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Valtrex for asymptomatic HSV2?
I recently tested positive for HSV2 using both the HerpeSelect IGG and immune assay tests. From speaking to past partners, it is clear that I was infected at least 18 months ago, though I have had no symptoms.
My GP does not believe that my situation calls for Valtrex or other suppressive drugs because I am asymptomatic. My understanding was that those drugs reduce viral shedding, not symptoms, and that the ethical thing to do would be to take them, in addition to using safe sex, to protect future partners.
Can you support or refute his position?
My GP does not believe that my situation calls for Valtrex or other suppressive drugs because I am asymptomatic. My understanding was that those drugs reduce viral shedding, not symptoms, and that the ethical thing to do would be to take them, in addition to using safe sex, to protect future partners.
Can you support or refute his position?
MEDICAL PROFESSIONAL
First to your second question and your doctor's interpretation of your blood test results: A positive blood test for HSV-2 means a person is infected. (If someone is exposed--that is, has sex with an HSV-2 infected person--s/he may or not be infected. If not infected, the blood test remains negative. If infected, it becomes positive.) The blood test is for antibody, i.e. the immune system's response to an HSV-2 infection; it does not directly detect the virus. However, everybody with antibody also has the virus, and everybody with antibody periodically sheds the virus and can potentially transmit the infection. However, there is no way to predict the actual likelihood of asymptomatic shedding or of transmission for any particular infected person.
The decision to take or not take antiviral therapy (or from a provider's perspective, to prescribe it or not) is a judgment call; there are no firm rules. Your knowledge of what treatment does is half right: it both reduces the frequency of symptomatic outbreaks and reduces the frequency of asymptomatic shedding of the virus. It reduces the potential for transmission to a sex partner. But the protection is not absolute in either case; breakthrough shedding and breakthrough symptomatic outbreaks sometimes occur.
Bottom line? No definitive answers. In my opinion, most HSV-2 infected single persons "out there" (dating and having sex with new partners from time to time) probably would do well to take suppressive therapy. But that does not negate the responsibility to inform partners; antiviral therapy is good, but not perfect. However, the combination of condoms plus antiviral therapy is highly effective in protecting partners.
I hope this helps. Best wishes-- HHH, MD
The decision to take or not take antiviral therapy (or from a provider's perspective, to prescribe it or not) is a judgment call; there are no firm rules. Your knowledge of what treatment does is half right: it both reduces the frequency of symptomatic outbreaks and reduces the frequency of asymptomatic shedding of the virus. It reduces the potential for transmission to a sex partner. But the protection is not absolute in either case; breakthrough shedding and breakthrough symptomatic outbreaks sometimes occur.
Bottom line? No definitive answers. In my opinion, most HSV-2 infected single persons "out there" (dating and having sex with new partners from time to time) probably would do well to take suppressive therapy. But that does not negate the responsibility to inform partners; antiviral therapy is good, but not perfect. However, the combination of condoms plus antiviral therapy is highly effective in protecting partners.
I hope this helps. Best wishes-- HHH, MD
Just to follow up, I saw my GP today and he was swayed by the comments here, particularly Dr. Handsfield, and he did prescribe Valtrex. Thanks so much for your help.
Thanks for all of the info. I am going to print this out and give it to my GP and hopefully he will agree. My top priority is doing everything I can to prevent transmission.
Grace, I do not currently have a regular partner, and my previous three partners (going back 8+ years) have tested negative recently (thank God!). I had tested negative a few times during those 8 years, so this is a recent and strange occurrence. I would think it was a false positive, but it was confirmed with the HerpeSelect immune assay in addition to the original IgG test. So maybe I'm one of those "it is theoretically possible, but has never been documented" cases of getting it from something other than sex. In any event, I just need to get on with things.
Grace, I do not currently have a regular partner, and my previous three partners (going back 8+ years) have tested negative recently (thank God!). I had tested negative a few times during those 8 years, so this is a recent and strange occurrence. I would think it was a false positive, but it was confirmed with the HerpeSelect immune assay in addition to the original IgG test. So maybe I'm one of those "it is theoretically possible, but has never been documented" cases of getting it from something other than sex. In any event, I just need to get on with things.
Encourage your doctor to check out the article from the NEJM jan 1, 2004 on valtrex and reduction in transmission of hsv2. Hopefully that convinces him that it's more than just about the number of ob's if you are in a relationship where one partner is hsv2+ and the other isn't. there is also some terrific info on hsv2 and valtrex on the valtrex website under the info for medical professionals section ( it's even good for folks who aren't in healthcare ).
Do you have a regular partner and if so have they been tested yet?
grace
Do you have a regular partner and if so have they been tested yet?
grace
MEDICAL PROFESSIONAL
You could also contact the American Social Health Association, which might have literature or other specific resources for providers interested in learning more about genital herpes management. Go to www.ashastd.org and follow link's to the Herpes Resource Center. (Full disclosure: I am on ASHA's board of directors and Dr. Hook is president of the board.)
MEDICAL PROFESSIONAL
There are lots of infections like that, i.e. the immune system bringing the intial infection to partial control but not total eradication, with the potential for future breakthroughs. In addition to HSV, it's the same with chickenpox (which therefore can lead to shingles 50 years later), many cases of hepatitis B (those who become carriers), and other viruses; and this is exactly how syphilis and tuberculosis behave in the absence of antibiotic therapy.
In terms of making the case with your GP, I guess the best I can say is to print out my previous reply and show it to him. You can also refer him to the scientific literature, which shows that HSV-2 transmission occurs mostly from people with asymptomatic infections, not those with symptomatic outbreaks. These days most docs aren't so put off by patients taking active roles in their own health care decisions.
In terms of making the case with your GP, I guess the best I can say is to print out my previous reply and show it to him. You can also refer him to the scientific literature, which shows that HSV-2 transmission occurs mostly from people with asymptomatic infections, not those with symptomatic outbreaks. These days most docs aren't so put off by patients taking active roles in their own health care decisions.
Thanks, your answers did help.
Disclosure and condoms are obviously required. However, given that suppressive therapy can further reduce the risk to partners, do you have any advice for communicating that to my GP and overcoming his reluctance to prescribe based on my asymptomatic state? I hate to be one of those difficult patients who thinks he knows better than his doctor, but I also hate the idea of not doing everything I can to reduce the risk to future partners.
Also, if you don't mind a brief followup on the testing/virus question, if everyone who has antibodies has the virus, does that mean that it is impossible for the immune system to successfully fight off the virus during initial exposure? Because if that were possible, wouldn't that lead to antibodies but no virus?
Disclosure and condoms are obviously required. However, given that suppressive therapy can further reduce the risk to partners, do you have any advice for communicating that to my GP and overcoming his reluctance to prescribe based on my asymptomatic state? I hate to be one of those difficult patients who thinks he knows better than his doctor, but I also hate the idea of not doing everything I can to reduce the risk to future partners.
Also, if you don't mind a brief followup on the testing/virus question, if everyone who has antibodies has the virus, does that mean that it is impossible for the immune system to successfully fight off the virus during initial exposure? Because if that were possible, wouldn't that lead to antibodies but no virus?
Oops, one more aspect of the question: my GP believes that my positive tests in IGG and imune assay indicate only that I have been exposed to hsv2, rather than a positive test for the presence of the virus. My understanding is that the IGG test shows antibodies to the virus, which could exist if one were exposed but did not contract hsv2, but that the immune assay test indicates the presence of the actual virus. Again, can you clarify this?
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