HSV Prophylaxis (Additional Steps)

[curious1990]

Hi Terri

Thanks for your time. I’m a man (negative) in a discordant relationship with a woman (positive). My partner has had GSV-2 for roughly 10 years and is currently on daily suppressive therapy with 500mg valacyclovir. We do all the standard risk-minimising steps, like using condoms etc. I’m interested in all additional steps with a fair basis in evidence.

The next best-supported step to me seems to be daily oral PrEP using FTC-TDF (Truvada)– 36% risk reduction (Daily Oral Tenofovir and Emtricitabine–Tenofovir Preexposure Prophylaxis Reduces Herpes Simplex Virus Type 2 Acquisition Among Heterosexual HIV-1–Uninfected Men and Women). Do you have any clinical experience or opinions on PrEP with Truvada for HSV?

There is firm evidence supporting a protective effect (in regards to HSV-2 acquisition) of tenofovir 1% gel for negative women (Tenofovir gel for the prevention of herpes simplex virus type 2 infection), especially in proportion to consistency of usage (up to 71% risk reduction). Is it plausible or reasonable to assume that the use of tenofovir 1% gel by a positive female partner in a discordant relationship might result in a significant or equivalent risk reduction for the negative male partner?

I have been curious about prophylactic antiviral use (e.g. valcyclovir) in the negative partner based on a number of perhaps loosely-supportive studies. However I have seen answers from you (e.g. https://westoverheights.com/forum/question/prophylactic-anti-viral/) that mention that the antiviral dose would likely need to be implausibly high to be efficacious. Would you consider a prophylactic dose of 1g daily (e.g. Prophylactic valacyclovir to prevent outbreaks of primary herpes gladiatorum at a 28-day wrestling camp) to be completely unsupported and implausible for genital or oral HSV risk reduction? i.e. no merit in considering even absent any significant downsides?

[Terri Warren]

I’ve not read any studies looking specifically at PrEp to prevent the transmission of HSV 2 and I think until that study is done, I wouldn’t recommend it.

The study of Tenofovir gel is sturdier and seem to me to be a reasonable option, except I’m not aware of the ability of anyone to prescribe this for this purpose at this time. it certainly is not yet FDA approved for this purpose. Are you aware of someone who would prescribe this for her and is she willing to use something that is not FDA approved for this purpose?

I think the taking of antiviral meds by the negative partner is unsupported, correct. I would say that if you have sex with this parter and right afterwards, she recognizes an outbreak that she has not previously recognized, a high dose of antiviral medication MIGHT be helpful, if taken immediately, to reduce the risk of the virus establishing latency.

These are just my opinions – you might find an ID doc who feels differently.

Terri

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