[Question #7758] To not spreading herpes, should I take 800mg Valacyclovir or 400mg Acyclorvir?

13 days ago
I have hsv1/2 since 2002 and my GF does not have it. She is very concerned of catching it. We mostly use condoms but don't always. I used to take 800mg Valacyclovir daily prescribed by a doctor at a STD clinic. But the last few years I switched to take 400 mg Acyclovir daily based on strong recommendation by my family doctor.  Since the two doctors strongly disagreed with each other, in your opinion, which is better between 800mg Valacyclovir daily, 400mg Acyclovir twice a day, or 400mg Acyclovir once a day? The STD doc thinks 800mg Val is the way to go, my doc thinks 400mg Acyc is good enough as I haven't had noticeable outbreak and if I really need something stronger some day such as getting herpes in my eyes, I will have some additional weapons. I found little research on 400mg Acyc daily for prevention of spreading. If you can give your opinion and provide some probability/data/research would be great! 
Also, do you know of any long term effects on taking them? I found research saying they may cause kidney problems. But there seems to be no long term study (10 years+) on any of this. Much appreciated!!
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
12 days ago
First of all, Valtrex (valacyclovir) doesn't come in 800 mg, it comes in 500 mg.  So the choice for best risk reduction is 400 mg of acyclovir twice a day (once a day won't do it) or 500 mg of valacyclovir once a day.  Both work well for the reduction of transmission, though only Valtrex has been officially studied.  I would disagree strongly with your family doc who says 400 once a day is enough.  It might be enough to reduce outbreaks, but not enough for suppression to reduce transmission. 

We have long-term data on suppression and it is safe.  We really don't see a problem with kidney function, over what the normal population has.  I think the issue is that if someone has existing kidney issues, the dose should be calculated, based on kidney lab values and may be reduced in the person with impaired kidney function. There is no requirement or suggestion that someone should do routine lab tests during, before or after beginning suppression.