Valacyclovir Options

[viking100]

Hi Terri,

Thanks for this service. I’m a male who has had genital HSV-2 since 2016. I have on average three outbreaks per year (visible blisters but no pain). I used Valacyclovir for my initial outbreak and occasionally since then. I tolerate it without any problems. I have just started to date a herpes negative woman for the first time since being diagnosed. She lives in a different city, so I will likely only see her a few times per month (at least at the beginning). I intend to start using Valacyclovir regularly (and we will use condoms). Here are my questions:

(1) I will use 500 mg or 1 g Valacyclovir daily. How does one know which dosage to use? (My doctor does not seem very knowledgeable)

(2) Given my circumstances, it may be an option sometimes to go off the meds for a few days or even a week. I read where you said I should be on it for 5 days before sexual activity, but there will be times when I won’t see my girlfriend for a week or even two. What are the upsides or downsides of going off the medication for some period of time and having it clear my system?

(3) Given that I’m only going to see her a few times per month, is there any argument or evidence for taking higher doses for the couple days before I see her? If yes, how high is safe?

(4) Does going on Valacyclovir require any blood work or any other monitoring/testing before or during usage?

(5) My blisters aren’t on the penile shaft, but in other parts of the genital region. Does this increase risk since the condom does not cover these areas? (I’m assuming that shedding will be in the same place as the blisters, but who knows I guess)

One final comment: based on the studies I have read, and your comments in this forum, I’m surprised at how much the risk can be lowered with the use of Valtrex and condoms (1-2% over a year). Herpes seems like an out-of-control epidemic, so it is counter-intuitive to me that we can reduce the risk this much. I guess I should be thankful.

[Terri Warren]

(1) I will use 500 mg or 1 g Valacyclovir daily. How does one know which dosage to use? (My doctor does not seem very knowledgeable)
In the old days, it was based on the frequency of recurrences. But we’ve looked at those two doses, comparing shedding rates, and there is little benefit for going to the higher doses.

(2) Given my circumstances, it may be an option sometimes to go off the meds for a few days or even a week. I read where you said I should be on it for 5 days before sexual activity, but there will be times when I won’t see my girlfriend for a week or even two. What are the upsides or downsides of going off the medication for some period of time and having it clear my system?
If there is only a week or so between visits, I don’t see a benefit of going of the meds at all then.

(3) Given that I’m only going to see her a few times per month, is there any argument or evidence for taking higher doses for the couple days before I see her? If yes, how high is safe?
You could – you could do 500 mg twice a day to keep drug levels more even. Not sure from a science point of view how much better that might be but no harm in giving it a try.

(4) Does going on Valacyclovir require any blood work or any other monitoring/testing before or during usage?
no

(5) My blisters aren’t on the penile shaft, but in other parts of the genital region. Does this increase risk since the condom does not cover these areas? (I’m assuming that shedding will be in the same place as the blisters, but who knows I guess)
Shedding is normally from the shaft of the penis or anus – very thin skin – regardless of the location of the blisters.

May I ask exactly how you were diagnosed with HSV 2?

One final comment: based on the studies I have read, and your comments in this forum, I’m surprised at how much the risk can be lowered with the use of Valtrex and condoms (1-2% over a year). Herpes seems like an out-of-control epidemic, so it is counter-intuitive to me that we can reduce the risk this much. I guess I should be thankful.

The reason the benefit is so high is the condom use. It reduces transmission by 96% when used with every intercourse and stays intact. The Valtrex is also useful at 48% reduction.

Terri

[viking100]

Thanks for your answers. Very helpful. I was diagnosed at an STI clinic. They took a swab of a blister that was oozing a little and sent it to a lab. I don’t know the exact type of test the lab did

[viking100]

Hi Terri,

You asked how I was diagnosed with HSV 2 (which I answered). What were you thinking? Should I do some other kind of test?

You said that shedding in men normally occurs from the shaft of the penis or anus because of very thin skin, regardless of the location of the blisters. I assume that shedding or transmission occurs from the blisters when they are present during an outbreak? Also, in the absence of an outbreak, how do we know that shedding occurs mostly from the shaft of the penis or anus? Is this an assumption because the skin is thinner or can this be measured? If there are any studies or analyses of this, I would love to review them. Can you direct me to them?

Thanks.

[Terri Warren]

No, I just wondered if it was a swab from a lesion or a blood antibody test.
Yes, shedding can occur from blisters, regardless of location.
We know about the location of shedding by doing studies where we have people doing daily home swabbing of their genital every day for some extended period of time and coordinating that with a diary of symptoms or not symptoms

You can Google PubMed and enter asymptomatic viral shedding herpes

Terri

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