February 24, 2019 at 3:55 pm #30989
I acquired HSV last April, confirmed by culture. The culture did not type out 1 vs 2. At that time, my partner had a cold sore, and had confirmed HSV-1 serology, but neg HSV-2 serology (but he had another partner at about the same time I was infected). I have had negative IGG 12 weeks after exposure, and negative Western Blot 14 weeks after exposure, but I’m assuming it’s type 1. I take Valtrex 1 gm daily for suppression. When I’m not on it, I generally get an outbreak within 3-10 days after stopping
I started suppression again Jan 1, and I had a few lesions at the time. After 2-3 weeks, there were ongoing lesions so I started taking 1 gm twice a day. It’s been almost five weeks at that dose, and I’m getting more and more lesions, more than I’ve had since my initial outbreak. The only thing that changed was in December I started taking an herbal supplement with St. John’s Wort in it. I stopped taking that last week. I have no other systemic infections at all, and am HIV negative at last check.
My questions: Can I assume this is HSV 1 based on the negative Western Blot and that my ex had oral cold sores (but could have gotten HSV 2 right before we parted ways)?
Have you ever heard of St. John’s Wort affecting valtrex?
How often do you see people with outbreaks that last this long while on suppressive therapy?
I have an appointment with my PCP in a few days, and in the meantime started taking valtrex every 8 hours. I’m not seeing an improvement at all.
Is there anything else you’d suggest?
Thank you for your time!
February 25, 2019 at 7:25 am #31044
You likely have a negative western blot due to the continued use of antiviral therapy. I can definitely cause false negatives on the blot.
Your situation is truly atypical and I would strongly suggest that you have these ulcers swab tested to determine that they are actually herpes lesions. First, HSV 1 recurs infrequently genitally and usually not at all on suppression.
If these actually are herpes lesions, you may need testing for medicine resistance.
Let me know
March 10, 2019 at 10:01 am #31602
Here’s my update: after continuing to get lesions for 2 months while on valtrex 1 g BID, I had the lesions re-swabbed, and they came back negative. My Western Blot also came back negative, now 11 months since I had my primary outbreak (I am not always on suppressive therapy, I have taken a month off at two or three different occasions). My PCP is sending me to ID. Some of my lesions are the classic ulcerated ones, but most just look like folliculitis but on a red base, but it feels like I’m being seared with a hot poker, and keep recurring on the same spot. Because of the pain, I think the latest swab was a false negative and it is HSV. I’m mostly concerned because I want to plan a pregnancy in a year or so, and I don’t want to assume it’s folliculitis if it’s not and pass on neonatal HSV, but don’t want to have a c section if it is just folliculitis (also it would just really suck being the 0.1% that have resistant HSV). I don’t even know what ID can do to help me with a diagnosis, but I’m going anyway.
March 14, 2019 at 6:31 pm #31867
I would strongly suggest that you stay off suppression entirely and with the next lesion, get it swab tested right away when it shows up. False positive cultures are rare indeed but so are false negatives on the western blot. We could expect a negative western blot due to your continued antiviral medicine use, however. If you are taking suppression when they get a lesion, you likely to get a false negative swab test. If you are off suppression for 3 months, that should give you plenty of time to develop antibody detectable by IgG and/or western blot and also, if you have an outbreak, you can get a more accurate swab done during that time.
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