Acyclovir side affects

[Deathtoherpes]

Hi Terri,
I am taking acyclovir because i have tested definitively positive for hsv 1 and 2, and i would like to avoid transmitting hsv2 to my gf who has tested pksitive for hsv 1. I have never had definitive herpes symptoms (only very minor, and indeterminate) but because of the blood tests i know i have it. I am taking 400 mg twice per day. I have noticed some side effects that are concerning to me:

1) blotchiness and itching on my penis
2) swelling and tingling around my lips
3) nausea

None of the symtoms are severe, all fairly mild, but definitely noticeable. And i definitely think its caused by the medication because i have noticed this when i have taken it in the past also.

My questions are:
1) are these normal side effects?
2) will they go away
3) should i stop taking it?
4) are there alternatives besides valtrex which is extremely expensive for me

To be honest, what im experiencing now is similar to what prompted me to go to the doctor to get tested in the first place. I would think there is no way this could actually cause an outbreak, right? For reference my first noticeable episode was 5 years ago, followed by a second 2 months ago. I started taking the medicine after the recent episode and now this happens? It seems strange and im not sure what to do.

[Terri Warren]

The nausea is not uncommon, but certainly less than 10% of people who take the medication get that. Usually it passes within the first couple of weeks of taking the medicine. The others are not. And no, there is no way that acyclovir would cause an outbreak. The swelling of the lips is certainly concerning and could suggest an allergic reaction. I don’t know if these will go away. And if you are getting these side effects with acyclovir, you would like also get them with Valtrex which is a prodrug of acyclovir. I think it would be best if you talked with the person providing you the prescription for this medicine and see what they think you should do. I can’t really asses the look of the blotchiness on the penis to know if it might be hives nor the swelling of the lips to determine if this might indeed be an allergic reaction. I will say that in 33 year of practice I’ve had perhaps 15 people stop taking these medicines because of side effects so they are indeed uncommon.

Terri

[Deathtoherpes]

Hi Terry,
I’m pretty sure what i thought was a reaction to the medication was actually an ob. Extremely confusing because i had not had an ob for over 5 years, then got one, started taking daily suppressive acyclovir and a 2nd ob a month later. Doesn’t make much sense.

There is something that im concerned about however. Since my symptoms are extremely mild, its somewhat difficult to tell when the ob starts and ends, and im not completely sure when its safe (or safest) to have sex. Rough timeline:

Started having tingling, itchiness, and redness on penis on tuesday or wednesday. By saturday the redness was pronounced enough to make me think that it was an episode. I increased my aclycovir from 400mg 2x per day to 3x per day (3x was taken saturday to wednesday). The redness was on the decline by monday. By thursday it was pretty well subsided- you could maybe see some outline of where it was in some lighting, or depending on the lighting and bloodflow in my penis. By friday i couldnt tell whether there was still something there or whether my brain was playing tricks on me. As you know the penis has various skin shades throughout.

On saturday night i had protected sex with someone aware of my virus and that only lasted a couple minutes. There was no trace of anything with an erect penis. When unerect there may have still been some remnants but it was too tough to really tell.

Im a bit concerned because today i feel like im 100%, and saturday night im realizing i may have only been about 97%, although i thought i was 100 at the time.

My questions are?

How high risk of a situation was saturday night? I was on consistent 400mg acyclovir 2x daily, we used a condom, it was very quick sex, the area of concern was mid-shaft and well covered by condom, and the symptoms of the ob were pretty much gone, if not completely.

Most of the stats i have seen are assuming there is no sex during an ob, but what defines an ob and when its over?

When in the cycle is shedding at its highest?

Are u always shedding if any tiny trace of herpes is present?

Because i’ve been paranoid i started researching and read somewhere that i should wait a full week after symptoms are gone. I was not aware of this at the time. Do you agree with that?

Also, how can i obtain a test to verify if symptoms i see are actually herpes? I have never had classic opened sores. Only small red swelling that has never been painful, only slightly itchy, so its never clear cut.

Thanks.

[Terri Warren]

Most of the stats i have seen are assuming there is no sex during an ob, but what defines an ob and when its over?
I would define an outbreak as a break in the skin of the genitals.

When in the cycle is shedding at its highest?
That varies so much from person to person – some before an outbreak, some after, some more inbetween.

Are u always shedding if any tiny trace of herpes is present?
yes, that is the definition of shedding. With or without symptoms

Because i’ve been paranoid i started researching and read somewhere that i should wait a full week after symptoms are gone. I was not aware of this at the time. Do you agree with that?

You know, I advised patients to avoid sex until new skin has replaced the lesion, but even then, shedding is possible. There is no one day when you know you are not shedding.

Also, how can i obtain a test to verify if symptoms i see are actually herpes? I have never had classic opened sores. Only small red swelling that has never been painful, only slightly itchy, so its never clear cut.

You could do PCR swabs at home to see if you are shedding virus. this isn’t cheap but is the only way to know just when you are actually shedding virus from the skin.

Terri

[Deathtoherpes]

Ok so my follow up questions are:

1) when new skin replaces old skin there is probably a period where u can still visibly see the area affected. This would mean that the herpes are gone, but there is temporary “scarring” while the skin completely heals and there is no more shedding at that time. Would you agree?

2) how does acyclovir help? Does it make you shed fewer days per year, or does it lower the amount that you should for each period? in other words, if you are shedding (with symptoms or not) would the person on acyclovir be less like to transmit during intercourse than someone who is not?
3) if someone has sex while they are actively shedding the virus, what are the odds of transmission in that single event? How about with and without a condom?
4) i know the stat is that someone with herpes who has like a 4% chance of transmitting per year if sex twice per week or something around there. But is that essentially the same stat as just happening to have sex on a shedding day? Or is it having sex on a shedding day AND then also spread the virus.
5) is it possible to have sex on a shedding day without a condom and not transmit the virus? Does acyclovir play any factor in that stat?

[Terri Warren]

1) when new skin replaces old skin there is probably a period where u can still visibly see the area affected. This would mean that the herpes are gone, but there is temporary “scarring” while the skin completely heals and there is no more shedding at that time. Would you agree?
I would not agree. Shedding can happen at any time, from healing skin, from blistered skin, from normal looking skin. there is just no time when you can be certain there is no shedding.

2) how does acyclovir help? Does it make you shed fewer days per year, or does it lower the amount that you should for each period? in other words, if you are shedding (with symptoms or not) would the person on acyclovir be less like to transmit during intercourse than someone who is not?

both, fewer days, lower virus count. Lower virus count may help with transmission, it depends on how low the count goes.

3) if someone has sex while they are actively shedding the virus, what are the odds of transmission in that single event? How about with and without a condom?

I don’t have those numbers for you, sorry. And we can’t really extrapolate too much from the studies that we have because they vary so much and they are happening under such controlled situations when we are looking for a specific transmission event.

4) i know the stat is that someone with herpes who has like a 4% chance of transmitting per year if sex twice per week or something around there. But is that essentially the same stat as just happening to have sex on a shedding day? Or is it having sex on a shedding day AND then also spread the virus.

That is an average, and the 4% is female to male transmission, no condoms, no meds.

5) is it possible to have sex on a shedding day without a condom and not transmit the virus? Does acyclovir play any factor in that stat?
It is possible, yes. Some of the transmission event also depends upon the person who does not have herpes and their immune response and whether they have had a long term relationship with someone with herpes. The longer the relationship the less likely transmission is to happen if it has not happened already. Acyclovir would reduce the risk of transmission if, on that day, the person had greatly decreased shedding.

This is your final post on this thread. If you have more questions, feel free to renew.

Terri

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