Swollen Lips

[palmjosiah]

Hi Terri,

I am a 21year Male, I first began having hSV1 cold sores on my mouth back in 2018. The outbreaks were pretty severe lasting about a 1 week to 1/1/2 week, with the top and bottom lip becoming very swollen (causing me to barely eat and drink through straw), and very red and tender, in addition to small sores primarily located along the outer edges of my top and bottom lips. I used to get them once a month, so I went to my PCP and she tested me for Herpes Simplex I & II lgM abs which was positive at 1.56. She also tested me for HSV2 glycoprotein g-spe which was negative at 0.07. She prescribed me Valaclovir and I didn’t notice any effects so I stopped taking it. After about 2 months after that visit I began drinking L-lysine 1,000mg daily. That prevented me from getting an outbreak for over a year. I got another outbreak after I stopped taking L-syne. I then resumed taking L-lysyne (Now 2,000mg), and I now tend to get cold sores every 4 months or longer. However back in April 18, 2022, (61 days ago) I got an OB and it lasted the regular week or so. 3 days after that outbreak, I did not get much sleep and I got another outbreak with swollen lips, and the swelling did not subside fully since then. I visited my PCP two weeks after my second recurrent OB did not fully heal and was prescribed Zovirax 200mg 4x a day. Thankfully my lips have gradually become less swollen, but I still get small cold sores periodically on random spots on my top and bottom lip. I apply acyclovir 2.5% cream on both entire lips about 1-2x a day in order to keep the sores from fully forming. They tend to dry out after 1-2 days. But my lips are still swollen. I visited my PCP again recently and he prescribed me Valtrex (brand name) to take 1g 3x daily for 10 days.
My questions are:
-Why are my lips still swollen after so much time? Is the virus still active and needs to go dormant?
– Is 1g Valtrex 3x daily a good dosage?
– What other steps can I take to help the swelling/virus go down?

[Terri Warren]

My questions are:
-Why are my lips still swollen after so much time? Is the virus still active and needs to go dormant?
– Is 1g Valtrex 3x daily a good dosage?
That is a high dose to take daily but if you take it only for a week or so, it is not a problem
– What other steps can I take to help the swelling/virus go down?
I don’t know why your lips are swollen, that is not a symptom of herpes.
You mention that your doctor did an IgM Test. These are never recommended and the large labs will all take the test off the market in 2022.
And the IgG was negative? I’m a bit confused about what is going on here. Has any swab tested been done of the lesions on your lips? When you are off the medication and get another outbreak on your lips of sores, I think you should have them swab tested using PCR sampling to be sure these symptoms are really due to HSV 1.

Terri

[palmjosiah]

Hi Terri,

My lips have only ever gotten swollen during active cold sore breakouts (in conjunction with sores) in the past. They have never gotten swollen at at any other time or for any other reason. I personally have never got my sores swab tested using PCR sampling, but I am certain that this is HSV-1 considering everybody in my family gets cold sores (although not so severe, usually only a little sore at one corner of their mouth periodically), and that I never got another OB during the time I initially starting taking L-lsyne supplements. The only diagnosis testing I received was a visual diagnosis from my PCP and the Positive antiquated lgM Test. Asides from that, thankfully the swelling of my lips has gone down substantially once I started taking 200mg Zovirax 4x daily. I also wanted to point out that any new formation of sores are prevented by the application of acyclovir 2.5% cream, which I use daily on the entirety of my lips. I also was very stressed and anxious over school over the past few months prior to this OB (anxiety; insomnia, etc.) to the extent which I never had before, which could have been one of the contributing factors to this second OB.
My questions are:
– Have you ever had a case of oral HSV-1 like this? (Swollen lips/sores;longer than 60 days)
– What type of Valtrex dosage would you recommend for me? (all things considered)
– Is it better to start off with 500mg-1,000mg of Valtrex initially daily? (Instead of the 3,000mg for 10 days)
– Is 400mg Zovirax 4x daily a good dosage for my situation?
– Are there any other steps I can take to help the swelling/virus go down? (Considering this is HSV-1)

Thank you

[Terri Warren]

– Have you ever had a case of oral HSV-1 like this? (Swollen lips/sores;longer than 60 days)
Never
– What type of Valtrex dosage would you recommend for me? (all things considered)
Certainly not topical cream. The recommended dose of oral treatment is 500 mg of valacyclovir once a day or 400 mg twice a day of acyclovir
– Is it better to start off with 500mg-1,000mg of Valtrex initially daily? (Instead of the 3,000mg for 10 days)
See above
– Is 400mg Zovirax 4x daily a good dosage for my situation?
See above
– Are there any other steps I can take to help the swelling/virus go down? (Considering this is HSV-1)
I am not aware of any other steps as I have never seen general lip swelling with HSV 1.

Terri

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