[Question #517] HSV1 gentially

40 months ago

My ex had HSV1&2 so I was tested with no symptoms and tested IGG positive to HSV1. Never had any symptoms until 6 months later I had genital sore. I was IGG tested again and pos for HSV1 neg for HSV2. Since that time from Oct 2014 -Oct 2015 I had four outbreaks (OBs). And currently one now. So my questions are 1. With no new partners from that last test 6 months ago should I be retested for HSV2? I just find it odd I suddenly started having OBs more than I did in the first 6 months. Everything that I've read says HSV1 rarely has OBs? Is this really true? and I am just an outlier or should I get blood tested again?

2. I was put acyclovir 800 mg BID for first outbreaks that all went away in a about two/three days but this time they had me try Valtrex 500mg BID but it seems to be taking longer to heal about 4-5 days. So is one med better or should I increase the dose of Valtrex or extend taking it for more than three days? Can they prescribe it for 6 or 10 days? I was pretty sick when I got this OB so maybe my immune system is taking longer to heal it too..is this theory true? Also if I have the acyclovir prescription can I switch to it after taking Valtrex because I was only prescribed the Valtrex for 3 days and it's taking longer to heal? 

3. When would you consider putting someone on suppressive doses daily? I really hope my OBs decrease, and I do not want to take it daily because of the side effects .. but at what point should I consider that?

Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
40 months ago
While most people with HSV 1 have rare recurrences, there are a few people who have more difficult with them.  Were any of your sores swab tested to be certain that they are HSV 1?  The screening IgG picks up 98% of HSV 2 infections, but with this frequency of recurrences if you were my patient I would definitely do a PCR swab of a lesion, right at the beginning of the outbreak, to be certain it is HSV 1.  There shouldn't be much difference in the two treatments, acyclovir is just way cheaper in general if paying cash.  And yes, if you were sick, you immune system may be having to juggle too many things at once and it may be dropping a few balls! 
I'm not sure what side effects your are having - for most people suppression is without side effects and is completely safe.  If your outbreaks are frequent, I would definitely consider suppression for you if you were my patient, yes.

Terri
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40 months ago
I was swab tested but not type specific because that provider said it didnt matter what type. But I guess I'm hoping for a ray of hope that it is hsv1 and the OBs will decrease or stop.  So you think another blood test is fine? Or do the PCR swab test? 
At four outbreaks in the first year you would do suppressive meds? Or wait a bit and see how it continues? I have had no major side effects besides nausea but am worried because I've heard it can cause hair loss? 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
40 months ago
It's too bad that the swab test was not typed, for sure.  But you can determine this with a good degree of certainty from the antibody test.  If you have another outbreak, I would avoid treating until you have had a PCR done of the outbreak - both to determine if these are all actually herpes outbreaks AND the typing, would that work for you?
While I have seen hair loss as a side effect of herpes medication, it has been very rare - maybe 3 cases in 33 years. 
You could wait a bit to see what happens.  Remember that taking herpes medicine really just shortens the outbreak by a few days, it does not cure it, and your decision to take medicine or not is somewhat dependent upon how much this bothers you and how much you want to reduce transmission to others - those are really the criteria.

Terri
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40 months ago
I was thinking since I have had the last three outbreaks in 4 months that I would try the suppressive therapy because I'm traveling a lot in next 6 months and don't want to deal with this all the time while gone. Also, I am with an hsv free partner and with them more frequent in last couple months I am very concerned about giving it to him. So could I do the suppressive therapy for about 6 months then see what happens? 
And couple ?s about suppression: do you see that people still have OBs while on it or most of the time they stop? And does hsv develop resistance to the antiviral drugs if taking them long term?  Also, after people come off suppression does the OBs come back more frequently because the body gets used to the antiviral meds and doesnt develop antibodies any more to fight it ? Do you see that without the suppression does it get worse or are the OBs about the same or decrease because after time people usually experience less OBs anyway?  Thank you so much
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
39 months ago
You could certainly do suppression, yes so talk with your provider about that script.  Has your new partner actually been tested to determine that he is HSV 1 and 2 negative?  Remember that the screening test for HSV 1 misses about 1 in 4 infections.  I do find that suppression is VERY effective, when the described outbreaks are actually outbreaks, yes.  Many people who know they have herpes get mixed up about what are outbreaks and what are not.  We don't see resistance in herpes often at all, in non-HIV infected people, whether they have taken medication or not.  Outbreaks do not come back more often after stopping suppression no.  I would say that I see the frequency of outbreaks staying about the same after coming off drug.

Terri
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