HSV1 since childhood // recurring outbreaks after 5 years of suppressive therapy

[marston22]

Hello Terri,
I’m a 27y old male. I’ve had HSV1 since my childhood, transmitted by my mother. OBs were somewhat inconstant – one every two or three months, sometimes less frequent, and always lasting more than a week, with blisters and all. About 5 or 6 years ago, a dermatologist introduced me to suppressive therapy : 500mg of valacyclovir taken daily. It has been of a tremendous help, shortening my OBs to once a year. Haven’t skipped a day since. I’ve also been diagnosed with dermographism around the same time.
But things have changed since last August. I’ve been having frequent OBs – once a month, sometimes twice. They’re very usually not serious : red and bumpy sores that appear just after a few seconds of burning sensation on the lip. They last either 12 hours or around 3 days, rarely more than that, and almost never blistering.
I haven’t been able to pinpoint the cause of these recent OBs. I’ve started drinking coffee around August – but I don’t know how related caffeine is to it. I even quit peanut butter altogether (which wasn’t easy), but it seemingly didn’t help. I’ve had a new (and sometimes stressful job) around november, but these newly frequent OBs started before it. I have been sleeping less for sure. A couple of weeks ago I decided to check in with a dermatologist : she was suprised at the amount of time I’ve kept taking valacyclovir and told me I should consider quitting it for a while once the OBs start calming down. She gave me a receipt for blood tests to do – I’ve already did a few, negative to HIV and other STIs, but I’ve yet to do the CBC (blood count) one.
Would you have any clue on what could cause that sudden new frequency in OBs ? I know stress and fatigue are huge triggers ; but afaik, it predates my new job and living habits.

[Terri Warren]

I definitely disagree with your dermatologist about stopping meds. There is absolutely no recommendation to do blood work when taking these antivirals either. There is no such recommendation in place anywhere to stop the medication. But if you are going to follow her advice and stop suppression, you may want to consider the CDC-approved dose for cold sores at the very start of an outbreak, 2 grams of valacyclovir, then 2 grams 12 hours later, for one day.

I would also suggest that you have these bumps swab tested to determine that they are, in fact, cold sores.

Can’t think specifically about why you might be having more cold sores but lack of sleep is certainly a trigger for many people.

Terri

[marston22]

Hello Terri! Thank you for your swift answer. I don’t think the dermatologist wanted a blood check specifically to check the potential effects of my long term treatment, but just to pinpoint any potential lack in my organism. Would you have any idea on what these bumps could be? Are there other virus or else that could cause these intense but, again, very short flareups?

[Terri Warren]

To know if these are indeed herpes flare ups, you should have a PCR or NAAT test done of the bumps. If they aren’t herpes, I don’t really know the other options here but your derm might

Terri

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