Anti-viral use for HSV-1

[SoCal]

Terri

I contracted genital HSV-1 more than ten years ago, from my then-husband. Recurrences are rare, and it has been over a year, maybe two or more, since the last one. I have no sense of prodrome because recurrences are so rare. I am beginning my first relationship since my divorce. I am naturally concerned about transmitting HSV to a seronegative partner.

My doctor gave me a prescription for 500 mcg Valtrex, twice daily, in case of a recurrence. I am more concerned about suppression. However, the guy I am seeing has a job that takes him all over, so we are only together maybe one weekend in four. I don’t want to take medications unnecessarily, but I do want to protect my partner as best I can. Condoms will be used.

I understand the suppression dose is 500 mcg, once per day. I have also read that Valtrex takes 5 days to take full effect, and that the effect lasts for 5 days.

1. Can I take Valtrex periodically for short-term suppressive effect, and if so, what is the recommended course of treatment, that is, how many days before we are together should I start taking the Valtrex, and for how many days should I take it?

2. I understand that the transmission rate/risk of HSV-1 is about 4% for a long-standing infection, reduced around 50% with anti-virals, and around another 50% with condoms. Is it true that the guy being circumcised reduces the chance of transmission even further?

Thank you for your help!

[Terri Warren]

1. Can I take Valtrex periodically for short-term suppressive effect, and if so, what is the recommended course of treatment, that is, how many days before we are together should I start taking the Valtrex, and for how many days should I take it?

Yes, you should start 5 days before you see him and if you want to be extra careful I would consider 500 mg twice per day for a couple of days before he arrives and during his stay. This is called episodic suppression

2. I understand that the transmission rate/risk of HSV-1 is about 4% for a long-standing infection, reduced around 50% with anti-virals, and around another 50% with condoms. Is it true that the guy being circumcised reduces the chance of transmission even further?

No, these are statistics for HSV 2, not HSV 1. HSV 1 is far lower! I would say 2/3 less. Do you actually know if this person has HSV 1 infection or not? Because if he does, you don’t need to worry about this. Have you asked him if he has ever had a cold sore on his lip?

Terri

• This reply was modified 7 years, 5 months ago by Terri Warren.

[SoCal]

Thank you so much for the information above. I will be sure to ask about cold sores.

Would 500 mg x 2 according to the above schedule get me to negligible risk, to the point where, say, condoms or dental dams are superfluous?

Also, does circumcision further reduce risk (for transmission to genitals, of course)?

Thanks again!

[Terri Warren]

Circumcision likely does reduce the risk of acquiring herpes. The risk, taking daily medicine and no sex during outbreaks, is likely around 1% or less.

Terri

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