[Question #8233] Mitigate risk of spreading herpes

47 months ago

I’m a female that was diagnosed with genital herpes 30+ years ago. Over the years, I was very fortunate to have not had many serious outbreaks. I was never informed until about five years ago, that I could take valacyclovir 500mg to treat both cold sores and genital herpes. I have been taking it 4 times a week and haven’t had an outbreak in quite some time. I may get a minor cold sore once or twice times a year caused by stress, at which time I increase the medication and it clears up in a couple days.

I am currently dating a wonderful man who does not have it and we both want to be informed on proper hygiene practices (washing hands, etc.), safe sex and how best to mitigate risk of spreading it for the following: kissing, fingering, oral sex and intercourse.

Thank you.

Terri Warren, RN, Nurse Practitioner

47 months ago

It appears that you have both oral and genital herpes. If he does not have either (and remember that a high percentage of people have HSV 1 in the US), kissing is a small risk for transmission of the cold sore virus as it you giving oral sex to him. In terms of the genital to genital transmission, him using condoms and you using daily antiviral medicine will reduce the risk to a very small number. But four times a week is not adequate. You need to take it daily and at about the same time each day if possible. Fingering with intact finger skin is not a risk. Him giving you oral sex is a small risk but quite small.

For the moment, I am assuming that you have HSV 2 genital infection. If that is incorrect, or you don't know the type, you may wish to have an antibody test to find out for sure. And if you were both were my patients, I would suggest that he too get an antibody test to find out if you are truly different in terms of herpes or herpes the same and don't know it. Let me know if you have other questions, OK?

Terri

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46 months ago

Terri,

FYI - I sent the same questions to my internal medicine doctor at the Cleveland Clinic and she recommended I take Acyclovir 400 mg orally twice daily indefinitely. Do you agree with this?

Also, as I'm reading through some of the other answered questions, some of the responses provided percentages on the risks. Could you please provide percentages in regards to my original question?

Thanks for your help.

Terri Warren, RN, Nurse Practitioner

46 months ago

Both acyclovir twice a day and valacyclovir once a day are fine - valacyclovir is just so much more convenient since it is once a day and it is the only drug that has been officially studied for reduction of transmission. So now, I always prescribe valacyclovir vs. acyclovir, just for convenience.

If you take daily antivirals and he uses condoms with every intercourse, having sex about twice per week on average, the risk is around 1-2% per year that your partner would contract HSV 2. If condoms are difficult, the risk rises a bit.

Terri

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