Loss of control of herpes suppression following bariatric surgery.

We report a 42-year-old female with confirmed recurrent genital herpes (HSV-2), which was well controlled on suppressive antiviral therapy with aciclovir 400 mg twice daily. The patient required bariatric surgery in order to manage what was deemed a dangerously high BMI. A Roux-en-Y procedure was performed which effectively reduced her weight; however, herpes suppression become ineffective post operatively, with serious herpes related complications, despite increasing the total dose of aciclovir and the frequency from twice daily to three times a day. Complete herpes control was restored by changing therapy to valaciclovir 500 mg twice daily. The Roux-en-Y procedure is the most common form of bariatric surgery. Consequences on the efficacy of different herpes antivirals can be predicted from what is known of their properties and sites of absorption. Similar problems with herpes virus suppression may be avoided by an anticipated change in therapy preoperatively.