Hello everyone, I had the following titers for antistreptolysin O (ASO): February 2017: 309 April 2017: 326 January 2018: 284 The normal range is <200 in my lab, so all three were flagged as elevated. Dr Lerner recommends to treat possible streptococcal infection before starting antiviral treatment, but his cutoff for starting therapy is ASO>400. According to Dr Lerner's research, untreated streptococcal infection can render antiviral treatment ineffective. I am wondering if this could be the reason why I only had limited success with high-dose Valacyclovir over the past year and if giving antibiotics a trial would make sense. Treatment would be Ampicillin/Sulbactam 2000mg/1000mg IV twice a day for 6 weeks. I'd love to hear your opinions.