[Question #2276] Valtrex for suppressive therapy- Questions

44 months ago

Hello again,

Before I begin, I would like to thank you. Thank you for recognizing that my thoughts were becoming obsessive and unhealthy. Admittedly, I had begun to spiral down a dangerous path of consumption with herpes thoughts. I assure you-I have sought help and I am doing much much better. That being said, I do have a valid question in regards to Valtrex and suppressive therapy. I hope you will answer my question, despite my anxious history, because I am seeking credible and reliable information in regards to this medication.

I have been taking Valtrex for suppressive therapy for my cold sores since late March/early April. I typically get 2-4 cold sores a year give or take. I decided to try it and I have only had one acute sore inside my nose that cleared up within a day or so. In any case, I would rather go back to taking the Valtrex during flare ups rather than every day for the rest of my life, but I have a few questions about that.

1-If I stop taking the Valtrex, does that make me more contagious, or is Valtrex solely used to reduce recurrences?

2-Will stopping the Valtrex make me more susceptible to an outbreak in the upcoming days/weeks after I stop? I am unsure if stopping the medication will mean my immune system will be less likely to control the virus for a while until my system goes back to “normal”.

3-I have clarified my boyfriend's cold sore status more clearly since we spoke before. Though he has not been tested for HSV1, he said he knows cold sores are herpes and said he gets them on his lip perhaps once every other year or so usually during the winter. He said he started getting them when he was pubescent, and they last about a week. I know from our talk that it is incredibly unlikely I could infect him with my cold sores genitally by performing oral sex on him. However, I guess I worry that if I stop taking the Valtrex, I will shed the virus more? I guess I have been using the medication as a psychological crutch and I worry that I am more likely to infect him while off the medication. Do couples who both get cold sores need to worry about asymptomatic shedding? What if I perform oral sex on him without a cold sore, but one appears the next day?

4-In your opinion, given the information I have presented, do you see a need for me to stay on the Valtrex daily? I think it is silly to assume at this point that my boyfriend does not have cold sores, since he has told me more than once that he does, but would you recommend I continue taking the medication to protect him further since he has not, in fact, had a blood test?

As always, I appreciate your expertise and I assure you that this post will be limited to rational and logical questions and will not stem from a place of anxiety.

Terri Warren, RN, Nurse Practitioner

44 months ago

1. Yes, stopping Valtrex will make you more contagious - you will shed virus more and probably have more recurrences while not taking medicine - and that makes you more contagious.
2. Yes, It has nothing to do with your immune system functioning - it's just that the medicine is no longer reducing viral replication
3. I would say that it is extremely unlikely - I have seen it once in 33 years in my practice - where someone has cold sores and then gets genital HSV 1.
4. That's your call - I don't think there is really a medical reason, but as I said, I have seen it happen once in 33 years of practice - but that has to be a call you and your partner make. most people would be satisfied with that very low level of risk - others might not be. I would be - you or he might not be.

You are doing just fine - completely reasonable questions.

Terri
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44 months ago

Thank you so much. So if I understand you correctly then-

1. I am extremely unlikely to infect my partner with HSV1 on the genitals regardless if I take the medication or not. Meaning, even if I stop taking Valtrex, the chances of infecting him do NOT increase, it just means I am less likely to have outbreaks.

2. A symptomatic shedding should not be a concern in my relationship, again, because we both have cold sores.

3. Because of these reasons, I should not feel guilty for stopping my medication because I am not putting my partner at any higher risk without it.

Terri Warren, RN, Nurse Practitioner

44 months ago

1. That is correct.
2. exactly!
3. correct

Terri
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44 months ago

Great, thanks!

Just as a follow up- I asked my boyfriend previously if he was okay with me performing oral sex on him and he said yes. He is aware of my concerns and has been patient with me until I feel comfortable. That being said, I feel like I've exhausted the cold sore "talk" with him and would love to put my worries aside without making a spectacle of my concerns yet again; however, I will if necessary.

1) my boyfriend knows I take mediation for my cold sores, but not that I am taking it daily. In your progressional opinion, do you believe that I am morally obligated to discuss going off the medication with him? Or do you think I can make this personal choice on my own since, as discussed, I am not putting him at risk for contracting HSV 1 genitally? ( I realize this is more of an ethical question rather than medical and that ulimately it's up to me to make that call; however, as a medical professional if you feel comfortable that my boyfriend's health won't be compromised in any way once I'm off Valtrex and that I wouldn't be robbing him of making his own decision when it comes to risk, that would be extremely comforting.

2) As my cold sores are often unpredictable, for peace of mind, would you say that even if I performed oral sex on my boyfriend and developed a cold sore hours later/the next day that the chances of infection are still just as low?

3) Last question unrelated to Valtrex - I saw a dermatologist for recurrent dermatitis (arms, legs, chest) and she is checking for eczema. I've read that those with eczema may contract eczema herpeticum if the rash comes into contact with HSV 1. My question is, if it does come back that my rash is due to eczema, do I need to be extra careful when my boyfriend or I I has a cold sore? I know auto inoculation of HSV1 to a new location on your body does not occur after a long standing infection; however, I'm wondering if the same applies to this case. If my boyfriend kisses my body (with or without symptoms) or if I touch an affected area accidentally after I touch my own cold sore, can I contract eczema herpeticum or am I still protected from auto inoculation/ infection because of my antibodies?

Thank you for your diligence, understanding, and most of all your patience. I am feeling much more assured and educated and as such, much more rational and healthy. You and the other doctors are truly a blessing helping us out via the forum. Enjoy your summer!

Terri Warren, RN, Nurse Practitioner

44 months ago

I don't think you need to tell him about coming off the medication, no. If you develop a cold sore after giving him oral sex, the chances are extremely low, as we have discussed at length, that you would infect him with HSV 1 genitally.
I think the chances of your acquiring eczema herpeticum are very low indeed - I am less clear exactly how this happens, whether aysmptomatic shedding is part of this picture or not. Perhaps your dermatologist would be a better source of information on this one.

You are most welcome - glad the board has been helpful to you

Terri
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