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Valtrex delay development of antibodies after recent exposure?

I have HSV 2 and am very sure I exposed my partner 30 days ago, as he began having symptoms a few days later after I suspected a breakout of mine that was extremely mild and almost went unnoticed.
He started taking some of my Valtrex to relieve some of his painful symptoms (the main one being a burning sensation while urinating and some groin pain) and it went away almost immediately.
the problem is, his symptoms keep disappearring and reoccurring, despite taking a very high amount of Valtrex (1-2 grams twice daily while having symptoms) and even a maintenance dose in between (1 gram daily). This last time, he had prostatitis in addition, which I read can also be a secondary infection with Herpes. He saw his urologist for that and was put on antibiotics which seemed to work. he hasn't been officially diagnosed yet for HSV2 because he never had sores present. The blood test results igM and igG both came back negative a few days ago after one month of exposure. So now his Urologist is saying that he doesn't think it's herpes, but I'm convinced it is, because all his symptoms (and he's been having several variations of them off and on) always respond to the large dose (2 grams twice daily) of Valtrex right away. However, at some point (about a week later), the symptoms return even while still on the Valtrex (1 gram daily). That's what is happening now.
so I have a few questions:
Did the Valtrex delay the development of antibodies and influence the results since it's only been 30 days since exposure? if yes, how long will it take for the antibodies to show up in the blood with Valtrex in his system if he is now taking it consistently? and why do his symptoms keep reoccurring? even with a maintenance dose of 1 gram after his symptoms disappear?. he has been under extreme stress lately for a prolonged period of time now, so could that be driving it?
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239123 tn?1267647614
MEDICAL PROFESSIONAL
I'm glad it's all working out.  Thanks for the thanks about the forum.
Helpful - 0
Avatar universal
thank you again.
you have helped clear up many confusing aspects of this situation.
the problem with the internet searching these days is that you get too much info and then when you're not an expert, you don't know how to put it together in order!
NGU is out of the question, but thank you for mentioning that possibility.
As it turns out, I knew he gets kidney stones, but never put that together as a possibility with all of this, and neither did he in terms of symptoms. painful urination, prostatitis, etc. could have all been from that.
The timing of it all was what caught us off guard.
meanwhile, he is stopping the Valtrex as you recommended.
However, he will most likely get tested again in a few months just to follow up.
thank you again!
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239123 tn?1267647614
MEDICAL PROFESSIONAL
"...are you saying that if he had contracted herpes from being exposed to me, the initial breakout would have happened anyway even with taking the Valtrex to stop it?"  Probably yes.  The symptoms might be milder, but maybe not much.  What is known for sure is that taking valtrex (or other anti-herpes drugs) does not prevent HSV infections unless taken before exposure.  Even a 1 hour delay after exposure does not prevent infection from taking hold.

By the way, prodrome symptoms often occur prior to outbreaks of recurrent herpes, but generally not with the initial infection.  And a herpes prodrome would not likely cause painful urination.

I understand why you thought it best to start treatment rapidly and you obviously meant well.  But the main effect has been to confuse things.  And it probably prolonged his (and your) anxiety about it:  for about a month, you both have believed he had new herpes, when in fact he did not. With prompt medical attention instead of treatment, this probably would have been clear 2-3 weeks ago.  If he had been examined promptly and the doc thought herpes was likely, the drug could be started at that time -- i.e. only a day or so later than what you did, but with intitial diagnostic tests in the works.

This should all work out OK in the end.  But don't forget to discuss the possibility of NGU with his doctor, and the possible need for you to be treated for it.
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Avatar universal
Thank you for the info.
so are you saying that if he had contracted herpes from being exposed to me, the initial breakout would have happened anyway even with taking the Valtrex to stop it?
I thought he was having initial prodromal symptoms, like the burning upon urination, but had not developed sores yet, because we had stopped the cycle by taking 1000 mg of Valtrex as soon as the burning began to get worse.
Helpful - 0
239123 tn?1267647614
MEDICAL PROFESSIONAL
Welcome to the forum.  Thanks for your questions.

The news is good:  The urologis almost certainly is correct.  Your partner doesnt have herpes.  

First, we get lots of questions from men with symptoms like your partner's.  Usually no STD can be found.  Some of his symptoms (painful urination, but not groin pain) are consistent with urethritis (infection in the urethra), which can be caused by herpes.  However, herpetic urethritis usually accompanies obvious external (penile) blisters/sores; it usually doens't occur alone.

Second, the on and off symptoms, and apparent improvement with valacyclovir, argues strongly against herpes.  Herpes symptoms cannot come and go within hours or a day or two; and anti-herpes drugs like valacyclovir do not improve pain so quickly, in any dose.  Their effect takes at least 2-3 days to get started.  Any apparent benefit from individual doses almost certainly is a placebo effect.

Third, having had a diagnosis of prostatitis (more about which below) and with symptoms finally improving on antibiotics, herpes is still less likely.  HSV doesn't cause prostatitis, and herpes symptoms don't improve with antibiotics.

Your partner's HSV blood test results don't mean much at this point. It is true that anti-herpes drugs can delay antibody development, but even without treatment with valacyclovir, 30 days is often too soon for antibodies to appear.  

At this point, my advice is that your partner stop taking any valacyclovir, and that he have another HSV blood test (IgG only, not IgM) about 3-4 months after his symptoms started (2-3 months from now).  I think it will remain negative.

Going back to your partner's prostatitis:  It can be difficult to distinguish prostatitis from nongonococcal urethritis (NGU) -- and if your partner is young (under 30) prostatitis would be less likely than NGU.  If he really has NGU, then you need to be tested for chlamydia and gonorrhea and treated with antibiotics.  This is something for him and you to discuss with the urologist.

Finally, perhaps you now understand that it was a mistake for your partner to start taking valacyclovir.  It doesn't work to prevent herpes when taken after exposure, and it's always best to wait for a definite diagnosis rather than treating symptoms without knowing the cause for sure.

Anyway, as I said above, the news about herpes is good.  But do follow-up on the possibility of NGU that would require you be treated.

I hope this has helped.  Best wishes--  HHH, MD
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