Hello doctor, I am a 46-year-old male. I have recurring HSV-1 around the base (and inside) the nose. I have an outbreak now and my last outbreak was about 52 days ago. In childhood, I began with blisters on the lips; in the past five to 10 years, it seems it has migrated to the nose. Also, in the past, I could take Acyclovir or Valacyclovir successfully for treatment. And for a period of some years, I was able to take 500 mg Valacyclovir daily as a prophylaxis. But now those drugs (and also Famciclovir, which I have tried recently) each cause dose-dependent unpleasant side effects of CNS stimulation and muscle tension. So, my upcoming question is regarding treatment strategy and options. My inclination when outbreaks recur is to take Famciclovir at a low dose (250 mg initially and 125 mg every 12 hours for three days). It is not clear how much this may actually help, but it is what I feel comfortable presently doing and the side effects are at least tolerable at this dose. I would not want to take it daily at this dose though. There tends to be a crash after finishing it from the drop/lapse in stimulation. With this background, on to my questions: Does the frequency of outbreaks increase the likelihood of spreading the virus to new locations? Again, I am seeing a frequency of about every two months. I am particularly concerned about ocular herpes. What I am driving at is, can I feel safe in avoiding taking a daily, preventive dosing of an antiviral? And when I get an outbreak, do I need to treat it at a high dose of antiviral (or treat it at all, really) to prevent the spread to new outbreak sites (such as to the eye, or even other parts of the face)? I worry that I need to try to endure the side effects of the antivirals in order to prevent the virus from spreading to new locations (again, such as the eye). Perhaps you can help assuage me of this fear. My current medications are Synthroid 75 mcg daily, Lansoprazole 30 mg daily AM, Omeprazole 40 mg daily PM and Prozac 35 mg daily.
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