Valtrex suppression not working

[Mohaert]

I have had herpes for over 8 years. I never had outbreaks until the past year, which prompted me to started Suppression w/ valtrex. The 1 gram dose wasn’t working and I was still getting outbreaks 1x per month. I started splitting the pill and taking it 2x a day however I am still getting an outbreak once a month. I am 100% positive it is an outbreak, it is an oozing cut near my vulva, same spot every time. Sometimes it is on my clitoris. I take It at 9 am and 7 pm on time every day. What should I do?

[Terri Warren]

I would suggest that you have the lesions swab tested on the first day that it arrives both for herpes and for bacteria and fungi. And how exactly were you diagnosed with HSV to start with and which type did you have? Have you recently changed sexual partners?

Terri

[Mohaert]

I was swab tested with a primary outbreak. They never told me what type it was. No recent new partners, I am married. Could fungi or bacteria cause sores that look like herpes? How likely is this?

[Mohaert]

I have been tested for BV, trich, and yeast and all been negative.

[Terri Warren]

I have most definitely seen bacterial infections look just like herpes. I had a patient once who was referred by her OB GYN due to “resistant herpes”. She was taking 2 grams of Valtrex a day, for 1 year, with no improvement. Upon exam, her lesions looked typically herpetic but when I went to swab them to look for acyclovir resistance, they sloughed off in a fashion not consistent with herpes, to the touch Sure enough, she had a bacterial infection, staph as I recall or it could have been strep, I treated her with antibiotics for 10 days and the lesions went away. When people tell me that Valtrex is making no difference at all, I ask them to be swab tested 1) to be sure it’s herpes and 2), if it, to test for antiviral resistance, which I have yet to see. I think it is worth a further medical evaluation for you.

Terri

[Mohaert]

Hi terry,
I got a culture swab for an active lesion and it came up negative for herpes. The description on my medical report was “2 mm long ulceration just inferior to clitoris, area is painful, no swelling,no exudate, no erythema.” I asked to be tested for other things such as staph or other bacterial infection, and the doctor said it doesn’t look like staph. With the negative swab they are recommending a blood test for hsv2 to determine if the sores are herpes related. My only positive swab test was in 2014 during my primary outbreak.

I have noticed triggers for when I get These sores: yeast infections, alcohol, and strenuous exercise.

The sores seem to go away after 1-2 days with my suppression meds of 500mg 2x a day. But the amount of sores I’m getting are between 1-3 a month. I’m not increasing my dose either between outbreaks

The sores look like cuts.

I’m at a loss as to what to do… as it appears the suppression meds are keeping the sores from recurring. Could it be something else? Any thoughts on what I should do? Thank you

[Mohaert]

Arent* keeping sores at bay

[Terri Warren]

If the swab test was negative and could absolutely be something else and likely is!
Fungal infections can definitely cause slit -like sores. Have you tried an antifungal medication on these?
You could do an IgG test for HSV 2 but with your history, it sounds like your first outbreak was more likely HSV 1. And even if your antibody test is positive for HSV 2, the herpes medicine isn’t helping and for years you didn’t have any outbreaks. My opinion is that this is due to something else. If you were my patient, I would do bacterial and fungal swab of these lesions and see what comes up.

Terri

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