How should I manage my recurring outbreaks?

[flowerfultrees]

Dear Terri,

I, a relatively healthy young adult woman, was initially diagnosed with herpes in January 2020 by swabbing an outbreak. It came back positive for HSV2-g. Even though 2020 was a stressful year, I didn’t have many outbreaks–maybe 1 or 2. In 2021, I had maybe one or two outbreaks also. I was on 500g of Valacyclovir since April of 2020.

However, starting in about May of 2022, I’ve been having a lot of outbreaks. I have them once every 2-3 months, and most recently now. My doctor had me increase my Valacylovir dosage to 1g daily in October, but I still have had two really bad outbreaks (December 2022 and currently) with many lesions. It looks like classic herpes on my genitals (red puffy skin, white blisters, lesions, scabs over).

How should I manage my recurring outbreaks (e.g. increase dosage)? I do have really high anxiety and sleep poorly, but I had those issues in 2020 and 2021 and I still wasn’t having nearly as many outbreaks. I’m in a relationship with someone who doesn’t have herpes and I don’t want him to get it, but it makes me very sad that I keep getting these outbreaks.

edit: I am also wondering how I should count outbreaks, because during these past two outbreaks, I’ll get a set of blisters and then they turn into lesions, but as the first set of blisters turns into lessions, I get MORE white blisters so these staggered outbreaks means it lasts for SO long. My current outbreak (lesion/scabbing stage) will probably heal early next week and then I’ll have to deal with the current white blisters.

• This topic was modified 2 weeks, 2 days ago by flowerfultrees.

[Terri Warren]

Well, that certainly sounds challenging. And I assume that you’ve had these outbreaks swab tested to confirm they aren’t some bacterial thing but indeed HSV? Are you taking any immunosuppressive medicines?

There are a couple of options here 1) have your outbreaks tested for acyclovir resistance (which is rare but happens) or 2) when you get the very first hint that an outbreak is coming, take two grams of valacyclovir and then 12 hours later, 2 grams again. See how that goes. During the outbreak, I would like you to consider 1 grams, three times a day for a week. That is the shingles dose so we know it is safe and effective. You could run this by your doc. Also, instead of 1 gram once a day, you could try 500 mg twice a day to keep your blood levels more even during the day of the meds. Hope these are helpful!

Terri

[flowerfultrees]

Thank you, I am not taking any immunosuppressive medicines.

I had my first outbreak (re: January 2020) swabbed for herpes, so it’s definitely HSV. I can’t really imagine my current situation is anything else because my herpes looks SO much like the google images, with clusters of blisters then lesions. Is my circumstance unusual? I don’t know anyone else with herpes, so it’s unclear to me what has changed.

Thank you for the advice on the medication — I’ll see how that goes.

[Terri Warren]

Your circumstance is unusual for certain and no matter how sure you are that these are herpes outbreaks, I think they should be swab tested. I’ve had patients referred to me with a similar scenario and even I thought they had herpes lesions but they were staph when I had them swabbed for everything – HSV, fungal bacteria. What can it hurt?

Terri

• This reply was modified 2 weeks, 1 day ago by Terri Warren.
• This reply was modified 2 weeks, 1 day ago by Terri Warren.

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