a few questions.....

Dear Dr. H.

I was raped 20 years ago.  I was tested for all std's. Turned out I had gotten warts on my cervix which where removed by my gyn.  I also came up positive for genital herpes.  To date NEVER had an outbreak.  I am with my husband for 10 years. About a year and half ago my Husband had an outbreak of  genital herpes, for the first time.  His outbreaks are very frequent.  He stated taking valtrex for outbreaks, then started taking valtrex everyday to control his outbreaks. Valtrex was helping until  recently he took a life ins blood test and his AST was 53 normal range 0-33, his ALT 141 normal range 0-45 everything else normal. I have read some stuff on the internet that suggest valtrex can cause this.  Is that true?  If so is there any other medication for him? He has stopped the Valtrex and his having a ton of outbreaks.
OK my next question, if you don't mind is....  How is it that I have transmitted this disease to my Husband when I have never had an outbreak myself??  I am having a very hard time understanding this std and how it works.

Any info you can give me would be greatly appreciated.
Thank you in advance

  

[H. Hunter Handsfield, M.D.]

First, most likely the Valtrex has nothing to do with your husband's abnormal liver function tests.  Even though listed as a theoretical side effect, in fact in the early studies of acyclovir and valacyclovir (valacyclovir/Valtrex is really a version of acyclovir), the frequency of mild liver dysfunction was equally common in people on drug and on placebo.  Further, even healthy people have occasional minor fluctuations in liver tests.  That said, his ALT is fairly high, and I would wonder about other things that could explain it, such as a new case of hepatitis, or pehaps alcohol damage if he is a drinker, or any number of other causes.  If his AST and ALT did not returned to normal after stopping Valtrex, he probably can safely resume it--but he should follow his own health care provider's advice on this.  As to other medications, if his doc is not comfortable resuming valacyclovir, with his doc's approval he could try famciclovir (Famvir) or acyclovir.  There is another drug, foscarnet, that conceivably could be tried--but that is a much more toxic compound; most likely his doc would agree it would be safer to resume one of the standard drugs.

In fact, your case is typical:  the people who transmit genital herpes to others most often have no symptoms; or if they have symptoms, they don't recognize them for what they are.  It is pretty common for herpes to first show up in a monogamous person after many months or years of repeated sex with an infected person.  Even people with no symptoms whatsoever intermittently have active infections (called 'asymptomatic viral shedding'), during which times they can transmit infection to their sex partners.

Having said that, it is also possible your husband acquired his infection from some other partner.  As an STD specialist, of course I see patients all the time in that situation, so you will understand why I bring it up.  But only you can judge whether or not he is likely to have had other sex partners about the time he started having herpes outbreaks.  Also, you don't say how your herpes was diagnosed 20 years ago and how certain your diagnosis is.  If there is any doubt, you should have a blood test for HSV-2.  It might be important--not to play detective about whether you infected your husband or not, but because it will tell whether you are immune (already infected) or might be susceptible to catching your husband's infection.

There are excellent online sources for extensive information about genital herpes.  Try my former health department (www.metrokc.gov/health/apu/std), CDC (www.cdc.gov/std), and the American Social Health Association (www.ashastd.org).

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