Medication Regimen

[rogerg1]

My girlfriend has herpes and I do not. She is 55 and I am 56. We would like to begin a sexual relationship. We will see a physician for reccomendations but wanted to get your opinion on:
1) What is the medication of choice and daily dosage to lessen the degree of viral shedding.
2) How long should it be taken before relations begin
4) What side effects are typical
5) Do any studies indicate problems from long term use. (and what would be characterized as long term use)
6) Is there any reason to believe that long term use lessens the benefit of the medication.

Thanks

[Edward W Hook, MD]

The effect of antiviral therapy for HSV is greatest when the drug is present.  Thus, within a day or so of starting medication there should be an effect and within a day or so of finishing the effect is likely to no longer be present.  Whether there is some residual effect following a long duration of therapy is unknown but it is safest to not presume that is the case.  

As far as the effect of infection present for years. the data are confliciting.  The clinical observation is that there tend to be fewer outbreaks over the years but that is hard to prove.

Sorry there are not better data for you. I hope these comments are helpful.  EWH

[H. Hunter Handsfield, M.D.]

rogerg1's follow-up questions, transferred from new thread (deleted):

Doctor, last week you reponded to my question about medication regimen re herpes. My other questions are{

1)  How many days or weeks should a couple wait to have sex after the one party (female) commences medication for viral shedding suppression?

2) does the fact that that party has had herpes for 15 years affect how or when the medication should be taken or dosage etc.

3) if the medication is stopped at some point to the benefits recede or continue

4) If there have been no outbreaks in years can the medication be avoided, or taken for a shorter duration?

Thanks again

[Edward W Hook, MD]

Welcome to our Forum.  Congratulations on the way you and your GF are approaching this. With proper precautions the risk of HSV transmission can be greatly reduced.  There are 4 different practices, each of which are proven to reduce the risk of HSV-2 transmission and that work additively.  The 4 practices are: 1).  Disclosure of infection to the uninfected partner - she's done that.  If you have not been tested for HSV using a type specific blood test for HSV in the past, you should be, just to be sure.  Remember, about 20% of American adults have HSV-2 and of those, 90% do not know they have it.  2.) Avoid sex during outbreaks; 3.)  Use condoms and 4.) the infected person should take suppressive therapy with an antiviral medication such as acyclovir or valacyclovir.  While all 3 available antiviral medications are likely to work since their mechanisms of action is the same, only valacyclovir has been studied for this purpose and therefore can be considered to be "proven" for this purpose.  Daily suppressive therapy will reduce recurrences, reduce asymptomatic shedding of the virus and reduce transmission.  

in answer to your specific questions:

1.  See above.  The study used valacyclovir 500 mg once daily.  Some health care providers use 1.0 gram daily
2.  Suppressive therapy should be take daily
3.  These drugs are remarkably safe and have few serious side effects unless you have kidney disease.
4.  No.  these drugs have been taken daily for years without causing problems.
5.  No

Hope these comments help.  Additional information about herpes can be obtained by accessing excellent informational web sites such as the one run by the American Social Health Association (disclosure, Dr. Handsfield and I are both on the Board of Directors of ASHA). EWH