HSV-1 recurrence ~1 month after diagnosis?

[mrburns]

I am 30, male. I caught GHSV-1 from genital to genital contact ~1 month ago. My casual female partner had unprotected sex with someone else a few days before we slept together. We used a condom and did not have oral sex. She was just pre-symptom when we had sex and I assume was shedding a lot at this time which is how I caught it genital to genital. She had her initial outbreak 1-2 days before I started experiencing symptoms.

We both tested positive for GHSV-1 via PCR swab.

Timeline
Nov 19: Exposure
Nov 23: Symptoms appear (lesions at the base of penis, some on foreskin under the glans, little to no pain)
Nov 25: Test positive (PCR), commence 1mg Valtrex 2x / day for 10 days
Dec 1: Symptoms mostly resolved
Late Nov to Mid Dec: Very stressed at work, long hours, very fatigued
Dec 19: Some prodromal symptoms (tingling in scrotum, base of penis, anal region). Possible lesion on foreskin, hard to tell at this stage. Unclear if recurrence or I’m reading too much into it.

From what I have read, GHSV1 recurrences are rare but I seem to be experiencing symptoms consistent with a recurrence.

Questions:
1. Assuming my symptoms are consistent with another outbreak, is this a recurrence or a continuation of my primary outbreak? I have read of people having continuations of their primary outbreak within 2-4 weeks of exposure. However, I’m a bit confused by my prodromal symptoms which would indicate a recurrence rather than an outbreak? It’s possible I could be reading too much into otherwise benign feelings (tingling etc).
2. What are the chances that my GHSV-1 has been misdiagnosed (and I actually have HSV2) given that both of us tested positive via PCR swab?
3. Would you advise treatment with Valtrex or let it run its course?
4. What are my odds of passing GHSV-1 to female partners in future?

• This topic was modified 3 months ago by mrburns.

[Terri Warren]

1. Assuming my symptoms are consistent with another outbreak, is this a recurrence or a continuation of my primary outbreak? I have read of people having continuations of their primary outbreak within 2-4 weeks of exposure. However, I’m a bit confused by my prodromal symptoms which would indicate a recurrence rather than an outbreak? It’s possible I could be reading too much into otherwise benign feelings (tingling etc).
It is possible that you are reading too much into the symptoms yes, or it could be a continuation of the prior outbreak.

2. What are the chances that my GHSV-1 has been misdiagnosed (and I actually have HSV2) given that both of us tested positive via PCR swab?
I think that is highly unlikely. Also, did anyone have an antibody test to determine if they were infected prior to this outbreak?

3. Would you advise treatment with Valtrex or let it run its course?
Let it run it’s course, I think, but your call. There is no downside to treating at all.

4. What are my odds of passing GHSV-1 to female partners in future?
Very likely. Someone had this previously but without an antibody test, it’s not possible to know which of you.

Terri

[mrburns]

Hi Terri, I have some follow up questions. It turns out what I thought was a recurrence two months ago was just a spot that has always been on my penis but I just noticed due to hyper-vigilance.

However, I am now certain that I’m having a recurrence of my GHSV-1 (confirmed by PCR swab) now some 3 months after my primary outbreak. I have unambiguous lesions in the exact same spot as the primary outbreak.

The outbreak occurred the day after I had protected sex. I have heard that the friction from sex can cause recurrences.

My questions are:
1. In addition to lubricant, what can be done to reduce outbreaks caused by friction during sex?

2. Can the type / brand of condom used trigger outbreaks? My lesions are at the base of the penis where the rubber base sits and rubs against – I’m wondering if this might be an issue.

3. Are there different ‘strains’ of HSV1 that could mean I am more prone to outbreaks than others? I’ve read it’s quite common that those with GHSV1 have an initial outbreak and then nothing. I’m wondering if I might have a more aggressive strain that causes more frequent outbreaks?

• This reply was modified 4 weeks ago by mrburns.
• This reply was modified 4 weeks ago by mrburns.

[mrburns]

One additional question to the above:
4. Does the fact I had an outbreak some ~12 hours after the trigger (ie friction from sex) mean it was likely that I was shedding at the time of sex or are the two events unrelated?

[Terri Warren]

My questions are:
1. In addition to lubricant, what can be done to reduce outbreaks caused by friction during sex?
You could take daily antiviral medicine for the first year of your infection, if you wish.

2. Can the type / brand of condom used trigger outbreaks? My lesions are at the base of the penis where the rubber base sits and rubs against – I’m wondering if this might be an issue.
We know of no brand of condom that triggers outbreaks

3. Are there different ‘strains’ of HSV1 that could mean I am more prone to outbreaks than others? I’ve read it’s quite common that those with GHSV1 have an initial outbreak and then nothing. I’m wondering if I might have a more aggressive strain that causes more frequent outbreaks?
The first year of having HSV 1 genital infection is not representative of how this will be in year 2 and forward. Your immune system is just getting used to this – give it a little time to do better.

4. Does the fact I had an outbreak some ~12 hours after the trigger (ie friction from sex) mean it was likely that I was shedding at the time of sex or are the two events unrelated?
I’m confused – you were shedding with the outbreak. Were you shedding ahead of the outbreak? No way to know, unfortunately, but maybe, but condoms likely would have taken care of that situation

Terri

[mrburns]

Hi Terri, thanks for your response. I understand that this is my final set of questions.

This recurrence has persisted for some 8+ days and is not showing many signs of abating.

The outbreak began with a large sore (several ulcer type lesions close together that formed a single large scab). This was healing ok until 5-6 days after it appeared when I knocked the scab accidentally causing a lot of pain and leading to it falling off.

The very next morning, I had a whole lot of (20 or so) small blisters appear around the scab. It seems that the trauma of knocking the scab provoked a ‘second wave’ of the outbreak, so to speak.

1. This recurrence has been worse than my initial outbreak which consisted of 2-3 small ulcer type lesions. I note what you said in your previous answer about this still being early days (3 months in from first outbreak) but I’m nonetheless concerned about its severity. Is this normal to have such a serious recurrence? Is it possible to provoke or worsen an outbreak through trauma such as knocking the scab?

2. The first sore of the recurrence was similar to my initial outbreak, appearing as an ulcer. The ‘second wave’ of the recurrence, however, appeared as lots of small clusters of fluid filled blisters. I have had ulcer type lesions swabbed by PCR both times and returned positive for HSV-1. I note that blisters are more consistent with HSV-2. Can recurrences manifest differently (ie ulcer or fluid filled blisters) or is it possible that I have HSV-2 as well as HSV-1? Perhaps the HSV-2 did not appear on the PCR swab as those lesions weren’t present at the time the sample was taken?

3. My doctor prescribed 500mg of Valtrex 2x / day for three days which I started on day 3 or so. I understand this is the recommended dose for recurrences but it doesn’t seem to have made a difference in my case. Should I continue taking Valtrex again given this has been quite a long recurrence or would it make no difference now that I’m some 8-9 days in.

[Terri Warren]

1. This recurrence has been worse than my initial outbreak which consisted of 2-3 small ulcer type lesions. I note what you said in your previous answer about this still being early days (3 months in from first outbreak) but I’m nonetheless concerned about its severity. Is this normal to have such a serious recurrence? Is it possible to provoke or worsen an outbreak through trauma such as knocking the scab?
No, I don’t believe so and this is extremely atypical for a recurrence. Are you taking any other meds, like steroids for anything?

2. The first sore of the recurrence was similar to my initial outbreak, appearing as an ulcer. The ‘second wave’ of the recurrence, however, appeared as lots of small clusters of fluid filled blisters. I have had ulcer type lesions swabbed by PCR both times and returned positive for HSV-1. I note that blisters are more consistent with HSV-2. Can recurrences manifest differently (ie ulcer or fluid filled blisters) or is it possible that I have HSV-2 as well as HSV-1? Perhaps the HSV-2 did not appear on the PCR swab as those lesions weren’t present at the time the sample was taken?
Have you had a recent encounter that would put you at risk for HSV 2? The blisters of HSV 1 and HSV 2 look identical – no different at all. I believe that HSV 2 would have shown up on the swab had it been there

3. My doctor prescribed 500mg of Valtrex 2x / day for three days which I started on day 3 or so. I understand this is the recommended dose for recurrences but it doesn’t seem to have made a difference in my case. Should I continue taking Valtrex again given this has been quite a long recurrence or would it make no difference now that I’m some 8-9 days in.
So very odd. Are you applying anything to the sores at all? You could try the cold sore dosing since this is HSV 1 (albeit genital). That’s 2 grams, the 12 hours later 2 grams of Valtrex again, see if you get any benefit.

Terri

[mrburns]

Hi Terri, thanks for your response.

As it turns out, I have been using Eluphrat ointment 2x / day throughout the entirety of my herpes outbreak on an unrelated folliculitis issue that I have on the top of my buttocks. The folliculitis and herpes just happened to roughly coincide (the folliculitis started several days before the herpes outbreak and this is around when I started treating it).

I get the folliculitis outbreaks from time to time during warm weather etc. My doctor prescribed me the Eluphrat ointment (well before my herpes diagnosis) which Google says “is classified as a high potency topical corticosteroid.”

Having done some research since you drew my attention to it, I understand that steroids / corticosteroids are strongly contraindicated with herpes because they inhibit immune response which is exactly what I need to respond to the herpes!

To be clear, I have not been applying the ointment on my genitals but on my folliculitis which occurs on the top of my buttocks, right in the sacral region. I will immediately stop using the ointment.

Questions:
1. I think I’ve been able to answer my own question but, in your opinion, could my use of the corticosteroid during the outbreak be the reason it is taking so long to heal and why I have had a ‘second wave’ of blisters?

2. Could use of the ointment a few days before I had the outbreak have lowered my immune response in the boxer shorts region to allow the herpes outbreak to occur in the first place?

3. I have been applying some tea tree oil directly on the herpes lesions and this seems to have been helping dry them out. Do you think tea tree oil is ok to use?

[Terri Warren]

1. I think I’ve been able to answer my own question but, in your opinion, could my use of the corticosteroid during the outbreak be the reason it is taking so long to heal and why I have had a ‘second wave’ of blisters?
It could be, yes, although topicals meds are somewhat less likely to have this impact

2. Could use of the ointment a few days before I had the outbreak have lowered my immune response in the boxer shorts region to allow the herpes outbreak to occur in the first place? that seems somewhat unlikely to me but possible, yes

3. I have been applying some tea tree oil directly on the herpes lesions and this seems to have been helping dry them out. Do you think tea tree oil is ok to use?
maybe, but I would rather you keep it dry as possible. Oils can keep it moist for a long time and slow healing.

Terri

[Author]

Posts