[Question #7106] HSV 1 recurrence and prodrome

9 months ago
Hello,

In July 2018, I had a genital herpes outbreak. In October 2019, I had another very mild outbreak, and that time was able to get a test to determine that it was HSV-1. 

Now, I am wondering what the likelihood is that I have another one coming on since I know that genital HSV-1 outbreaks decrease over time, especially after 2 years.

Last week, I had a pimple in my genital area that I am 95% certain was just a pimple (closer to the buttock than genitals, pus and blood came out when squeezed, firm to the touch, healed quickly). But since I am meeting up with a sexual partner this weekend (we've both been isolating to be responsible about COVID), I got particularly worried and I think I might have worried myself into a false prodrome. For a couple days now, I've been acutely aware of every itch and pain in my genital area and have been checking for lesions constantly. Today, I'm particularly itchy in one spot but I also think it may be due to the length of my public hair. There are still no visible signs.

What's the likelihood that I'm actually experiencing a prodrome and have an outbreak coming? Are there any other telltale signs I need to look out for? If I don't have any lesions by Friday, can I assume I am safe? Or do I need to tell my partner if I'm still having slight itching/pain? He already knows that I have herpes, I'm just wondering if I need to bring this up as a potentially riskier time to be having sex. 

Thanks so much!
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
9 months ago
I'm so sorry this got lost along the way somewhere.  What you describe does sound like just a pimple to me. 
The telltale signs of an outbreak coming are a crawling under the skin feeling, tingling in the area, for some people, pain down the back of the leg. 
I don't know how you handled this with your partner, but if he knows you have HSV 1 genital infection, I think it is adequate to leave it at that for now. 
Do you know if he has ever had a cold sore or has he ever been tested for HSV 1?  If yes, and he is positive for either, he is not at risk of acquiring your HSV 1 genital infection, which would be good.  About half the US population has HSV 1, so the chances you are having sex with someone who also has this infection are very high.

Terri
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9 months ago
Thanks Terri. I think I did end up having a mild outbreak (unrelated to the pimple) so I told him and we did not have any vaginal or oral sex. He has had a cold sore before but it still seemed better to abstain during an active outbreak. 

So a couple other questions I have... both times I've had a recurrence have been on some type of outing or vacation. I tend to get anxious before traveling so I'm wondering if it's stress related. I know 2 times isn't enough to make it a clear pattern but it seems possible it's related. Is there any recommended/approved usage of acylovir to specifically prevent an outbreak? Like taking it for a week leading up to what might be a triggering event? Also, I've read about Lysine as a supplement to prevent outbreaks. Is there any data to support the use of Lysine? 

Up until a couple weeks ago I thought I had very slim chances of ever having more outbreaks since I'd already had one and I know genital HSV 1 is generally so mild. I'm just feeling a little discouraged by the fact that I've had 3 outbreaks in just over 2 years. Isn't this a bit abnormal?
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
9 months ago
So I am going to assume that you are not taking it suppressively.  So yes, you can start taking a suppressive dose 5 days in advance of your trip and when you leave, it will be fully effective.  Lysine has not been proven through good studies to be helpful but some people find it to be helpful.
The first year of having herpes is not representative of how the future will be, and I know this is over two years.  I think you should wait a little longer to see how this is for you personally.  Too early to tell, I think

Terri
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8 months ago
Thanks Terri.

So when I wrote in 3 weeks ago, I was having slight pain/itching/discomfort that I was not sure was prodrome, or as a result of just having trimmed my pubic hair, or both. I think it did turn out to be an outbreak, though very mild, and I did not take acyclovir. I'm now having very similar symptoms but also just trimmed my pubic hair. Is it possible that another outbreak could be happening so soon, or is it possible that the first one is still "active" since I didn't take anti-virals? I started taking them yesterday just in case. Just wondering what your opinion is on what might be happening. Everything is so mild that it's hard to tell if I'm being a hypochondriac or am actually having outbreaks.


Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
8 months ago
I understand that sometimes it is difficult to know what's an outbreak and what's something else.  there is no reason NOT to take antivirals - it's not like antibiotics where you have to finish an entire course or resistance can result.  go ahead and treat and see how it goes. That's fine to do.  Without a swab test, there is simply no way to know for sure if something is an outbreak or not, for sure.

Terri
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