Aa
HErpes:Acylovir
Hi Doctor,
I am a male who has protected oral and protected Insertive ( vag and anal) sex with CSW once every 2 or 3 months. I also get tested for STDs every 6 months. So far I am free of all diseases including HSV-1 and 2( as per blood work). I have been doing this for two years and take utmost care in terms of using covers for both oral and regular sex. My problem is after a recent encounter two days back, few hours after one such encounter, I started having burning pain and itching in my groin area which lasted one whole day. Eventhough I know from research, it is unlikely to be genital herpes( too short incubation), it did get me worried a little about the same. I haven't noticed any rash yet, so I am pretty sure it is not prodrome of herpes. I will be a little more reassured if you could confirm the same.
My other main question is, is there a way to minimize my risk of getting herpes further than already what I do in terms of using protection. I was planning on taking Acylovir a twice before and once after( 6-8 hours apart each pill) the each encounter that I will have in future. This is to try and bring my risk down to getting hsv infection to as near Zero as possible. Do you recommend it? Why or why not. I have tried searching extensively regarding this issue in medical articles but have not found any reasonable litrature.
Sorry for posing an academic sort of question, but I would like to be safe completely without absitenence.
Thank you.
I am a male who has protected oral and protected Insertive ( vag and anal) sex with CSW once every 2 or 3 months. I also get tested for STDs every 6 months. So far I am free of all diseases including HSV-1 and 2( as per blood work). I have been doing this for two years and take utmost care in terms of using covers for both oral and regular sex. My problem is after a recent encounter two days back, few hours after one such encounter, I started having burning pain and itching in my groin area which lasted one whole day. Eventhough I know from research, it is unlikely to be genital herpes( too short incubation), it did get me worried a little about the same. I haven't noticed any rash yet, so I am pretty sure it is not prodrome of herpes. I will be a little more reassured if you could confirm the same.
My other main question is, is there a way to minimize my risk of getting herpes further than already what I do in terms of using protection. I was planning on taking Acylovir a twice before and once after( 6-8 hours apart each pill) the each encounter that I will have in future. This is to try and bring my risk down to getting hsv infection to as near Zero as possible. Do you recommend it? Why or why not. I have tried searching extensively regarding this issue in medical articles but have not found any reasonable litrature.
Sorry for posing an academic sort of question, but I would like to be safe completely without absitenence.
Thank you.
MEDICAL PROFESSIONAL
Welcome to the STD forum. These are very reasonable questions. Congratulations, by the way, for taking care to proect yourself from STDs during your commercial sex exposures.
I agree with your own analysis of your symptoms. The brief time from exposure to onset indeed argues against herpes. So does the nature of the discomfort. Prodrome only precedes recurrent herpes, not initial outbreaks. Prodrome results from reactivation of virus in a nerve root -- but it takes a several days for infection to be established in the nervous system. The initial symptoms are purely cutaneous, although certain neurological complications can show up a few days into a severe initial HSV infection -- but not at the outset. So if the pain had been herpetic, it would be only because the infection was taking hold in the skin -- in which case you would have developed lesions, would not have resolved in a day or two, and healing would take a couple of weeks. You can dismiss herpes as a cause -- and any other STD as well. This sort of thing probably is some sort of chemical or allergic reaction, e.g. to lubricant, perfumes, douche product, etc.
Whether acyclovir taken before exposure would prevent HSV has never been studied. There are reasons to believe it would not be effective -- but it might. The explanation is a bit complicated. Acyclovir per se has no activity against HSV. An enzyme called thymedine kinase (TK) degrades acyclovir to a compound that kills the virus. But thymidine kinase is produced only by the virus itself, and only when it replicates after infecting susceptible cells. So until HSV enters a cell and infects it, acyclovir has no impact at all. Thus, the drug may not work as prevention. That said, one can also guess that as soon as HSV enters a cell and starts to replicate, it would immediately produce the TK that activates the drug and, in effect, commit suicide before establishing a permanent infection. And animal research (done many years ago) suggests that pre-loading test animals with anti-HSV drugs can prevent infection by experimental inoculation with HSV. The same mechanisms apply to the other available antiherpetic drugs, valacyclovir and famciclovir.
So it is impossible to say whether treatment before a sexual exposure would reduce the risk of infection. My guess is that it would have at least some benefit, but can't say more than that. These drugs are virtually without side effects, so there probably would be no harm in trying. If you were to give it a try, I would say that taking one dose an hour before sex and a second one a few hours later is all that would be necessary -- but this too is just a guess.
Bottom line: Given the care you are taking, I don't see any need for such treatment; your risk for genital herpes is very low.
I hope this helps. Best wishes-- HHH, MD
I agree with your own analysis of your symptoms. The brief time from exposure to onset indeed argues against herpes. So does the nature of the discomfort. Prodrome only precedes recurrent herpes, not initial outbreaks. Prodrome results from reactivation of virus in a nerve root -- but it takes a several days for infection to be established in the nervous system. The initial symptoms are purely cutaneous, although certain neurological complications can show up a few days into a severe initial HSV infection -- but not at the outset. So if the pain had been herpetic, it would be only because the infection was taking hold in the skin -- in which case you would have developed lesions, would not have resolved in a day or two, and healing would take a couple of weeks. You can dismiss herpes as a cause -- and any other STD as well. This sort of thing probably is some sort of chemical or allergic reaction, e.g. to lubricant, perfumes, douche product, etc.
Whether acyclovir taken before exposure would prevent HSV has never been studied. There are reasons to believe it would not be effective -- but it might. The explanation is a bit complicated. Acyclovir per se has no activity against HSV. An enzyme called thymedine kinase (TK) degrades acyclovir to a compound that kills the virus. But thymidine kinase is produced only by the virus itself, and only when it replicates after infecting susceptible cells. So until HSV enters a cell and infects it, acyclovir has no impact at all. Thus, the drug may not work as prevention. That said, one can also guess that as soon as HSV enters a cell and starts to replicate, it would immediately produce the TK that activates the drug and, in effect, commit suicide before establishing a permanent infection. And animal research (done many years ago) suggests that pre-loading test animals with anti-HSV drugs can prevent infection by experimental inoculation with HSV. The same mechanisms apply to the other available antiherpetic drugs, valacyclovir and famciclovir.
So it is impossible to say whether treatment before a sexual exposure would reduce the risk of infection. My guess is that it would have at least some benefit, but can't say more than that. These drugs are virtually without side effects, so there probably would be no harm in trying. If you were to give it a try, I would say that taking one dose an hour before sex and a second one a few hours later is all that would be necessary -- but this too is just a guess.
Bottom line: Given the care you are taking, I don't see any need for such treatment; your risk for genital herpes is very low.
I hope this helps. Best wishes-- HHH, MD
Thank you very much Doctor. I really appreciate you taking the time to give a complete explanation. I do have a medical background myself, so was able to understand your explanation completely. It does seem very logical. I will try Acylovir as suggested by you and continue to take other precautions before and during each encounter.
Again thanks a lot for the info. It was very informative.
Again thanks a lot for the info. It was very informative.
You are reading content posted in the STDs Forum
Herpes spreads by oral, vaginal and anal sex.
Herpes sores blister, then burst, scab and heal.
STIs are the most common cause of genital sores.
Millions of people are diagnosed with STDs in the U.S. each year.
STDs can't be transmitted by casual contact, like hugging or touching.
Syphilis is an STD that is transmitted by oral, genital and anal sex.
