Time-sensitive exposure risk question

[Loretta]

Hello Terri,

I am a 46 year old female who has had genital HSV2 for twenty years. Have taken valacyclovir as needed for outbreaks, which have only occurred about once every two years. Have not taken it daily for suppression since they rarely occur.

Currently on day 4 of an outbreak. Have been taking 2g of valacyclovir every day (1000mg every 12 hours) for the past three days. I’m also covering the spot in a zinc cream to speed healing and help mitigate pain. The spot is sore but very small, on edge of vaginal opening.

I am getting married tonight and my honeymoon is tomorrow. My partner is negative. He cannot use condoms for trauma reasons.

-Because I’m on day 4 of a recurrent (not initial) breakout and taking 2g/day of antiviral med, is my risk of transmission to him low enough now that we could have intercourse tomorrow (day 5?)

-Is continuing to take 2g of valacyclovir daily for the next week to mitigate exposure still helpful, or harmful?

Thank you

[Terri Warren]

oh my goodness.
First, does he know about the HSV? Is he worried about contracting it from you?
I honestly can’t say with any certainty that you will not transmit but I think the odds are in your favor, with the relatively high doses of antivirals on board and being on the 4th day of an outbreak.
Would you consider using a female condom? That would be an option for the two of you.
I think you can continue the meds for the rest of the week. It’s definitely not harmful and could be helpful.
If you are going to having regular sex with your new husband, I think you should seriously consider suppression.

Terri

[Loretta]

Thank you for your reply. Yes, he knows, but we have both been under the impression that we were quite safe considering the last outbreak I had was before we even met a few years ago. I now know I will need to start suppression therapy, because I want to hopefully avoid this kind of outbreak and risk to him if I can do anything to help it.

-Today I am more symptomatic than yesterday- swollen inguinal lymph nodes, sore throat, my lesion is very tender. Is this an indication of higher transmissibility risk?

-Lastly, for the past twenty years my lesions have always stayed to one side of vaginal opening and I’ll only have one at a time. Today I woke with some nerve pain/lymph node symptoms on the side opposite of the current lesion. Despite being on 4 days of a high antiviral dose, could I have transferred a second lesion to myself right next to the other one? That would definitely set the clock back on this.

Thank you

[Terri Warren]

When you are more symptomatic, I think you are more infectious. Be careful. You didn’t transfer it, it did it itself.
How was the wedding?

Terri

[Loretta]

The wedding was lovely, thank you for asking.

We took the risk and had oral sex and intercourse when it seemed the lesion had healed, although I still have tenderness there and intramuscular pain. But this morning at a routine gynecologist visit, they they found a growth on my cervix that was easily felt. They are going to send me to someone else to have it evaluated. I didn’t realize I could have a herpes lesion on my cervix that would be large enough to feel with a fingertip. Now I am concerned.

I am back to taking 1g/daily valtrex and can only hope I didn’t transmit to my husband. But I am feeling quite down about it.

[Terri Warren]

That’s not what they are feeling on your cervix, I’m quite certain. A herpes lesion on the cervix would most likely be ulcerated, not protruding. But it could be many things and all should be addressed. I’m guessing you did not infect your husband, sounds like between meds and limited symptoms, that’s unlikely.

Terri

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