Recurring Herpes: Insights on Hormonal Changes and Treatment

Q: Recurring Herpes: Insights on Hormonal Changes and Treatment

Hello： I have never been tested for type 1 or type 2 herpes virus, but regardless of whether it is type 1 or type 2, it cannot be cured, right? --> Yes, so do I still need to get a blood test to determine whether it is type 1 or type 2? --> However, it needs to be confirmed by a

Recurrent herpes outbreaks?

Hello, doctor.
Around the time of menopause, approximately at the age of 48, I began to frequently develop blisters in the areas near the upper thigh and on both sides of the groin.
Occasionally, blisters also appear in the external genital area near the pubic hair.
Sometimes, if I leave them alone, they heal naturally in about 1 to 2 weeks.
However, in the past couple of years, the frequency of these outbreaks has increased significantly.
Almost as soon as one area heals, another area immediately develops blisters, which is quite bothersome, and topical treatments have not been very effective.
Two months ago, a dermatologist prescribed antiviral medication for me to take daily.
During the two months of treatment, aside from a few days of insomnia and slight redness with itching on my buttocks, I did not experience any herpes outbreaks.
I thought I would stop the medication to see what happens, but this week the blisters have started to appear again, and they are very itchy.
I have not had blood tests to determine if I have type 1 or type 2 herpes virus, but regardless of which type it is, it is known that there is no cure, correct? Do I still need to get tested to find out if it is type 1 or type 2? Since I only started having recurrent outbreaks around the time of menopause, could this be related to hormonal imbalances during menopause, causing the frequent recurrences? Would hormone replacement therapy be helpful? Given the high frequency of my outbreaks, should I consider long-term use of antiviral medication for herpes, rather than stopping? Thank you for your response, doctor.

Youyou, 50~59 year old female. Ask Date: 2024/03/02

Dr. Du Shixi reply Urology

Hello: I have never been tested for type 1 or type 2 herpes virus, but regardless of whether it is type 1 or type 2, it cannot be cured, right? --> Yes, so do I still need to get a blood test to determine whether it is type 1 or type 2? --> However, it needs to be confirmed by a doctor that it is herpes because I only started having recurrent outbreaks around menopause.
Could it be due to hormonal imbalance during menopause that is causing such frequent recurrences? --> Not necessarily, but it is very likely that the immune system has weakened.
Would hormone replacement therapy help? --> I don't understand, but it is mostly ineffective.
Given the high frequency of my outbreaks, should I be on long-term antiviral medication for herpes without interruption? --> It is not recommended to use it that way; usually, it is only taken for a few days.
Please consult a specialist for diagnosis.
Wishing you good health.

Reply Date: 2024/03/02

More Info

Understanding recurring herpes, particularly in the context of hormonal changes during menopause, is a complex issue that intertwines dermatological, gynecological, and endocrinological aspects. The symptoms you describe—recurring blisters in the groin and buttock areas—are indeed characteristic of herpes simplex virus (HSV) infections. The two main types of HSV are HSV-1, typically associated with oral herpes, and HSV-2, which is more commonly linked to genital herpes. Both types can cause similar symptoms, and once contracted, the virus remains dormant in the body, leading to potential recurrences triggered by various factors.

Your observation regarding the onset of these symptoms around the time of menopause is significant. Hormonal fluctuations, particularly the decline in estrogen levels during menopause, can impact the immune system. Estrogen is known to play a role in immune function, and its reduction may lead to a decreased ability to suppress viral infections, including herpes. This could explain the increased frequency of outbreaks you are experiencing.

The use of antiviral medications, such as acyclovir or valacyclovir, is a common approach to managing herpes outbreaks. These medications can help reduce the severity and duration of outbreaks and may also be used as suppressive therapy to decrease the frequency of recurrences. Given that you have experienced a significant reduction in outbreaks while on antiviral therapy, it may be beneficial to consider a long-term suppressive treatment plan, especially if your outbreaks are frequent and disruptive to your quality of life.

Regarding the question of whether you should undergo testing to determine if you have HSV-1 or HSV-2, it can be helpful but is not strictly necessary for treatment decisions. The management of herpes is generally similar regardless of the type, and knowing which type you have may provide some insight into the nature of your outbreaks. However, the focus should primarily be on controlling the symptoms and reducing the frequency of outbreaks.

As for hormone replacement therapy (HRT), there is some evidence to suggest that restoring hormonal balance may help improve immune function and potentially reduce the frequency of herpes outbreaks. However, the decision to pursue HRT should be made in consultation with your healthcare provider, considering your overall health, risk factors, and personal preferences.

In summary, your recurring herpes outbreaks may indeed be influenced by hormonal changes associated with menopause. Long-term antiviral therapy could be a viable option to manage your symptoms effectively. Additionally, discussing the potential benefits of hormone replacement therapy with your doctor may provide further avenues for managing your condition. It is essential to maintain open communication with your healthcare provider to tailor a treatment plan that best suits your needs and lifestyle.

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