Let me start out by saying three important things:
Here are the main things to know about reducing the risk of transmitting HSV from an infected person to a non-infected partner:
Is there therapy to prevent herpes transmission?
Suppressive therapy with a valacyclovir 500 mg pill once daily is beneficial in decreasing transmission to an uninfected sexual partner.
How do we know that? In 2004, a large study published in the New England Journal of Medicine followed 1484 heterosexual monogamous couples where one partner had an HSV-2 infection and the other didn’t. The couples were instructed to use condoms, and the HSV infected people took either 500 mg of valacyclovir once daily or nothing (placebo) for eight months.
The susceptible partner (the partner who had never had genital lesions from HSV) was evaluated monthly for clinical signs and symptoms of genital herpes. Taking valacyclovir 500 mg daily led to a reduction in transmission of genital HSV-2 to the uninfected partner.
What are the chances I’ll get herpes?
So in the study, researchers followed sexually active couples for eight months where one partner had an HSV infection and the other did not. Of the 741 couples where the infected partner did not take valacyclovir, 16 (3.6%) developed an outbreak of herpes—compared to only 4 of 743 (1.9%) couples where infected partners took 500 mg of valacyclovir daily.
Valacyclovir 500 mg taken daily reduces the number of days that HSV-2 DNA is detected in genital secretions to almost zero, which is why it helps prevent transmission.
Does it matter which herpes virus caused the genital ulcers?
Remember, valacyclovir has not been studied in those with genital lesions due to HSV-1, though we assume the reduction in risk is similar regardless of whether the ulcers are from HSV-1 or HSV-2. Half of new cases of genital lesions are caused by HSV-1, so the old idea that HSV-1 causes mouth sores and HSV-2 causes the genital ulcers no longer applies.
Is valacyclovir better than acyclovir or famciclovir?
If you’re talking about reducing repeat herpes infections, valacyclovir, acyclovir and famciclovir appear to be equally effective. However, only valacyclovir has the evidence shown above—where it prevents herpes transmission from an infected person to non-infected person.
Hope this helps.
Dr O.
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