My wife and I have experienced recurrent genital herpes outbreaks for thirty years. They are classic with a prodrome, followed by grouped vesicles on an erythematous base which ulcerate, scab and heal. Our lesions are always in the same suprapubic spot with predictable size, pain, and healing time.  Recently, she developed herpetic lesions in a different suprapubic spot. It was much more painful, larger and took longer to heal. When almost healed, she developed another outbreak at her usual spot with usual size, pain and healing time. After a few days, she developed a third set of herpetic lesions at yet another suprapubic spot. It was not as bad as the first but still worse than the usual lesions.  I have not had any outbreak during all of this. She has Sjogrens and recently discontinued Plaquenil because it was ineffective. She had COVID last year and is fully vaccinated and boosted. Otherwise, we are in good health. Can you please explain what happened and provide any recommendations. Thank you. 

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Your response inquiring about any  health issues is quite interesting. Initially, I thought to myself, "No, other than the systemic Primary Sjorgren's Syndrome." But actually, she has suffered from a series of significant acute infections lately. As I mentioned, COVID last year after the single J&J vaccine but before being boosted. It attacked her throat and swallowing felt like razor blades going down. Then, she stopped the Plaquenil somewhere around the new year. The rheumatologist felt it was ineffective. In February, she underwent elective surgery on her achilles tendon and developed a serious Pseudomonas post-op infection which caused wound dehiscence with purulent drainage. As described below, the serious recurrent herpes in early June. Last week, she was hospitalized with a rapid onset E.Coli Pyelonephritis and sepsis. Each one of these significant infections might be explained individually as "unusual," but when strung together over such a short period of time might be worth considering.

Given all that you have said, I wonder if her immune system has just been challenged a  bit much lately for it to be able to handle the herpes virus in the same way it used to.---

Thanks for the advice Terri. Your consultation was most helpful.

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