Why Now Follow-up

[stunned1]

Terri – I couldn’t retrieve my password so I had to start a new account. Please view this as continued discussion from User Name Stunned:
My partner experienced what she thought was an outbreak (3 tiny blisters in an area the size of the tip of a pencil eraser on the lower part of her labia, just outside the opening) 5 weeks and a day after we were last together. She was scheduled for a check-up 3 days later. The doctor visually diagnosed it as a herpes outbreak, however both the culture and igg came back negative. So at this point I believe I’ve been infected for a long time (4.66 igg). Should she have another blood test later? How long?

If I have future outbreaks, will they likely be in the same spot as my first (half-inch above base of penis, about the size of a quarter)? Does the size of my first outbreak give any indication of likelihood of future outbreaks or severity of them?

Regarding my upcoming hip replacement surgery, you recommended starting the Valtrex 1 week prior as a suppressant dose. I have a fully prescription. Will taking it longer in advance of the surgery provide a better chance of no outbreak due to the stress of the surgery? Any potential complications with the surgery or anesthesia by taking it as a suppressant? How long after the surgery should I take it (I’ll have about a 5 week recovery period)?

If she remains negative, is there anything she can take as a preventative? Given the location of my outbreak, is use of a condom still prudent? Would any transfer likely come from the spot of the outbreak?

If I don’t need the suppressant dose because of a lack out outbreaks, how far in advance of having sex do I need to take it to be an effective suppressant…or do I just need to be on it continuously? If not on a suppresant, will my igg continue to increase from 4.66, and if so how high and is that relevant to anything?

Other than making one susceptible to HIV during an outbreak (not an issue for us), are there ANY short or long term health implications to having HSV2?

Thanks so much!

[Terri Warren]

So if the blisters on her were actually herpes, it is likely new infection. Waiting three days after symptoms appear and having a culture done (PCR is far more sensitive) may be the reason the swab test was negative. She may have herpes now and an IgG test is a few months will be positive (if she has herpes now). If she does not have herpes, there is nothing she can take as a preventive, only you should take drug for prevention of transmission. The lack of outbreaks is not a reason for you to be on suppression, you will still shed virus albeit less frequently. If you are only going to take suppression with sexual encounters, you should start 5 days before the encounter, either 500 mg of Valtrex daily or 400 mg of acyclovir twice daily. That medicine will not, at this point, impact your score

Your outbreaks may well come in the same place but they may also show up anywhere in the boxer shorts area.

As far as we know, there are no long term implications for your health for having HSV 2.

Terri

[stunned1]

Thank you!
What abut my questions related to upcoming surgery? And about the need for a condom considering the site of my outbreak would not be covered by one?
Do you recommend to your patients that they take a suppressive dose as a routine, even if there are long periods between sexual activity?

[Terri Warren]

You should take it for about a week after the surgery, I think. And there should be no complications with surgery because of the drug. I think starting a week in advance is adequate.

The answer to your next question is that we recommend it daily unless there are long periods of sexual inactivity in between each other.

Terri

[stunned1]

Thank you again.
My partner and I intend to marry. Given our ages and my vasectomy, children are not in our future. Neither of us consider using a condom long-term in marriage viable. I’ll readily take the daily suppressive dose of Valtrex to reduce the risks of transmission. Is transmission in a long term sexually active relationship inevitable, or might it never occur if suppressive dose is taken and there is no sexual contact during an outbreak? (I saw in one of your responses that you have been in a long term relationship with an HSV2 positive partner absent condom use and you continue to test negative.) Would condom use be effective for us given the location of my first outbreak?

In reading some of the other posts, my impression is that, given a choice between the two, oral HSV2 is much less onerous than genital HSV2. Would it make any sense in my situation for my partner to intentionally seek to contract oral HSV2, or is it more prudent to simply wait and see if transmission genitally occurs? Oral sex (giving and receiving) is a big part of our relationship. I want what is best for my partner, while neither of us want the “spectre” of possible transmission to interfere with our sexual relationship.

[Terri Warren]

It is certainly possible that transmission will never occur, yes.
So we don’t know if her blisters are herpes, right? If they are not, then yes, if she acquired HSV 2 orally, then it is would be unlikely she would acquire it genitally. Whether she would intentionally agree to get it orally is certainly a choice the two of you could consciously make.

This is our final post on this subscription. If you have other questions you will need to renew your subscription.

Terri

[stunned1]

I will renew for more questions, but could you please answer the one I asked above about whether a condom would be effective for us given the location of my first outbreak?
Thanks!

[Terri Warren]

Virus can be shed anywhere from the penis and is shed from the rectum as well. Condoms would help to reduce transmission.

Terri

[stunned1]

Thanks Terri.
I see from other posts that some folks have sought to acquire HSV2 orally, supposedly because the outbreaks are less severe and perhaps less frequent. And I see that you’ve been in relationships with HSV2 positive partner for…18 years?…and remain HSV2 free because of your partner’s use of suppressive dose. Why would it make sense to acquire HSV2 orally when there is the possibility that with suppressive dose it may never be transmitted? Do you ever recommend that your patients seek to get it orally, and if so, why?
In a long distance, yet monagomous relationship, where outbreaks remain infrequent or non-existant after the first one, is it medically prudent to be on a daily suppressive dose rather than to start it 5 days out from being together with my partner? I understand there are potential liver problems (any other concerning side-effects you know of?) with Valtrex, so this is partially why I don’t want to take it daily if not necessary.

[Terri Warren]

People might chose to acquire HSV 2 orally because it recurs very infrequently and sheds very infrequently and once you acquire it orally, you would not get it genitally. Of course, now we are talking about people who don’t already have HSV 2.
There are no known potential liver problems with these medicines. If you are reading that somewhere, I don’t believe it is reliable information.
But it is fine to take it for five days ahead of sexual contact instead of every day.

Terri

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