I have questions... Still learning... Looking for some insight.

So I'm 36, just got diagnosed with HSV2 in May of 2016. My doctor gave me a 3 day dose of anti-virals to take when I got an outbreak. I had about 5 in a year so about 2 months ago, my doctor gave me a prescription for daily anti-virals, and told me to also take the 3 day does ones if I got a "break through." Well, I got a " break through" on my butt cheek area, which I didn't realize was even HSV2 at first. I thought it was just a few pimples, but then it spread to look like a rash. This was worse that any of my previous outbreaks... Which seemed to be steady with only a sore on my labia.

This butt cheek/ back of thigh break through is healing, but I get a sore popping up here and there... I don't understand why if I'm taking the DAILY meds, this break through is being so stubborn.

So my questions are:

1.) Is the way HSV2 works is that wherever it develops, is where it will be, OR it pops up and then if the blisters pop and the liquid goes on the nearby skin, it'll pop up there too?

2.) Why would the outbreak or "break through" get bigger (or more severe?) after going on the daily anti-virals?

3.) Is it referred to as a "break through?" Is that the correct term?

4.) Is there usually one dose that is the norm for daily anti-virals? Mine is 1 gram, I believe. Or do people sometimes need a bigger daily dose?

5.) I feel like the daily dosage just made my outbreak worse... Like maybe I should stop taking them daily. Does that happen to people? I feel like I'd rather have the one sore on my labia than this bunch of them on my butt cheek/ back of the thigh. I feel like if this keeps up, I'll never be able to have sex ever again.

Any insight and information is appreciated.

Thanks.

Hi, @PaintedToes, and welcome!

1. Genital HSV2 lives in a group of nerves at the base of your spine. While many people commonly have outbreaks in the same area, it is possible to get outbreaks anywhere in the boxer shorts region—just depends on the nerve pathways the virus decides to take to exit the body.

2. I don’t know. Is it possible the new sores on your butt isn’t herpes? If they’re still there (and open) or if they come back, you might consider asking your doctor to swab them. It could be a totally different issue.

3. Most people use the word outbreak, whether we’re talking about a little redness or a single bump, or oozing sores. Rest assured, we know what you mean! :)

4. Which antiviral are you taking? When I initially tried Valtrex, the doc told me to take one 500 mg pill per day for suppression. I’m currently on acyclovir, for which my doc told me to take a 400 mg pill twice a day for suppression. I bet you could find typical doses with a google search.

5. If you feel the daily suppression therapy has made things worse, there’s no harm in stopping to see if it clears up. You might also try switching antivirals. I’ve seen a number of people on here (myself included) say that their body tends to prefer one antiviral over another and work better.

Thanks for the info!

1. I recently learned that it can show up anywhere in the boxer short region, but I'm wondering if it just pops up where is going to be our can it pop up and those sores ooze and thus spread it to a surrounding area??

2. What other issue could it be? It looks like the other ones on my other butt cheek.

4. I'm taking a daily 1 gram dose of valacyclovir... With a 3 day dose (of 2 500mg per day) on top of that if I had a "break through" while on the daily ones.

5. Is that a thing? The daily suppression making things worse?? I mean, when I was on the "take it when you get an outbreak" 3 day dose, it did the job pretty well, so I don't know about taking a different anti-viral. Plus, isn't this brand the generic version of Valtrex? What's the difference between valacyclovir and acyclovir? And how did you know to change anti-virals? What made you change?

1. I don’t know the answer to that for sure. What we do know is that it’s a good idea to wash your hands with soap and water after touching any outbreaks and before touching other parts of your body (especially in the first several months to a year after acquiring the virus). Once your body has gotten a better handle on the virus, you’re much less likely to inadvertently spread it to other parts of your body.

2. That’s a good question for your doctor. Think of it this way.....how many of us thought we had yeast infections, razor burn, pimples, and irritation from intercourse, but didn’t think of herpes? A lot of us. When herpes is new to us, and we’re still wrapping our heads around the diagnosis, it’s common to think that every bump, rash, and redness in the genital region must be herpes. Nearly 90% of those with genital HSV2 don’t know they have it because they either have symptoms or they attribute mild symptoms to something else. Once you’ve had some distance from the diagnosis (time and perspective), it’s easier to see other possibilities. Maybe these new bumps are herpes. If it’s very different than what your previous outbreaks have been like, it might be worth asking your doctor about it. There’s a lot of unknowns about why HSV behaves as it does. Just like it’s a mystery why someone can go years after getting HSV without ever getting an outbreak and then suddenly get one out of nowhere.

5. I’ve only been on these forums about a year, and so far I don’t recall anyone mentioning that an antiviral made outbreaks worse. A number of people have said, however, that one antiviral worked better for them than the other. Valacyclovir is the generic for Valtrex, and acyclovir is the generic for Zovirax. They’re similar medications, but not the same. Acyclovir is an older drug and Valtrex became more popular because you only have to take it once per day (vs twice per day) because it is better/more easily absorbed by the body. In my experience—Valtrex did not stop or slow down my outbreaks. It also gave me numerous prodrome sensations (zingers—tingling nerve sensations) throughout the day. Drove me nuts, so I stopped after six months. About six months later, I tried acyclovir because I still wanted to be able to take an antiviral to reduce transmission rates for when I started dating again, and I heard someone on this forum say one antiviral worked better for them than the other. Lo and behold, I had no zingers on acyclovir, no outbreaks, and the itching (my primary symptom) was reduced to almost nothing or only felt rarely. It’s been wonderful!!!!

I guess the bottom line for me is, who knows why they behave differently for different people. But since it’s super easy to stop taking them, why not give it a try and see if your outbreaks calm down? Asking your doctor for a different prescription is also super easy. It can’t hurt to experiment and you might find something that works for you! Maybe that something is acyclovir, maybe it’s episodic therapy with Valtrex (where you only take pills when you get an outbreak), or maybe you do better with nothing at all. You could even take it a step further and keep a calendar or log and see if you notice any patterns with certain triggers (stress? Lack of sleep? Certain foods?).

If there is one thing I’ve noticed from reading the stories of others, it’s that there is no one-size-fits all treatment for HSV. It can take some time and experimentation to find what works best for you. Good luck!

P.S. I strongly recommend this short handbook written by an expert on HSV: https://www.westoverheights.com/herpes/the-updated-herpes-handbook/. For even more details, her full book, available on Amazon, is awesome and has so much good information in it!

Thank you so much for all of the info and insight! I really appreciate it.

1. I always wash my hands every time I touch an area or use the bathroom. I'm diligent.

2. Yeah, it sucks that there are so many unknowns about HSV2.

5. Good to know about your experience with the different medications.

So... You stopped the daily medication for 6 months... And got no outbreaks?...And then tried the acyclovir? (How long have you had HSV2?)

And thanks, I will check out that book. I have learned a lot from the videos with Adrial on here and I watched the Ted Talk with Ella Dawson. Good perspectives from both parties.

I went in for a Pap smear early last year and spontaneously asked for an STD panel since I was recently divorced and had just started a new fling. The clinic I went to is a rarity because they included HSV in that panel. I was floored when I tested positive for HSV1 and HSV2. Both my ex-husband and the Mr. Fling eventually tested negative, and I haven’t had any partners since, I now know I acquired HSV somewhere between losing my virginity and getting married, 18-25 years earlier. (I could have even gotten HSV1 has a kid.). My outbreaks aren’t bad enough to swab, so I’m left to assume I have genital HSV2 and oral HSV1, because that’s the most statistically likely scenario.

Shortly after diagnosis, I started Valtrex and took it for 6 months. (I was hopeful my relationship with Mr. Fling would continue.) Once I realized the itching and minor irritation and redness I occasionally experienced was an outbreak, I could tell that I was still having outbreaks nearly every month on Valtrex. The zingers were driving me bananas though, so I stopped for six months. Frankly, I was depressed as hell (Mr. Fling didn’t stay around), so I figured, what’s the point of taking anything? And I continued to get mild outbreaks but without the annoying zingers. The same mild symptoms I had for 20 years, so I was used to it.

Once I started to recover emotionally, I read something on this forum that made me think I should try acyclovir. I still wanted the option of an antiviral that my body tolerated well because I was a lot more optimistic about a future relationship even being a possibility. So after six months of taking nothing, I started taking acyclovir. After about a month or two, I realized that not only was I not getting the annoying zingers I got on Valtrex, but my itching went WAY down to almost nothing. In the 10 months I’ve been on it, I think I can recall twice when I had just the **slightest**, barely noticeable, bit of itching for about a week—I now believe those are outbreaks. (I’m convinced hormones and my monthly cycle are a trigger for me.)

So even though I’m not seeing anyone right now, I continue to take them because after 20 years of feeling like I was cursed with a periodically itchy crotch and frequent yeast infections, I am virtually symptom free! Life is good! :)

Oh my. Well then maybe I’ll try not taking the dailies... thanks again for sharing. Appreciate it!

Ps. Got my answer to my question from that handbook: "Sometimes outbreaks occur in the same place every time they appear, but sometimes outbreaks move to a different location. It should be noted that when outbreaks show up in a new location in the boxer shorts area, it isn’t because the infected person has spread the virus themselves. The virus has just “chosen” to travel along a different nerve to get to the surface of the skin.".

Thanks again!!

Oh good!! I swear I’ve read that a hundred times, but I’m still learning something new!