Why are outbreaks more frequent?

[asdasdf143123___]

Had herpes for a bit more than 2 years.
2017 had 5 outbreaks
2018 had 11 outbreaks
Why?

[auntiejessi]

There are many possibilities for this.

Were you more stressed? Tired? Were you getting enough sleep? Have a secondary infection? (You don't mention your gender, but if you have a vagina, it's possible that you might have a yeast infection or bacterial vaginitis, or another STD. If you have a penis, it could be a fungal infection or another STD.) Have you been sick a lot? If you have a cold, the flu - things like that, your body is trying to fight one thing, making it harder to fight others.

Hormonal issues can also trigger outbreaks - menstruation, birth control pills, menopause, etc. Also, medical conditions that affect hormones - thyroid problems, for example - and some medications can cause this as well.

If you shave your genital region, that might be triggering the outbreaks. Some people find using a trimmer helps, or if you are using a trimmer, try a razor or waxing. Changing your hair removal method may help.

You may not ever figure out what is causing the increase, but consider suppressive therapy, like daily valtrex or acyclovir. Valtrex is more expensive, but is a convenient once a day dose. Acyclovir is MUCH cheaper, but it's twice a day. If you are in the US, your choice may depend on cost/insurance coverage.

[asdasdf143123]

Male. I don't think I'm having any of the things that you described. I'm about to get tested for AIDS and maybe syphilis. Didn't really consider a fungal infection.

Are there any specific STDs or fungal infections you recommend I test for?

[auntiejessi]

A fungal infection would likely cause symptoms - I wouldn't worry about that without symptoms.

I'd test for gonorrhea, chlamydia and NGU as a male. You can have those without symptoms. Definitely test for syphilis and HIV, though I don't know your history, risk factors, etc., so I can't comment on the changes that you'll have any of them. In any case, if you've had unprotected sex, it's always good to test.

[asdasdf143123]

Got tested for both HIV and syphilis and don't have either. Started daily acyclovir suppressive therapy. STILL HAVING OUTBREAKS!!! had 3 outbreaks in the last 40 days. What else can I do?

[Doxiemomma52]

I was told that a compromised immune system would make you more at risk for outbreaks.  I've been getting quite a few lately but have also been going through a very rough patch (caretaker for Dad with dementia, Dad recently passed, my dog lost use of her legs and required emergency spine surgery, trying to get ready to move, etc.)  I'm also concerned about my physical health in general although that could also be compromised due to stress.  But I'm going to get a complete physical shortly and also talking with a therapist to help deal with stress.  I'm already on meds for depression but they may not be the best ones so seeking advice on those, too.  In other words, I'm not focusing on the herpes but on my overall physical and mental health.  If there's a problem with any of those, that could easily explain the more frequent outbreaks.  I was also told that the so-called suppressive therapy doesn't reduce the number of outbreaks; they just shouldn't be as intense and should resolve more quickly.  This info came from somebody at the 800 line for Women'sHealth.gov, so I assume it's credible.  They are one of the major clearinghouses for herpes publications.  

[auntiejessi]

asdasdf, How long have you been on the acyclovir? Maybe you'd do better with valtrex (there's a generic for it now, so it should be cheaper than the brand name), or famvir. With valtrex, you can take either 500 mgs or 1000 mgs, and maybe the higher dose would work for you.

Suppressive therapy DOES decrease the frequency of outbreaks. There are huge studies that prove this, and it says on womenshealth.gov that they do - https://www.womenshealth.gov/a-z-topics/genital-herpes and https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/414294.

Doxiemomma does have a point - how is your overall health? Are you sick with another infection - a cold, the flu, something else? Are you stressed over things beyond having a lot of outbreaks? Getting enough sleep? Eating well? You may also have a trigger you don't know about. Some find that shaving your genital area triggers an outbreak, for example, and they wax instead, or vice versa. Some people have food triggers.

Doxie - I'm sorry you are going through so much. My dad died at the end of the summer after a long long illness, and I had moved the month before it, etc., etc. I hope things start improving for you soon, as well as your doggie. :)

[asdasdf143123]

I've only been on the suppressive therapy for 2.5 weeks now, but I had an outbreak only several days after starting it. Getting plenty of sleep and food. Diet consistent between 2017 and now. Don't have HIV, often get the flu in the winter (just for a week), generally feel pretty healthy. Maybe the last 3 weeks I've been feeling itchy down there, but nothing the doctors can see although I haven't had them scrape the skin to test for fungal infections (although fungal infections should be visible). Don't shave.

[auntiejessi]

Oh give it some time. The virus is responding to the suppressives. For them to even work to reduce transmission takes about 5 days. If after a two or three months you are still getting outbreaks so often, then talk to your doctor about changing meds. You've ruled out other infections, and your overall health seems okay. Some people (including myself) just seem to get frequent outbreaks when not on suppression. I started on Valtrex, went to famvir, then acyclovir before I finally got some relief.

Keep us posted on how you're doing. :)

[asdasdf143123]

Having another small outbreak now. Been consistently taking the suppressive therapy (aciclvor 400mg twice daily). very frustrating. why would i only have 5 outbreaks my first year without suppressives (when i've heard the first year is the worst) only to have more frequent outbreaks in the third and second year WHILE ON SUPPRESSIVE THERAPY. I mean, i've already had 4 outbreaks in 2019. what the hell?

[auntiejessi]

The first year can be the worst for some, but not for everyone.

When was the last time you had a physical? Wouldn't hurt to get some blood work done and make sure everything is okay.

The other thing is that maybe something else is triggering it, and you have to dig deeper to find it. Have you changed laundry detergent? Soap? Started eating anything different?

I'm sorry this is happening.