Preventing Genital Herpes Transmission

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Preventing Genital Herpes Transmission

Question:

I have genital herpes. I rarely have an outbreak — maybe once a year or less, but of course I have no idea when an outbreak will happen. Should I be on Valtrex to prevent transmission of the disease?

Answer:

In situations such as yours, with very infrequent visible outbreaks of genital herpes, there is no right or wrong answer. Here are some facts that can help you decide whether you want to take Valtrex (valacyclovir), acyclovir or famcyclovir daily.

Antiviral drugs for herpes suppress viral replication and decrease the frequency of outbreaks when taken daily. However, the drugs do not cure the infection. When the antiviral medication is stopped, the virus usually becomes active again.

The Centers for Disease Control and Prevention encourages people with six or more outbreaks per year to consider suppressive therapy for personal comfort and to decrease the risk of transmitting the herpes to a sexual partner. With frequent attacks, viral shedding and the risk of transmission is high, both during and between outbreaks.

For a person with only one or two attacks per year, the occasional outbreaks can be treated intermittently with Valtrex at the first sign of symptoms. However, there is still the risk of transmission between episodes. The amount of viral shedding, and therefore the risk of transmission to a partner, varies from one person to the next. There is no reliable way to measure viral shedding.

If you have one partner and he or she has no history of genital herpes, you can expect to decrease the risk of transmission of the virus by taking valacyclovir 500 mg daily. In addition, male condoms should be used consistently and you should avoid sexual activity during an outbreak.

Howard LeWine, M.D., is chief editor of Internet Publishing at Harvard Health Publications. He is recognized as an outstanding clinician and teacher and is a recipient of the Internal Medicine Teacher of the Year award at Brigham and Women's Hospital. Dr. LeWine continues to practice Internal Medicine; most recently he became a hospitalist after practicing primary care for over 20 years.

Last updated:	July 20, 2009