Gay male, moderately sexually active for decades, so presume I've been exposed to HSV somewhere along the line but never noticed symptoms. HIV and STD tests always negative. But in March last year I felt a bump on my left buttock, it went away, came back in June, went away, came back in August and I saw my dr., who on visual inspection said it was herpes, but no test was done and I didn't know I needed to ask for one. Dr. said I could choose to treat it or just let it run its course, and prescribed Acyclovir to have on hand for episodic treatment; he asked if I'd been under stress since that could trigger it, and yes, I've been helping 4 old friends with terminal cancer. Another outbreak in December (in same place) was pretty bad but I hesitated to take the Acyclovir because I'd made the mistake of reading the possible side effects. That was pretty dumb, and when it came back in Feb. I took the Acyclovir for a week (3x/day). Now it's only 2 weeks after that treatment finished and there are red blotches and sort of tingling again. So this is seeming pretty frequent and I'm thinking I need to shift to suppressive therapy, probably with Valtrex.

Two questions: 1) would you recommend I get tested to be sure it's HSV-2?  If so, should it be the "type-specific antibody testing"?  2)do I need to treat this current outbreak before starting the suppressive dosage, or is it ok to switch to the suppressive therapy now? Thank you for your help.

well, if all things were equal in these days, I would strongly suggest that you have an further episodes swab tested.  But with the medical system pretty overloaded, you could, for now, go by the visual diagnosis of HSV.   It absolutely should have been swab tested at that time.  But given where we all here, you can just begin doing suppression now - 500 mg of valacyclovir once a day OR 400 mg of acyclovir twice per day.  You could also get a type-specific antibody test BUT for now, it would be better to stay home and assume you have HSV 2.  When the COVID crisis is over, yes, a type-specific IgG test would be best to sort out what is going on.

Thank you so much for your reply.  Two questions:

1) During an outbreak, is it possible to inadvertently spread it if I touch it and then touch another part of my body?  Thinking about while in the shower.

2) Presuming it's ok to start suppression with Acyclovir (which I have on hand) and then switch to Valacyclovir once I can get a prescription of that delivered?

1.  What you are describing is autoinoculation and almost always happens with brand new infection, before an immune response has been mounted.  After, very very rare.

2.  Yes, that's just fine.

Terri