Recurring OHSV2

[TryingToUnderstand]

Hi Terri,

Thank you for all of your work. I was diagnosed with HSV2 by IGG blood test a year ago (HSV2 15.5 index, HSV1 <0.9 index). At the time of diagnosis, I had not had an outbreak that I have ever been aware of but also recognize that my index value is high enough that I have HSV2. I contacted past partners to disclose and found out that a past partner also has HSV2, further confirming my diagnosis. My provider offered a daily Rx of valtrex (500mg) but I declined at the time as I hadn’t had or wasn’t aware of outbreaks and my last three partners had not contracted HSV2 from me. I had a cold sore appear last fall (itchy, water blisters, yellow scabbing/crust, size of pencil eraser), it went away after a week. A second appeared a day or two later, which I had swabbed. The swab was negative (provider said it was scabbed over and wouldn’t be reliable) and the provider prescribed 2mg valtrex as an episodic treatment for when I had outbreaks. I didn’t have any other outbreaks/symptoms until two weeks ago when I had another cold sore. I took the episodic dose again (2mg) and it began to resolve. I decided to go on the daily antiviral. The next week (3 days after starting daily 500mg) I had another outbreak in the same location. My provider suggested taking an episodic dose with the daily 500mg. It cleared in 3 or so days. They suggested going to 1000mg a day for 7-10 days if symptoms reappeared. Three days later I felt the tingling again and took an extra 500mg that day, beginning the 1000mg/day regimen. A cold sore still developed (same location) although MUCH milder. Is this normal – 3 outbreaks in 3 weeks? Could something else be going on? As someone who hasn’t been on antivirals previously, shouldn’t my body be responding better? Especially since OHSV2 is rare and OHSV2 outbreaks are rare? Am I missing something? I’d like to protect my current partner and they are being wonderfully patient but right now it feels like I am never outbreak free?

[Terri Warren]

I think you’ve jumped to the conclusion that this must be recurrences of oral HSV 2 and I think that may be a mistake. I would strongly suggest that you have a PCR swab done of the sore for HSV and typed. The IgG test misses 30% of HSV 1 infections compared to the western blot so it is possible that you do have HSV 1 and that is causing the sores. The behavior of what is going on here is inconsistent with what oral HSV 2 normally does.

Terri

[TryingToUnderstand]

Thanks for the quick reply! I may be jumping to conclusions about OHSV2, as you said, and may have HSV1 as well. I did have a swab done last fall during the outbreak and had a swab done for the third (most recent) outbreak at the same time I posted here. Both swabs were negative for HSV1 and HSV2. I was not on antivirals for the fall swab, but was on antivirals for the second, which I believe can impact results. I guess my follow up questions are:

1. Is that given the amount of antivirals I had in my system at the time, would three outbreaks in a row be “normal”?
2. I am continuing 500mg daily. Is it correct that I should expect the outbreaks to settle down over time?
3. The third outbreak was not as minor as I first thought, and 7 days out, still feels sensitive/tight/dry (the scab is gone) despite abreeva during the ob and chapstick frequently. I’m assuming that this is just me being overly aware after three in a row, does that sound possible? Or is there anything else that I should be aware of? Or just stay patient?

Thank you.

[Terri Warren]

1. Is that given the amount of antivirals I had in my system at the time, would three outbreaks in a row be “normal”?
I’m a bit confused as I didn’t think you were on antivirals for all three, but antivirals can impact swab test results, yes.
2. I am continuing 500mg daily. Is it correct that I should expect the outbreaks to settle down over time?
If the antivirals are not making a difference now, I see no reason they would help in the future.

3. The third outbreak was not as minor as I first thought, and 7 days out, still feels sensitive/tight/dry (the scab is gone) despite abreeva during the ob and chapstick frequently. I’m assuming that this is just me being overly aware after three in a row, does that sound possible? Or is there anything else that I should be aware of? Or just stay patient?
If the scab is gone, that’s about as good as it is going get until the tissue gets a bit more loose from healing.

Terri

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