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Recurrent herpes outbreaks, reduced immunity - Online Doctor Chats

Date : 21-Feb-2012
User rating for this question
Very Good Posted in: Infections
Answered by

General & Family Physician
Practicing since : 2005
Answered : 2308 Questions
User :   Hi
User :   Hello
User :   I have a couple of questions about why I may be getting more herpes outbreaks now than I used to
Doctor :   ok
Doctor :   please proceed
Doctor :   Please mention your age, and the first episode of herpes, when u had
User :   I used to only get them once or twice a year for over 17 yrs, but for the past year I have been getting one every 6 weeks or so. They are not bad, and short lived but still.. I am 40 have had herpes since I was 23
User :   I have had cold sores since I was a kid
Doctor :   can u describe your current episodes ?
Doctor :   have u been treated with antiviral medications or ointments any time ?
User :   well I either get a cold sore on my mouth, and then a week later I will get a genital one on the back of my left thigh
User :   no antivirals because of bad reactions in the past
User :   and attacks were minamal
Doctor :   which antiviral was prescribed ? do u remember ?
User :   no I do not remember the name, they gave it to me while pregnant to avoid a c section
User :   but had bad reaction to them and was told not to take them anymore
Doctor :   ok
Doctor :   usually recurrent herpes are associted with acute stressful situations or reduced immunity
Doctor :   But presence of just one or two lesions and cold sores are usually not the presentation of such herpetic recurrences
Doctor :   recurrent herpes would present as multiple ( > 10) follicular vesicles that form pustules over a week and then result in crusted lesions
Doctor :   the episode is usually associated with severe pain, in the region involved and the lesions then leave a visible scars on the skin
Doctor :   Have u had episodes that i have just described ?
User :   well I'm trying to make sure I understand what u are saying, bare with me
Doctor :   ok
User :   so u are saying if it was a problem with my immune system that I would have multiple lesions in different areas or more than one cold sore?? and they would last longer??
Doctor :   yes, that is correct
Doctor :   But i mean, more lesions concentrated within a single zone (dermatome)
Doctor :   dermatome = area of innervation by a single spinal segment ( or a single spinal nerve)
Doctor :   like 10-15 lesions in close association, on the thigh or the belly or the flanks
Doctor :   a single follicle or pustule , that is not associated with severe pain is usually not due to herpes
User :   well the sores I get on the back of my left thigh are always very painful but there is usually only one lesion that is the size of a pencil eraser and one tiny one rite next to it, so is that not the worriesome type??
Doctor :   yes , this does not seem to be due to herpes,
Doctor :   this might most probably be due to folliculitis (bacterial infection) of the hair follicles on the skin
Doctor :   application of neosporin ointment on the lesions will help to clear such lesions (bacterial folliculitis )
User :   I guess we are out of time, I hate that, because I didnt get to a conclusion, I was told they were herpes, and I get the prodome and all
Doctor :   but recurrent herpes, as i have mentioned, presents with severe pain for a few days, followed by the multiple lesions,
User :   yes and i do get severe pain, just dont get huge lesions
Doctor :   In that case, the pain is due to bacterial folliculitis
Doctor :   in case of persisting doubts, you can do a skin test of the secretions of the infected lesions , (TZANCK smear)
Doctor :   this will provide the final diagnosis, and confirm the probable diagnosis, if it is herpetic in origin
Doctor :   I hope this helps
Doctor :   to clear any doubts
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