[Question #6995] Herpes transmission risk vs. valacyclovir side effects

10 months ago

have never officially been diagnosed with genital herpes on account of a lesion test coming back negative, but I had three recurring genital outbreaks within the span of about a year in 2008-2009, and my blood test came back positive for HSV-1.  I have had no genital recurrences since 2009, though I average about 1-2 oral outbreaks per year.  I am now in a committed relationship, and to minimize risk of transmission to my boyfriend, we decided, in consultation with my doctor, that I should take 500mg of valacyclovir daily.  Since starting the valacyclovir, I have been experiencing uncomfortable intestinal issues (bloating, flatulence, constipation, diarrhea, an urgency to empty my bowels but an inability to do so) that has disrupted my sleep, made me decide to abstain from alcohol consumption (on account of it seemingly worsening the intestinal issues), and generally made my life less pleasant.  I would like to go off the valacyclovir or cut back to taking it only on days when I expect to be intimate with my boyfriend, but I don’t want to expose him to considerably greater risk of transmission.  What are my options?  If I go off the valacyclovir, how much greater likelihood does my boyfriend have of becoming infected?  Can I cut back to taking it only on days when we expect to be intimate, or does non-daily use of valacyclovir invalidate its effects as a herpes suppressant?  Thank you in advance for your response.

P.S. My boyfriend and I use condoms/dental dams religiously for both oral sex and intercourse.


Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
10 months ago
I am going to assume that your partner tests negative for HSV 1, is that correct?  I ask because about half the population has HSV 1 infection and if you are both infected, this is a non-issue.
If you are concerned that the IgG test missed an HSV 2 infection, you could obtain the herpes western blot which picks up 8% more HSV 2 than the IgG test.
If your concern is HSV 1, and your partner is negative, the greater risk is him acquiring your oral infection, which could be through kissing or receiving oral sex.  If you have HSV 1 genitally, then the risk is very very low in transmission through intercourse.  It must be taken five days in advance of sexual contact before it is fully effective.  Taking it only the same day you want to have sex is not effective for the reduction of transmission. 
If you are using condoms regularly, you are already going a long way to reducing transmission.  Is your partner worried about contracting HSV 1 from you, assuming he has tested negative?  Or is this your worry?

Terri
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10 months ago
Terri,

Thank you for your quick response.  My boyfriend has also taken a blood test and tested positive for HSV-1.  However, I got my first cold sore as a child, so I'm quite sure I had oral HSV before acquiring it genitally, and I'm afraid the same could happen to him, and he now shares that concern, as well.  From everything I've read, my genital experience seems more consistent with HSV-1 than HSV-2 (outbreaks within first year and then none for a decade except for oral), so I'm not convinced I "missed" an HSV-2 diagnosis, though I'd happily take the herpes western blot to rule that possibility out.  
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
9 months ago
So I think I'm missing something here.  How exactly were you diagnosed with HSV 1 genital infection?  You mention that you had genital outbreaks, but were any of them swab test positive? And if yes, for what type?  You only mention a positive blood antibody test.  Sorry, I'm just seeking some clarification here.

Terri
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9 months ago
The first time I had a genital outbreak, my regular doctor wasn't available, so I saw a different doctor, who prescribed me some medicine, and the lesions seemed to clear up quite quickly.  There was no mention of herpes.  Then, a few months later, I had another outbreak, and I saw my regular doctor, and she diagnosed it on the basis of seeing it (and from my relaying that it had happened once before).  I believe she said the lesions were too far healed to warrant a swab test at that time but that I should get swabbed if it recurred again.  I believe she prescribed me Valacyclovir or Acyclovir, which didn't do much to heal the lesions but which she said I could take again at the first signs of onset. When the genital outbreak recurred a third time several months later, I immediately started the medication but still developed the same lesions.  I got a swab test, but it came back negative.  The doctor just told me that the swab tests often gave false negatives, but that she was confident I had genital herpes.  I have (thankfully) never had another genital recurrence, so I've never had the opportunity to get another swab test.  The blood test only showed that I have HSV-1, which I assume it would have shown before I ever had genital outbreaks, as I mentioned that I got my first cold sore as a kid.  I had been recently sexually active (both oral sex and intercourse) at the time of my first genital outbreak, so I assumed I had acquired an STD from my new partner, but when I confronted him about it, he claimed to have no knowledge of having any STDs  himself.  I never made him get tested, as we broke up before the recurrences began, and I didn't know after my first doctor visit to suspect herpes.  Also, although I am quite certain I had a cold sore as a child (as it is documented in a school yearbook photo), I don't recall having any cold sore recurrences until after I started having genital outbreaks.  Then, once the genital outbreaks stopped, the oral outbreaks began.  
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
9 months ago
well, this is a very interesting situation.  We don't know with 100% certainty that you have genital herpes, do we?  It sounds like maybe you do, but it is so unusual to get HSV 1 genitally after having a history of cold sores.  And you had a negative swab test during an outbreak.  But then we aren't actually positive that you had HSV 1 orally as a child, though you think so.  But no recent history of cold sores until you got past the genital outbreaks. That's also a little odd.  Because it is so unusual to get HSV 1 in a new location after having a well established oral infection.  The chance that this would happen to you AND him is exceedingly slim.  What are you the oral outbreaks like?

Terri
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9 months ago
For the oral outbreaks, I typically begin to feel a sort of tingling/swelling sensation before I can actually see anything.  Then, I often can see a really small seed-like bump on my lip (I think they've always appeared exclusively on my lower lip), and it often seems as though my whole lip is swollen as if I were using a lip plumper.  Then, the seed develops into one or more small, tightly-clustered  blisters.  Then the blisters begin to pop and crack, and when they crack, they pus.  The pus then dries, and when I eat or talk too aggressively, they pop open again and pus some more.  This cracking/pussing cycle usually goes on for several days up to a week before the cold sore finally heals.  
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
9 months ago
well, that certainly sounds like oral herpes to me. 
I still believe that it is extremely unlikely that he would acquire HSV 1 at a new location on his body.  We know it is possible, but very rare.

Terri
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