure that they were already exposed. Oh well, it is what it is. 
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79 months ago
Two more questions. I've been doing some reading here and understand that being on Valtrex as a suppressive can tamp down the detectable antibodies to HSV in your system. Since I was diagnosed via a positive swab culture I'm not concerned about antibodies being available for any blood test to detect so I was wondering if :

1. Is there any advantage to going off the Valtrex so I develop more antibodies?  I was exposed to the virus on 8/31/18, developed primary outbreak symptoms a week later and have been on the Valtrex since 9/10/18. 

2. Being a Lymphoma patient with a squashed immune system my oncologist has me on Valtrex (500 mg 2x/day). I read elsewhere here that the typical suppressive dose for Valtrex is only 500 mg/day but that for some situations you like it at the gram/day dose that I am on. Does a gram/day provide more suppressive power perhaps or keep a more constant level in one's system?

Thanks.
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Terri Warren, RN, Nurse Practitioner
79 months ago
1.  No, there is no advantage in going off medication.  You had a positive PCR swab and that's all you need to confirm your infection.  It's fine to stay on meds
2.  One gram provides slightly better coverage than 500 mg but not a huge difference.  But the medication is not even activated unless there is virus present and replicating so I think it's fine to take 500 mg twice a day.

Terri
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