recurrent outbreaks/suppressive therapy

[lex250]

Hi Terri,

Firstly thank you so much for your help.
I am 24/f, diagnosed with genital hsv-1 6 months ago after a painful, initial outbreak. I have been on suppressive therapy for about 4-5 months, 500mg of valtrex a day. In the last 6 weeks I have had 2 very minor outbreaks- not painful, barely visible, caught at an early stage. Boosting Valtrex to 1gram a day for 3-5 days would make them go away. My doctor has put me on 1gram of valtrex a day from now on. It has been two weeks. I now have what think may be another outbreak- one very small blister, not painful unless I touch it a lot, not on my vulva but further up on my pelvic bone, about an inch and a half up from my clitoris, under my hair. I do not shave (ruling out ingrown hair).

I am confused as to why I am having so many outbreaks while on suppressive therapy, however mild. I expect outbreaks, obviously, but I understood that genital hsv-1 had less outbreaks, especially while taking suppressive therapy, but not this often.

Suggestions? Details- I take 1 gram of valtrex once a day as of two weeks ago, before that 500mg once a day for 5 months, plenty of sleep and eating regularly and healthily, minimal sugar intake, but my stress level is higher than usual now due to work but not too high, maybe medium level of stress. Temporary as it fluctuates with my job. (Thought these details may be helpful)

Any feedback would be helpful! Thank you!

[Terri Warren]

The first six months are not indicative of how outbreaks will be in the future. Sometimes, even with therapy, it takes a while for the immune system to kick in and start taking control. You might need to be patient and see how this goes. My second though it – are these really outbreaks? Are you certain? Has any swab testing been done from the symptoms? You are probably right, but I’m just checking to see how certain you are these are actually outbreaks.
You might try breaking the 1 gram dose into 2-500 mg doses instead to get more even levels of medicine throughout the day. Sometimes that really helps, you could try it.

Terri

[lex250]

Thank you for your prompt reply! My initial outbreak 6 months ago was swabbed and tested positive for HSV1, but the recent ones have not been. So I am not certain it’s an outbreak, but I am assuming…

What do you suggest I do- aside from becoming more patient- to help my immune system take control?

Thanks!

[Terri Warren]

I don’t believe there is anything more that you can do at this point. It just isn’t that unusual to have more outbreaks in this very early time after being diagnosed. If you were our patient, we would bring you back in when you are experiencing these recurrences to be certain they are actually outbreaks.

Terri

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