I have recently been diagnosed with genital herpes. My doctor has advised me to monitor how often I get outbreaks before determining if I should go on a daily medication (or just take it when I feel an outbreak coming on). Although I trust my doctor, I keep reading different things on line. Should I or shouldn't I take a daily medication? My partner is a little uncertain and nervous and I am trying to reassure him, but I need some reassurance myself! I keep hearing and reading different things and it is making me more confused. Thank you.
The specific course of herpes treatment depends on the individual. For those with few or very mild outbreaks, treatment may not be needed at all. For others, taking an antiviral medication during an outbreak can shorten the duration of symptoms and speed healing. It can also be useful to know if your genital herpes is caused by HSV-1 or HSV-2. Your doctor could test a sample from a sore during an outbreak, or could obtain a blood test for HSV-2 between outbreaks.
In some cases, usually with a person experiencing frequent episodes of symptoms, it’s often desirable to take medication daily. This approach, known as suppressive therapy, has shown to stop approximately 75% of outbreaks for most. It’s important to discuss your feelings and experiences about these outbreaks with your doctor because some people experience a great deal of distress and discomfort with even a few outbreaks in a year. Others would find it very difficult to take a medication every day unless the outbreaks were quite frequent.
If your partner has not yet been tested for herpes (remember that we don’t know if this person has HSV 1 or HSV 2), a blood test can be done to better understand your partner’s risk for developing genital herpes. If you’re both positive for HSV-2, for example, there’s little reason to worry about issues of transmission or reinfection. Both you and your partner should remember that most people with HSV-2 don’t even know it. Discussing the results can help both you and your partner have a better understanding of your choices for treatment and prevention.
While HSV is most contagious during outbreaks, the virus can be transmitted even with no symptoms present. If your partner doesn’t have HSV-2, there are ways you can reduce his risk of acquiring the virus from you. The first is obvious, simply not having sex while you’re experiencing any symptoms of herpes (including itching or tingling that can precede an outbreak).
Condoms and dental dams can also reduce the risk, but aren’t fully protective here, as HSV can be present on skin a condom or dental dam won’t cover.
In addition to reducing the number of outbreaks, daily suppressive therapy with an HSV antiviral drug can reduce the risk of transmission to a partner significantly. Studies with one medication, Valtrex®, showed daily use can reduce the likelihood of transmitting HSV-2 to a partner by about half. This approach can be especially valuable to couples in long-term relationships who don’t want to use condoms and dental dams.
-- J. Dennis Fortenberry, MD, MS
Indiana University School of Medicine