[Question #5785] HSV-2 spreading post tx and lesions appearing healed

21 months ago
I  got back together with and I'm living with, my former ex girlfriend, (who has a relatively "high notch count," & "feels safe visually screening partners"), but refuses condom use.  After seeing her negative  STD tests and talking to her gyne, I felt safe with her w/o protection.

Post 2 months of being sexually active with her I developed 2 small skin tears under the R side of my glans from aggressive sex, (important to mention I get 3-5 hours of sleep a night, for 3 the past 3 months b/c work issues, ..back to normal in a month).  The 2 skin tears  developed into the site of 2 HSV- 2 lesions, a week later.

The lesions healed and I've been on 2 grams BID Valtrex per my NP, which I plan to continue forever, unless instructed to do more.

Once the lesions disappeared I resumed unprotected sex with her as I was told the chances of me developing additional lesions  on my penis was rare, as was giving her lesions.
However it appears that now I have additional lesions, (much smaller, but more numerous), on top of my gland, R side, and distal R side of my shaft.

She continues to have no visible lesions.  Is this scenario common?  Can it possibly get worse if I continue what I'm doing..ie; spread lesions to additional areas of my penis or the current lesion sites become more numerous...or cause her to have lesions?
If so, can this happen when lesions are shedding or active, as well as when non active?  Do I need additional medication, or a higher dosage of valtrex to quicken dormancy of my lesions, (which are mild), and/or prevent exacerbation, and/or prevent additional lesions .  
Also would it help our situation if she was on Valtrex?  If so, and she has no visible signs, what is the best way for her to take it?

Thank you.

Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
21 months ago
First of all, are you sure about that dose?  It's very high and not the recommended dose.  She might have been thinking of the dose for cold sores - 2 grams and then 12 hours later 2 grams again, for one day?  The normal suppressive dose for genital herpes is either 500 mg once a day OR 500 mg twice a day OR 1 gram once a day.  These are CDC recommendations.  I think either you or your NP is confused here. 
I think the first thing that needs to happen here is for her to get tested for HSV 2, with an IgG blood antibody test, if that has not yet been done.  Are you making the assumption that she gave this to you?  I'm thinking you should not make that assumption but rather she should be tested.  I am assuming that you know that you have HSV 2 from a swab test?
If you are both indeed infected, each of your immune systems will handle herpes in it's own way.  Nothing you are doing together sexually is making it worse or better.  The only exception would be that for some people, really aggressive sex can trigger an outbreak.  For you, if your infection is new, the first six months will be the roughest but soon your immune system will get a handle on the virus and you will most likely have fewer outbreaks. 
If she IS infected but has no lesions taking Valtrex will not make any difference.