I am a 24 year old straight male, and I've had herpes, HSV-2, on my penis for 2.5 years. 

I always use a condom with casual relationships and about 80% of the time when I'm in a monogamous relationship. I let my female partner in monogamous relationships decide if they don't want to use the condom every time we have sex. I tell every single one of my sexual partners, regardless of how serious our relationship is, about my herpes. 

I take 500 mg of valacyclovir daily, which reduces my outbreaks from monthly (without medication) to every three months (with 500 mg). I was wondering if valacyclovir is the best prescription to prevent spreading herpes, and if moving up to 1 gram daily will lead to even fewer outbreaks for me and if it will lower the probability of spreading herpes to a female partner.

In other words, what are your thoughts on valacyclovir's effectiveness or is there something that's better, and if moving up to 1 gram of valacyclovir will lower the chance of spreading my herpes even more than 500 mg to a female sexual partner would.

There really isn't anything better, no.  Sometimes increasing the dose to either 1 gram a day or 500 mg a day can make a difference in the recurrence rate, however.  I have a patient who was routinely breaking through on 500 mg daily and when I switched her to 500 twice a day, she stopped breaking through.  I think it is definitely worth a try.

You sound like you are handling herpes exceedingly well right now, disclosing, treating, condom use most of the time.  Good job!

Terri

Thank you for the information! 

My follow up question, if I double my dose from 500 mg to 1 gram of valacyclovir daily will that decrease the chances of spreading to my female partner even more?  For example, if taking 500 mg decreases the chances of spreading herpes for every sex act by some percentage, will taking 1 gram decrease the chances even more? Will 1 gram make it even less likely and help me protect my female partner even more.

It is likely that increasing the dose to 1 gram will result in less viral shedding.  It won't be a big difference, but I believe you will see some improvement in outbreaks, and that most often correlates with less viral shedding and less risk of transmission.  More than 1 gram likely won't help more.

Terri

My final question is about the initial outbreak of herpes and valacyclovir. If I were to transmit HSV-2 to my partner and they have an outbreak, will the standard dose of 1,000 mg of valacyclovir twice a day for 7 days help prevent them from having more frequent outbreaks the sooner the first outbreak is treated.

Another way to put it, when someone first has an outbreak and  the prescribed valacyclovir is administered within 24 hours of outbreak, will that in turn lead to fewer outbreaks in the future because it was treated so quickly? I only was prescribed valacyclovir after maybe my 5th outbreak, and I'm curious if the sooner someone begins treatment from the initial outbreak the less likely they are to have as frequent or sever outbreaks moving forward. 

To simplify further, "the sooner I first take valacyclovir from my initial outbreak, will that lead to fewer recurrences/less severe outbreaks for the rest of my life?"

Thank you for your help.

No, treatment with a first infection doesn't change the future outbreak recurrence rate.

But the sooner they take it, the fewer symptoms they would have with a first infection, and that would be good for sure.

Terri