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Dr. Andrew Rynne
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Dr. Andrew Rynne

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Suggest treatment for herpes while on Valtrex

Answered by
Dr.
Dr. Arnab Banerjee

Critical Care Specialist

Practicing since :2012

Answered : 1290 Questions

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Posted on Fri, 26 Aug 2016 in Sexually Transmitted Diseases
Question: Ok im very irritated. Iv had hsv1 since i was a kid and rarely get any outbreaks and if i do its minmal and usually contanned with abreva however in thats last month i have two extremely violent outbreaks back to back. They start in the corners and within 24 have effected the lips area and producing two major lessons. On the second i havd the two doses of valtrex in my system within 2 hrs of waking up with that feeling. Its seems as though it has little to no effect. I need to understand why these outbreaks are reoccuring and what i need to do to not have them anymore. Its ruining my life. Please advise as to triggers and additional corrective action
doctor
Answered by Dr. Arnab Banerjee 6 hours later
Brief Answer:
you need to get clinically examined and investigated thoroughly ..

Detailed Answer:
Hello xxxxxxxx, Welcome back to HCM,

I've gone through your query and understand your concern..

Don't worry, let me guide you step wise, just go through the below questionnaire and try to find out which is it, and even if you can't find, just let me know the details so that I can guide you accordingly..

The first and foremost thing to note here is, when dealing with a viral outbreak like Herpes, our body's immunity plays the biggest role..

So first of all, you need check if there's a sudden drop of immunity, it can even be due to mild influenza, fever, sore throat, loose motion etc. , so let me know if you had it in recently..

Next to note, HSV1 is extremely notorious due to sudden weather change, it generally remain in hibernating phase during one specific climate(eg. cold) and suddenly gets activated due to change in the climate as well as humidity, so is there any ?

Thirdly, please let me know about the sexual history, as it's extremely important too, is there any risky exposure in the recent past ?

In case of any doubt, there's a need to undergo for a complete STD screening at the earliest..

Fourthly, there can be resistance due to prolonged repetitive use of valtrex also, that's another reason for not getting adequate response despite therapy..in that scenario you may need a prolonged therapy with Acyclovir after getting checked up by an Infectious Disease specialist..

Another possibility is underlying secondary bacterial infection, which is lowering your immunity and making you prone to HSV repetitively..

I'd suggest you at this point to schedule an appointment with an Infectious Disease specialist for a thorough physical check-up as well as few relevant investigations (i.e. Hemogram, ESR, CRP, Viral Antigen and antibody specific for HSV 1 &2 ) and a few more as per the findings..

Let me know how it goes and also if you've any further queries, i'll be glad to clarify..

Take Care
Kind Regards


Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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Follow up: Dr. Arnab Banerjee 16 hours later
I have already had a full std check that verifies the hsv1 in my system.
No i have not been sick
No new partners sexua
Yes it has gotten quite hot l
doctor
Answered by Dr. Arnab Banerjee 50 minutes later
Brief Answer:
Nothing to worry, however routine and timely follow-up to continue..

Detailed Answer:
Welcome back Dear,

Thanks for following up with these details,

Now, the most likely culprit here is the change in climate, so don't worry..
It's a self limiting condition which'll resolve on it's own within a week at the maximum..

In the meanwhile, you can apply Acyclovir ointment(ZOVIRAX) instead of Valtrex over the lesions, it'll help in reducing the pain and discomfort over the area(you need to have a prescription for this from your local physician)..

Just try to remain indoor in side the air conditioning for the time being, avoid direct sun light exposure.. you can apply soothing gel containing Aloe-vera, it'll provide further symptomatic relief..

Try to remain stress free, keep yourself indulged in to activities and hobbies, it'll take the mind away from this..

Let me know if there's any further queries, i'll be glad to clarify..

Take Care
Kind Regards

Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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Follow up: Dr. Arnab Banerjee 9 minutes later
Well just got back from my doc they switched me over to the acyclovir tablets 3 times a day since the valtrex was having no effect and are having me use mupirocin oentment
doctor
Answered by Dr. Arnab Banerjee 6 minutes later
Brief Answer:
good, then continue them as advised already..

Detailed Answer:
Welcome back Dear,

Good to know these details, seems like your in right hands only..

Start taking Acyclovir, and if needed it can go up to as many as five times a day..
However, as for now start it thrice daily, also remember to drink a lot of water- stay well hydrated while on Acyclovir(try to drink at least a liter extra in total through out the day)..

Yes, you can continue the mupirocin, a topical antibiotic, which'll prevent any further associated infections..

Let me know how you stay in the due course..

Take Care
Kind Regards

Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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Follow up: Dr. Arnab Banerjee 11 hours later
Well the first 12 hrs of acyclovir is showing no effect. The large lesion othe bottom lip is spreeding. Though it is scabing over. In areas. The top lip is still entirely covered with very small blisters. I need major assistance with this is there nothing stronger to stop this from spreeding
doctor
Answered by Dr. Arnab Banerjee 1 hour later
Brief Answer:
it's too early, give it a while longer..

Detailed Answer:
Hello Dear, Welcome back,
Thanks for following up,

It's a tablet dear, it's too early, give the drug some time to take effect (it takes even up to 72 hrs to take complete effect form person to person)..

Spreading is a part of the process only, later on they tend to form scab and finally dried down to form crust , the whole process takes about 8-10 days in total..

As of now, please have faith in the treatment and try those other measures which i've already mentioned, the cumulative effect fasten the process of healing..

You must note that, herpes spread is directly related to stress(which i've already explained to you in details), so try to keep yourself busy so that the mind doesn't get time to think about it too much..

If they persist beyond the mentioned time frame / or suddenly increase in number(the actual blister) then you can contact your Doctor for a incremental dose in Acyclovir..

Later on you can get in touch with a Dermatologist for a session of Laser therapy (they are the best advancement in management so far, usually have a very high success rate), but that's only recommended after the active outbreak period gets over..

Don't worry, it'll get over soon..

Take Care
Kind Regards

Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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Follow up: Dr. Arnab Banerjee 16 hours later
Ok so now i have a rash on my arm. Is it possible for hsv 1 to spread like that or is that just hsv 2 that does that.
doctor
Answered by Dr. Arnab Banerjee 2 hours later
Brief Answer:
it needs a clinical examination to determine the exact cause..

Detailed Answer:
Hello Dear, Welcome Back,

Well, this is a new onset rash and it may or may not be related to HSV (1 or 2 ), so this needs a clinical examination to determine whether it's related to the previous outbreak (it seems very unlikely though, as Herpes doesn't spread like that, it always follows the dermatome)..

However, for your assurance, you can go ahead get it check to rule out any other associated etiology..

Take Care
Kind Regards

Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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