[Question #1491] HSV2 and Valtrex

45 months ago
Kudos to everyone in ASHA for your great work and thanks for answering my question

Partner 1: Genital Herpes for approx. 8 years with 1-2 symptomatic recurrences per year. On Valtrex for 2 years with 0 symptomatic recurrences per year
Partner2: Never clinically symptomatic; HSV2 IgG status unknown
Exposure: Two instances of unprotected sex (vaginal), 3 and 5 days ago

1. Is there any data to suggest that, if potentially exposed to asymptomatic viral shedding,  a new infection might be prevented if Partner2 took Valtrex (1G PO BID for 10 days)
2. In the absence of any data, is there any contraindication to doing this (for e.g. there is no rationale based on the mechanism of action of Valtrex)
3. Does oral sex in this instance have any risk of transmission?

Thank you

Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
45 months ago
1.  No.  There has been no research done on this issue but from a feasibility point of view, she would have to take high doses of medicine for a week or so to even think about impacting transmission and it would need to have been started right away - like within just a few hours. 
2.  Latency is pretty quick to happen.  If this didn't start 3 days ago when you had contact with this woman, there would likely be no benefit at all doing it now.  There has been a study in mice looking at this and there was some benefit when started immediately.
3.  Oral sex?  Them giving you oral sex, you giving them oral sex?  Your question isn't clear to me.

Terri
---
45 months ago
Follow up:

-Thank you

-Clarification:
Partner 1 (Female): Genital Herpes for approx. 8 years with 1-2 symptomatic recurrences per year. On Valtrex for 2 years with 0 symptomatic recurrences per year
Partner 2 (Male asking question #1491): Never clinically symptomatic; HSV2 IgG status unknown
Exposure between Partners 1 and 2: Two instances of unprotected sex (vaginal). [7 and 5 days ago]

1. There is no human data/guideline that supports the use of Valtrex prophylaxis for Partner 2 to prevent transmission  of HSV2 after unprotected sex (see above) with Partner#1
Am I understanding correctly?
2. If one were to use intuition and the referenced mice study, prophylaxis would have to be initiated within hours of exposure with no guarantee of benefit
Am I understanding correctly?
3. Is there a risk of HSV2 transmission from Partner1 to Partner2 purely via oral sex from Partner1 to Partner2 or from Partner2 to Partner1?

Thanks





Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
45 months ago
1. Yes you are understanding that correctly
2.  correct
3.  I'm pretty confused now.  I am assuming that you are neither partner 1 nor partner 2, you had sex with both of these people, is that correct?  Or are you one of the partners you describe?  If partner 1 only has genital herpes, there is no risk of herpes transmission if she is the giver of oral sex to partner 2.  If partner 2 is the giver of oral sex to partner 1, there is a very small risk of partner 2 acquiring oral HSV 2 from partner 1.

Sorry I'm not fully getting the scenario!

Terri
---