I have tested positive for HSV1 and have had some lesions in my mouth. I take valtrex daily for suppression and have used denavir occasionally as well. This time, the ulcers ar on my lip and tongue and are so painful that nothing has helped. Can you offer any advice besides the anti-viral? Is there anything that will relieve the pain? And how long is normal duration? I'm HIV negative (been tested frequently and have not had risky relations) and I find it unbelievable that the lesions last longer than a month sometimes....and advice?

Without being able to see the lesions and culture them for myself it is very difficult to come up with an accurate diagnosis or plan of treatment. My first concern though, would be that you continue to have what is believed to be herpetic outbreaks while on anti-viral medications. If you are breaking though on suppressive therapy, I would suggest you have these ulcers looked at by someone familiar with oral medicine or oral pathology and possibly have a biopsy performed.

The object of anti-viral therapy is to stop reproduction of the virus. Once the virus has stopped replicating you can use topical or systemic steroids to reduce the inflammation, therefore the pain. Please be advised that any steroid use should follow 24 hours of antiviral therapy as steroid acts like gasoline to a fire in the presence of active herpes. In other words, use the antiviral to stop reproduction/replication (at least 24 hours of therapy) and then use topical steroid to reduce the pain and inflammation.

As far as pain relief, there is a product known as Ulcerease which my patients swear by for temporary relief of pain due to aphthous and herpetic ulcers.

I hope this information proves helpful!

DR