Valtrex?

[china1111967]

Hi Doc,

Does taking Valtrex after exposure to HSV-II reduce the probability of seroconversion?  If so, how successfully?

If it does, I would assume that the longer you take to commence treatment the lower the positive effect.  How long after exposure do most people seroconvert (assuming no lesions or eruptions)?

Many thanks

[H. Hunter Handsfield, M.D.]

In animal experiments, HSV cannot be prevented once the virus has been inoculated into the skin or a mucous membrane.  Specifically, if an antiherpetic drug like acyclovir etc is started more than an hour after exposure, there is no effect in preventing infection.

There are no data in humans.  But unless you took valacyclovir (Valtrex) before the exposure to HSV-2, or within an hour after sex with an infected person, most likely it would have no effect in preventing infection.  Therefore, it would not prevent seroconversion (which is simply a measure that infection occurred).  Whether such treatment might delay seroconversion has not been studied, but most likely not.

The time to seroconversion has been discussed innumerable times on this forum.  With the most commonly used commercial tests for HSV-2 antibody, the HerpeSelect test (Focus Technologies) and the Captia HSV-2 test (Trinity Biotech), most newly infected people have positive tests by 6 weeks, but in 20-30% of cases it takes 3 months or longer.

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

[china1111967]

Thanks Doc, it does.
Best regards

[china1111967]

Dr H,

I went off the Valtrex and about 10 to 14 days later (last night) I noticed one pimple like bump at the site of a hair follicle and one small pus filled area (but not at the site of a hir follicle), both at the base of my penis shaft near the juncture with the scrotum.

I have posted a message in the community forum regarding these current developments sbut would also very much value your thoughts ...

(Stupidly) I pulled the hair follicle out and also squeezed the pus filled area. That was about 18hrs ago.  The bumps are still present, but are not notably painful at all.

My Questions:
- i realise that the lesion with the hair follicle could be an infected hair follicle, but 1) its location, 2) the existence and proximty of what seemed to be a second but flat but purulent area in the absence of a hair made me think that there is a good chance that the lesions are herpetic.  Is this logic correct?
- If it is HSV, if after the lesions have burst, should the lumps remain and should the site be painful?

I am currently travelling for business and am in a country where such matters are frowned upon and the only accessible doctors are those engaged by or connected with my employer - having the lesions examined until I return home is unfortunately currently out of the question.

I will consult a medical practitoner upon return to my base country, but would welcome any thoughts and observations that you may have for me.

Kind regards

[H. Hunter Handsfield, M.D.]

This doesn't sound like herpes, both by your description of the lesion (presence of a hair, pus, etc) and the location (herpes rarely occurs in the groin).

[china1111967]

Doc,

The lesions aren't in the groin, but rather at the base of the shaft of my penis, where it meets the scrotum. Does this make a difference?

Does the fact that the bumps/pimples/lesions are still there after being effectively "popped" support that they aren't herpetic?

Many thanks

[H. Hunter Handsfield, M.D.]

Makes no difference.  Doesn't sound like herpes.

Time to end this thread.  No more comments, please.

[radian]

I disagree. If you take it within an hour or so of exposure there is some degree of chance it will stop a latent infection. There are animal studies to back this up

[H. Hunter Handsfield, M.D.]

There is no disagreement.  I was alluding to the same animal studies in my initial response ("There are no data in humans.  But unless you took valacyclovir (Valtrex) before the exposure to HSV-2, or within an hour after sex with an infected person, most likely it would have no effect in preventing infection.")  That animal model research also showed that delaying more than an hour did not prevent infection, so that there is no practical value in real-world prevention in humans in taking antiviral drugs after exposure.  (How many people know they were exposed to herpes within an hour after sex with a new partner, and also have access to acyclovir or valacyclovir so quickly?)  And once infection is established, there is no reason to suppose seroconversion would be delayed, which was one of china's main questions.