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Herpes questions
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An_247419 posted:
My boyfriend and I have recently become sexually active. It turns out he has HSV2 genital herpes and my antibody test showed positive for HSV1, (negative for HSV2) I have never had any outbreaks that I am aware of.

My boyfriend had not had an outbreak for 2 years and had not been on suppressive therapy. Five days before we decided to initiate a sexual relationship, he started on Valtrex 500mg each day to lessen my chances of contracting HSV2. All went well for about three weeks, then he had his first outbreak in 2 years. This was disappointing as he was on Valtrex.

I understand from Terri Warren's book "The Good News about the Bad News' that being on suppressive therapy only decreases the likelihood of outbreaks by 70 - 80% (pg 89). So he is willing to continue Valtrex to protect me if necessary and continue to expect the occasional outbreak.

But, here are the questions:

1. Again on page 89 of Warren's book, she states all three antiviral medications work equally well to suppress outbreaks as well as reduce shedding by 80- 94%. But, Valtrex is listed as the only one shown to reduce the chance of infecting a sexual partner (by 48%) How is that possible? Is it only because the clinical trials have not been done to prove acyclovir and famciclovir do not reduce transmission? It would seem we could expect from what is reported by Ms. Warren that any of the antivirals would work equally well to reduce transmission (if taken correctly). This matters because Valtrex is about three times as expensive as acyclovir.

2. Again referring to Ms. Warren's book, on page 43 she writes that "shedding is not a concern from buttocks skin, thigh skin, or abdominal skin during times of not symptoms. My boyfriend's area of outbreak is in his pubic area 3 -4 inches from his penis and closer to his lower abdomen. Does th location suggest he can expect to have minimal shedding except for times of outbreaks? This would determine whether we feel comfortable just having him on medications when he feels symptoms coming on and not on daily therapy. Not only is this a cost and side effect issue, but he is on various other medications (we are both 61). The less medication the better.

3. Acyclovir seems safe given its 20 year history. However, my boyfriend had a history of kidney disease (nephrosis) which was last treated in his early twenties. At the time it was life threatening but there have been no further symptoms for about 40 years. None the less, are you aware if daily antiviral therapy is safe for daily use with someone with a history of kidney disease?

We appreciate your help. I am a Family Nurse Practitioner myself and am having a hard time getting correct information. Even the local infectious disease physician in our town seemed over his head when I went in for an appointment and asked just basic questions.

I refer to Terri Warren's book because she mentioned she often answers the questions in this forum.

Thanks
Travlinggal



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elle0317 responded:
Terri used to come by on this exchange: http://exchanges.webmd.com/sexual-conditions-and-stds-exchange but it not so often anymore. Maybe you could post it there in case she does see and can respond to you.
 
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Travlingal382 replied to elle0317's response:
Thanks


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