Hello doctor, I am a 28-year-old female with a height of 5 feet 5 inches weighing 140 pounds, healthy, non-smoking, non-drinking female with no drugs and no other known health problems. Two months ago, I was exposed to HSV-1 and then seven days later, I was tested positive for HSV-1 oral with IgG of 1.51 and IgM confirming a recent infection. The same day I started taking Acyclovir for three weeks and then one month later, I was switched to Valtrex (Valaciclovir) at 1 g twice daily. I started having HSV-1 facial symptoms, but never any outbreak. It started with tingling lips and then nerve pain running all over my face, cheeks then under my eyes. The last two weeks, the nerve pain has gradually increased from my eyes to my head, mainly at my trigeminal ganglion. The pain is 5/10 and is now on my forehead and the top of my head. I am still taking the Valtrex but would like to know is this common with HSV-1? What should I worry about from a neurological standpoint? Five weeks later, I still have never had a cold sore outbreak. Today, I went to see a neurologist and because I am four weeks pregnant, he suggested that I not have an MRI and not take neurologic medicines. He basically said I should just wait to see if it impacts more than the TG and wait to see if nerve pain goes away. Can someone please help me? Should I be worried about herpes encephalitis? In the past, I have been on Gabapentin.
Hello. Your symptoms are compatible with trigeminal neuralgia. I agree with your doctor's decision to avoid performing brain MRI (magnetic resonance imaging) or any medication within the first trimester. Regarding encephalitis, you should know that it is a very serious condition, characterized by acute confusion and persistent seizures, associated with fever. So, you can understand that it is not your case. You should also know that pregnancy makes you more vulnerable to trigeminal neuralgia. I suggest you taking just Acetaminophen (Paracetamol) or Ibuprofen for the pain. Consult your specialist doctor, discuss with him or her and with their consent take the medicine. In the second trimester of your pregnancy, I would recommend performing a brain MRI and checking again IgM (immunoglobulin M) levels. For the moment a neurological consult would help exclude any other physical signs of neurological disease. Regarding the outbreak, you should know that even though you do not have it, as IgM has resulted high, the presence of infection has been confirmed. It usually stays hidden inside the trigeminal nerve ganglion within the skull. For more information consult a neurologist online -->