still confused

[tes77]

I originally posted my questions on April 18 under "confused about transmission." Not sure if I'm supposed to post another question or what, but here goes. I recently went to my first herpes support group and the suggestion was to only take Valtrex when I get outbreaks if I'm not involved with anyone. However, the outbreak that I just had, which I thought was my first, was so bad (lasted 4 weeks, painful urination, hard to sit and lie down, sores on both sides, just felt crappy) that I'm afraid to not take it every day as I thought Valtrex lessens the amount of outbreaks and severity. Am I right? Do you think it's wise to take it every day? I can't imagine going through that pain again. Also, I heard that subsequent outbreaks are not supposed to be as severe as the primary. But, now I'm not so sure this was my primary first infection because my partner (who I've been having unprotected sex with for many months and 6 days before my outbreak on April 3) says that when he called his MD for test results, he was told "everything was ok." I asked him what his HSV-1 and HSV-2 levels were and he said that the MD did not go into specifics. I would have thought he would have tested positive for HSV-1 since he told me he's had cold sores before. He also didn't get the results until over 2 weeks. Is this typical? Now I'm thinking that I must have gotten it from the person I had unprotected vaginal penetration with for approx. 2 min. in January. However, I had no symptoms until after having sex with my partner in April. Not sure what to do. I am no longer with my current partner, so I guess I don't necessarily have to take Valtrex every day, but I'd like to avoid outbreaks if possible. Any advice?

[H. Hunter Handsfield, M.D.]

The decision to take suppressive therapy, or not, is a very personalized one and needs to be made with the advice of a personal health care provider, not a distant online source.  So I'm not going to try to make that decision for you.  If you take Valtrex to prevent outbreaks or to help prevent transmission, you MUST take it once a day; taking it irregularly won't work and will increase the chance that your virus will become resistant to the drug.

I also cannot solve the question of when and where you became infected and will not try.  It's often not possible to sort it out, and generally it doesn't matter.

Find a herpes-knowledgeable heatlh care provider and follow his or her advice.  Also consider getting into a dialog on the MedHelp herpes community forum, where the moderator is a true expert on herpes management, including the social aspects.  Finally, you can call the American Social Health Association's Herpes Resource Center for personalized telephone counseling.  See the website at www.ashastd.org.  (Full disclosure:  Dr. Hook and I are on ASHA's Board of Directors.)

Finally, please note the MedHelp rule about a maximum of 2 questions every 6 months in the moderated forums.

Best wishes---  HHH, MD