[Question #4000] HSV-2 and valtrex

32 months ago
I was diagnosed with hsv-2 almost 2 years ago. I had a horrible first ob and my dr put me on valtrex. She encouraged me to take it as suppressive therapy bc I was having a terrible time dealing with it both emotionally and physically. So I’ve been taking it for almost 2 years, but I have continued to get regular outbreaks (at least once a month) even on the valtrex. I’ve been nervous to go off of it bc I was afraid it would be way worse off of it than on. Anyway, about 5 weeks ago I stopped taking it, I’m getting bad outbreaks as I expected.  My questions for you are:

- Was my body developing antibodies while on the valtrex? I’ve read your responses to other people saying that the valtrex does prevent your body from developing them, but I assumed that meant with the absence of symptoms.  If I’ve still been getting outbreaks, then has my body still been trying to fight the Infection? Now that I’m off of the valtrex will my body learn to fight it on its own or is it too late for that? I guess my major concern is if I’m doomed to a lifetime of terrible outbreaks bc I took valtrex for the first 2 years after infection. Will this get better with time or does me still having all these outbreaks after 2 years mean that I’m one of those people who are going to suffer forever? 

-  It seems from other answers to other posts that you support suppressive therapy, do you feel that’s the right path or do you encourage people to let their body adjust on its own? Should I stay off of it for awhile to see how my body does on its own? I’d rather suffer through it now if it means it will get better in the long run by staying off of the valtrex.

-  I’ve read about pritelivir, do you have any insight on how it’s doing in trials and when it could be available?

It’s hard to figure out what to do....

Thank you in advance!
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
32 months ago
I do think that after two years, you have probably made antibody, even on suppressive therapy though it is difficult to say.  You may wish to try treating outbreaks as they come up now for a few months - I like 2 grams, then 12 hours later 2 grams again and that's it.  The issue with antibody development is when Valtrex is taken right after first infecton, in terms of antibody development.  And we don't honestly know how important antibody development is when on Valtrex. 
I do support suppressive therapy yes.  But let's see how it goes if you are off medicine, except for treating outbreaks, for now. 
Tell me about your outbreaks on therapy - what do they look like and have you had them swab tested recently?

Terri
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32 months ago
Does that mean that I am doomed to a lifetime of ob’s bc I got bad advice when I first got it and you just don’t want to say it? I asked this question of my dr and she said valtrex doesn’t affect antibody development and I emailed a research guy and he said the same thing. I even called your person to person service and they said it doesn’t affect it either. How is anyone supposed to know to try not to take the valtrex when they are first diagnosed when professionals don’t even know? So frustrating. 

My outbreaks vary a lot. Sometimes they are on my anus (never had anal sex, but that’s my herpes favorite place to pop up) and sometimes they are like little papercuts right inside my vagina. When I stopped the valtrex it took about 3 weeks to get an outbreak, but it was worse than my most recent ob’s and def lasted longer.

This is another thing I have a hard time finding info on: the numbers always say for people between the ages of 14-59 or whatever it is. How can you find info on smaller age groups? Like for 40-50 yo female/males who are single? Or even by race: single, black or white women/men over the age of 35. It’s hard to find more specific statistics.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
32 months ago
How you were treated when you were first infected has nothing to do with your outbreak pattern now.  Take that off your list of worries.  I don't know what you are talking about with a person to person service but they are incorrect about antivirals impacting antibody development.  The University of Washington who performs the most specialized herpes antibody test, the western blot, definitely says that if people have taken antiviral medicine it can prolong the time to which antibody is made.  I don't know who the research guy is, but this may not be widely known.  I had someone who started Valtrex suppression with first infection and had been on it 9 months and had not yet made antibody.  She needs to document seroconverion so I pulled her off medicine and she became antibody positive within a month. 
But again, I don't think your use of suppression is having any impact on your outbreak pattern. 
The papercuts are you experiencing inside the vagina may well not be herpes - it might be good that have that confirmed by a swab test. 
We do have data on specific races and ages and gender.  If you describe your situation, I can let you know the percentage infected, probably

Terri
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32 months ago
The paper cut outbreaks are similar to the first symptoms I ever had. I was diagnosed back then with a swab, then a blood test about a month later said it was type 2.  I haven’t gotten a swab done after my first diagnosis, but I will the next time I get those symptoms to confirm that’s what it is.

You did make me feel better with saying how I was treated when I was first diagnosed doesn’t affect my outbreaks now. Just to confirm: the antivirals slow the development of antibodies, but once you go off of them, your body will start producing them at the same rate again?  And since I was getting outbreaks while on the meds, my body was probably still producing them over the past 2 years?

 I’m going to stay off the meds for now while I’m not dating anyone and see how it goes, I appreciate that advice.

As for the person to person service, it’s a resource listed on the university of Washington’s website. It’s also through the ASHA. I would think they would/should know facts when charging $20 for a 20 min call. The guy was very nice and understanding and I’m glad I called, but he clearly wasn’t as informed as I thought he was. 

I am a single, white 39 year old female. I tend to date black men of about the same age. I would appreciate you giving the stats for both of these categories.

I know this is my last follow up, so thank you for the information. This has been a really tough road, don’t mean to come off as angry.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
32 months ago
Interesting.  It must be through ASHA.  I'll be sure those folks have the correct information. 
Yes, your body will be making antibody (or more antibody) when you come off the medication.
The paper cut like things are suspicious to me - when you are off the meds and you have them, I would suggest getting them swab tested to see if that's what they are for sure.  It would just be so unusual for you to continue to have no relief from antivirals. 
I know this can be a real challenge, a little anger would be pretty normal.

Terri
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