My boyfriend has genital herpes.  He cannot obtain an orgasm using a condom, which he has always used during sex.  He wants to stop using a condom.

As a woman, what is my risk (%) of transmission of genital herpes to me if he does not use a condom during sex BUT takes Valtrex 500mg. only 4 times a week.  He used to take Valtrex 500mg. daily but says that the side effect him physically too much.  So, what is the reduction in transmission to me?

Do you know if your boyfriend has HSV 1 or HSV 2 genital infection?  That is an important distinction as HSV 2 is quite a lot more transmissible genitally than HSV 1.

Cutting the medicine to four times a week, I am assuming every other day, is not sufficient to reduce transmission to you.  And if he also doesn't use condoms, then the risk goes up again.

With no condom and inadequate antiviral therapy, the risk to you is probably somewhere around 10% per year, but if the sexual relationship is new (without condoms) it could certainly be higher. 

What side effects is he having? 

Terri

How is it possible for me to have only a 10% possibility of getting genital herpes with inadequate (4xwk.) antiviral therapy and no condom usage, as you stated below, but an almost 50% possibility of getting genital herpes with adequate (daily) antiviral therapy and, (I PRESUME, no condom usage) -  which you stated in response to my earlier Question #7783.  This doesn't make sense to me.

Also  to answer your question, taking daily valtrex caused him to have constant headaches and bad, daily indigestion.  Would 400mg. daily of acyclovir cause the same side effects?

If I, not having genital herpes, took an antiviral of 400mg. or 500mg. daily, would this give me any protection against acquiring genital herpes from my partner?

Thank you very much, Ms.Warren.  I greatly appreciate your clarifications.

I think you've posted two different threads here. 

Antiviral medicine reduces transmission by about 50% (so from an average of 10% to an average of about 5%) - if I stated something else that was confusing, I'm sorry.  I'll go back and check it. 

If he is having unpleasant side effects from Valtrex, he is likely to have the same side effects from acyclovir but he could certainly try it.

You taking acyclovir or valacyclovir would not reduce transmission, but it is a common question that people ask for sure.

Terri

Given that we don't know anything about the efficacy of taking Valtrex 4 times a week, I would have to say that it is not effective and place it in the "no meds" category.  It might be somewhat helpful, but it certainly wouldn't be very effective.  So we go back to our original number - about 10% with no condoms, no meds, no sex during outbreaks, and sex about twice a week.  These studies, where we get this data, is on discordant couples - one has HSV 2 and the other doesn't.  And they have been together for a while already and that is an important piece of information because most transmission of HSV 2 happens in the first three months of a new relationship.  And these study people are past that time in their sexual relationship. 

So 10% means if 100 infected men were having sex one on one with 100 uninfected women, in that "survivor" group of people in the study who have not yet been infected, 10 out of 100 would get HSV 2.

I hope that provides the clarity that you are seeking.

Terri