Valtrex prophylaxis?

[Dumbfounded284]

Dear Dr.

Thank you so much for being on this board and taking time to answer so many questions.  I think its awesome.

I was diagnosed with HSV 2 by a culture in August of this year.  I have been with my husband for 17 years and have not been with anyone besides him in that time.  I believe that this was a "gift" from my first husband.  Anyway, my current husband was tested last month and his result was equivocal 1.06. HSV Type 2 specific IgG.

I have only had one outbreak and that was in August when I was diagnosed but because of my husbands test result, I have decided to go on suppression therapy.  I take Valtrex 500mg daily.

I read somewhere, and I can't remember where, that if he were to take Valtrex before we have sex as well as using safer sex practices, that it would further help prevent him from being infected.  It said that there has not been any research done, but that there was a possibility that this would work.  I would really appreciate your opinion on this.

Thanks again for the help.

Cat

[H. Hunter Handsfield, M.D.]

I'll try to help.  But first let me congratulate you for having learned quite a bit about herpes and your efforts to help others.  You have made several accurate and useful comments for others with herpes questions on the herpes community forum.

Second, I have to wonder why you are taking Valtrex.  There are two main indications for such treatment.  The first is to reduce the frequency of recurrent outbreaks, but apparently you have had only a single recognized episode, diagnosed 2-3 months ago.  I advise my patients to wait several months before starting suppressive treatment, to see whether they have recurrent outbreaks and, if they do, their frequency and severity in the absence of treatment.  You might have few or no additional oubreaks and thus no need for treatment to prevent them.

The other reason is to prevent transmission to a partner.  But as you already know, it is likely your husband already is infected -- and once someone has been infected with either HSV type, s/he can't catch the same type again.  Given your husband's low-positive test result, he might not be infected; perhaps you caught your HSV-2 from a partner before your marriage.  But even so, it isn't clear that suppressive therapy is necessary.  If transmission to your husband hasn't occurred after 17 years of unprotected sex, obviously the risk is low.

To your specific question:  It is logical to assume that taking an antiherpetic drug would prevent infection if taken by an exposed partner, but there is no research on this and no data exist to know for sure whether or how well it works.  But for the reasons discussed above, most likely there is no need for this anyway.  I suggest staying away from an unproven kind of treatment that probably isn't necessary.

I hope this helps.  Best wishes--  HHH, MD  

[H. Hunter Handsfield, M.D.]

One more thought:  There is a silver lining if your recent outbreak was the initial one.  In that case, future recurrences are likely to be milder.  You shouldn't be fearful that future episodes would be as bad as that one.  This might influence a future decision by you and your doctor about ongoing suppressive therapy.

[H. Hunter Handsfield, M.D.]

Yes, your husband probably should be tested again.  Although I didn't stress it in my first reply, I was not confident you have been infected for more than 17 years, and now I am even more skeptical.  The first episode of genital herpes is generally the worst, whereas outbreaks in chronically infected persons generally are mild.  So the apparent severity of your recent episode suggests it might have been your initial infection and that your husband the source.

This isn't hard and fast, and some recurrent outbreaks can be severe.  But this has implcations you should consider in asking your husband to have another test.  Are you confident he has had no other partners and could not have acquired HSV-2 quite recently?  I'm not accusing him of infidelity; you know him and your relationship and I do not.  But this would be consistent with both the severity of your symptoms and his low-positive blood test, which might reflect an early positive result in someone who recently acquired HSV-2.  His repeat test might give a clue about this, especially if it shows a substantially stronger result.  Generally I try to avoid getting into the "who had it first?" game, but I want you to be aware of the possible implications of repeat testing.

Thanks for the thanks about the forum.  I hope this additional reply is helpful and not obtrusive.

[Dumbfounded284]

Thank you for your response.  At the time I started taking Valtrex, I was not aware of my husband's status and I wanted to make every effort to protect him until I knew.  My Dr wants me to stop taking Valtrex after 90 days, which is coming up soon.  Now that I know my husband's status and have a better understanding of herpes, I feel better about stopping Valtrex and learning how I will be affected in the future or if I will be affected at all.

I do believe that I contracted herpes many years ago from my ex, and that would mean that I went all of those years with either no symptoms or symptoms that were so mild I didn't realize I had anything at all.  2008 has been a very "interesting" year for me and maybe the stress from everything else brought it on and it won't be a reocurring problem for me.

I won't be trying to give my husband Valtrex to prevent being infected, but I had to ask about it.  There is a lot of information out there, and while some of it is good, I've found that a lot of it is bogus.

Your answers were very helpful to me.  Thanks again for taking the time to answer so many questions.  Its great that you and Dr Hook are so willing to educate people and help us deal with our diagnosis.

Cat

[H. Hunter Handsfield, M.D.]

You're welcome.  Your husband doesn't need another (tie-breaker) test.  For sure he doesn't have it.

Best wishes---  HHH, MD

[Dumbfounded284]

Hi Dr Handsfield,

I just wanted to give you a follow up on my situation.  My husband tested again and came up negative. (<.90 )  Even though I never believed that he has had another partner, it did quiet the voice in the back of my mind.  I didn't realize how much it actually did bother me.

Whether he wants to go for a tie breaker is up to him,  I think I've been on him enough since August. :)

Thanks again for taking the time to answer so many questions.  I have gotten quite an education reading this, and the HSV forums and it has helped me deal with my diagnosis and get on with my life.

Cat

[H. Hunter Handsfield, M.D.]

He can be tested at any time.  If he still has a borderline positive result (under 3.5), perhaps one additional test would be a good idea later.

[Dumbfounded284]

I just have one more question.  If I have exceeded any limit on questions I will pay for it.
Should my husband wait a couple of months before testing again?  His test was done on 9/26/08.  

Thank you again for being so patient and helping me with my questions.

Cat

[Dumbfounded284]

I have no reason to believe that he has had another partner.  I spoke to him about the questions that I have been asking, and he said that he would get tested again if you thought that he should.   I understand that you aren't accusing him of anything, its just the nature of the subject that brings these questions up.  

My first husband, on the other hand did have many other partners and I feel that he is most likely the source.  I keep trying to think of anything that happened in the past that could have been an outbreak that I thought was something else.  About 10 years or so ago I had a UTI that I had a terrible time getting rid of, but thats the only thing I can think of and from what I have read, it really doesn't fit the bill.  

The next steps for me I suppose are to have my husband get tested again, and to stop taking Valtrex to see what happens. Time will tell what I'm dealing with.

I appreciate your response, thanks once again!  It has been very helpful to me.

Cat

[Dumbfounded284]

After giving some thought, (maybe thinking too much :)  ) I would like to ask you another question, if you don't mind.   Would you recommend that my husband get tested again?  If his result comes back actually negative, I would like to do everything I can to keep him negative.  While I only had one outbreak, I sure don't want another one, it was pretty awful, my Dr thought it was shingles.  I do however understand why I should not continue with suppressive therapy at this time, it makes sense and I'm fine with it.

Maybe I'm making too much out of it, but I am really trying to learn everything I can and keep things in perspective, but now that I know I have herpes, I would hate to not do everything I can to protect him from getting herpes if he is truly negative because of the potential it has to make him miserable.

Thanks again for your help,

Cat