Once Daily Valacyclovir For Reducing Viral Shedding In Subjects Newly Diagnosed With Genital Herpes
Academic Editor: Received
Abstract
1. Introduction
Genital herpes is most commonly caused by infection with herpes simplex virus type 2 , and is one of the most prevalent sexually transmitted diseases worldwide . The incidence of new infections is about 1 million cases per year in the United States . At least 50 million persons in the United States have HSV-2 infection . However, 86% of these individuals are unaware of their diagnosis, either because they do not have symptoms or because they have symptoms that go unrecognized .
Previous studies demonstrated both viral shedding and recurrences are more frequent in the first year after initial HSV-2 infection . In one natural history study, women who acquired genital herpes within a year before enrollment had more frequent shedding compared to women who had been infected for one year or more . Another study found that individuals diagnosed for 6 months were twice as likely to shed asymptomatically compared to those diagnosed for more than 6 months . Collectively, higher viral shedding and recurrence rates in subjects with newly acquired infection may translate to an increased risk of transmitting virus to uninfected sex partners.
2. Materials and Methods
2.1. Design
2.2. Study Population
2.3. Procedures
2.4. Laboratory Methods
2.5. Statistical Analyses
3. Results
3.1. Subject Characteristics
3.2. Viral Shedding
4. Discussion
What Factors Influence The Cost Of Treating Genital Herpes
Oneâs total cost of treatment will vary based on insurance status, the prescribed antiviral, where they receive their prescription, and planned sexual activity. It is important to remember that some people only take antiviral medication when actively experiencing an outbreak. In contrast, some continue to take the medication every day despite not currently experiencing an outbreak.
When Is Treatment Necessary
Herpes can cause blisters to form on or around the mouth or genitals. These blisters then break, forming open, painful sores that may take at least 1 week to heal.
The symptoms may clear up on their own, and they may reappear later, in what some people call outbreaks or flare ups.
Once the virus enters the body, it never completely goes away. Some triggers that can cause herpes symptoms to reappear include:
- friction in the genital area
- a weakened immune system
Doctors may prescribe one of the following antiviral medications to help manage herpes symptoms. A person can also take some steps at home to ease the symptoms, and we describe these later in the article.
Please note, the writer has not tested these products. All information is research-based.
Read Also: How Do You Know If You Got Herpes
How Will My Healthcare Provider Know If I Have Genital Herpes
Your healthcare provider may diagnose genital herpes by simply looking at any sores that are present. Providers can also take a sample from the sore and test it. If sores are not present, a blood test may be used to look for HSV antibodies.
Have an honest and open talk with your healthcare provider about herpes testing and other STDs.
Please note: A herpes blood test can help determine if you have herpes infection. It cannot tell you who gave you the infection or when you got the infection.
Also Check: At Home Remedy For Genital Herpes
How Does Genital Herpes Spread
Herpes can be spread when an infected person has lesions blisters and open sores on their body or when you do not have any symptoms. Taking antiviral medicine can help you reduce the risk of spreading genital herpes to your sexual partners. You can also:
- Inform your sexual partner that you have genital herpes.
- Use a condom every time you have sex.
- Refrain from having sex when you have symptoms.
- Abstain from performing oral sex if you have blisters or open sores around your mouth.
Don’t Miss: How To Get Rid Of Herpes Virus From Your Body
How Is Genital Herpes Managed Or Treated
If you have mild symptoms or infrequent outbreaks, you might not need or want treatment. During an outbreak, these steps can ease symptoms:
- Apply an ice pack to your genitals. Wrap the ice pack in a washcloth or apply it over your underwear.
- Keep genitals dry. Wear cotton or other nonsynthetic underpants and avoid tight-fitting clothes. Moist sores take longer to heal.
- Soak in a warm bath.
- Take nonsteroidal anti-inflammatory drugs to relieve pain.
- Wear loose-fitting clothing.
Antiviral medications can prevent outbreaks. They can also lessen symptoms and help symptoms go away faster. You take this medicine as a pill, intravenous injection or skin cream. When taken daily, antivirals can prevent an outbreak. They lower the chances of spreading the virus to other people.
Herpes Medication Does Not Reduce Risk Of Hiv Transmission
A five-year international multi-center clinical trial has found that acyclovir, a drug widely used as a safe and effective treatment taken twice daily to suppress herpes simplex virus-2 , which is the most common cause of genital herpes, does not reduce the risk of HIV transmission when taken by people infected with both HIV and HSV-2. The results of the study are published in the New England Journal of Medicine online today, and will appear in the Feb. 4, 2010 issue of the publication.
Up to 90 percent of people with HIV infection also have HSV-2 infection. Most people who are infected with HSV-2 do not know they have the virus because symptoms can be mild or absent. HSV-2 infection can cause recurrent sores and breaks in the skin of the genital region, which can be mild and often go unnoticed. HSV-2 infection also attracts immune cells called CD4 T-cells to the genital region, which HIV uses to establish or pass infection.
Multiple studies have shown that frequent genital herpes recurrences increase the amount of HIV in the blood and genital tract. The HIV virus is also shed from genital herpes ulcers and persons with such ulcers transmit HIV to others more efficiently. Five preliminary studies showed that it is possible to decrease the amount of HIV in the blood and genital tract through treatment to suppress HSV-2, but these studies did not measure whether this translated into a reduction in HIV transmission.
Don’t Miss: Does Herpes Affect Your Kidneys
Herpes Drugs Dont Stop Herpes Shedding
Got Genital Herpes? Youre Still Infectious, Even if Drugs Cut Symptoms
Even when they dont have an active herpes outbreak, people who carry genital herpes viruses are at risk of infecting their sex partners. With the discovery of drugs that prevent herpes outbreaks, there was hope that the drugs would also prevent herpes transmission. But theres been troubling evidence that this may not be true.
Now University of Washington researcher Christine Johnston, MD, and colleagues show that people with no herpes symptoms often shed infectious genital herpes virus even while taking very high doses of anti-herpes drugs.
Short episodes of genital shedding occur frequently with antiviral therapy, even for high-dose regimens, Johnston and colleagues report. These breakthrough episodes are typically , last several hours, and occur at much the same rate irrespective of antiviral dose.
One in 5 Americans and Europeans carries HSV-2, the virus that causes most cases of genital herpes HSV-1 causes some cases. Most people have few, if any, of genital herpes painful symptoms: blisters on or around the genitals or rectum.
Theres no cure for herpes infections. Thats because herpes viruses travel up nerves to take up latent form in the nerve root. Powerful anti-herpes drugs acyclovir , famciclovir , and valacyclovir prevent most outbreaks in most people. But they dont eliminate virus hiding in nerve cells.
Can Genital Herpes Be Treated
Your physician can prescribe different medications to help reduce your symptoms and speed up the healing of an outbreak. These medicines work best when you start them soon after an outbreak occurs.
To reduce pain during an outbreak:
- Sit in warm water in a portable bath or bathtub for about 20 minutes. Avoid bubble baths.
- Keep your genital area clean and dry, and avoid tight clothes.
- Take over-the-counter medications, such as acetaminophen or ibuprofen. Avoid aspirin.
Let your physician know if you are worried about your genital herpes. He or she can recommend a support group to help you cope with the virus.
Don’t Miss: How To Boost Immune System To Fight Herpes
Antiviral Drug Reduces Genital Herpes Transmission Between Sexual Partners By 50 Percent
SEATTLE â Dec. 31, 2003 â An international team of researchers finds that taking a single daily dose of an approved antiviral drug known as valacyclovir can reduce the transmission of genital herpes to uninfected partners by 50 percent. The results are published in the Jan. 1 issue of the New England Journal of Medicine.
The team of researchers led by Dr. Larry Corey, a member of Fred Hutchinson Cancer Research, conducted a study of nearly 1,500 heterosexual monogamous couples in which one partner had genital herpes and the other did not. Infected partners who received a standard daily oral dose each day of valacyclovir were half as likely to transmit herpes simplex type 2 than infected partners given a placebo.
University of Washington collaborators included Dr. Anna Wald, associate professor of medicine and laboratory medicine, and Dr. R. Ashley Morrow, professor of laboratory medicine.
The strategy potentially could be applied to combat the spread of other sexually transmitted diseases that are caused by viruses.
“This is the first demonstration that an antiviral drug can prevent a viral sexually transmitted disease,” said Corey, also a professor of laboratory medicine at UW and head of Fred Hutchinson’s infectious diseases program. “The study provides the conceptual framework to extend other viral sexually transmitted diseases, such has HIV infection.”
Media Contacts
Acyclovir May Cause Side Effects Tell Your Doctor If Any Of These Symptoms Are Severe Or Do Not Go Away:
- numbness, burning, or tingling in the arms or legs
- temporary inability to move parts of your body
- shaking of a part of your body that you cannot control
- loss of consciousness
Acyclovir may cause other side effects. Call your doctor if you have any unusual problems while you are taking or using this medication.
If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration’s MedWatch Adverse Event Reporting program online or by phone .
Don’t Miss: Can You Cure Herpes 1
Genital Herpes During Pregnancy
Prevention of neonatal herpes depends both on preventing acquisition of genital herpes during late pregnancy and avoiding exposure of the neonate to herpetic lesions and viral shedding during delivery. Mothers of newborns who acquire neonatal herpes often lack histories of clinically evident genital herpes . The risk for transmission to the neonate from an infected mother is high among women who acquire genital herpes near the time of delivery and low among women with prenatal histories of recurrent herpes or who acquire genital herpes during the first half of pregnancy . Women who acquire HSV in the second half of pregnancy should be managed in consultation with maternal-fetal medicine and infectious disease specialists.
All pregnant women should be asked whether they have a history of genital herpes or genital symptoms concerning for HSV infection. At the onset of labor, all women should be questioned thoroughly about symptoms of genital herpes, including prodromal symptoms , and all women should be examined thoroughly for herpetic lesions. Women without symptoms or signs of genital herpes or its prodrome can deliver vaginally. Although cesarean delivery does not eliminate the risk for HSV transmission to the neonate , women with recurrent genital herpetic lesions at the onset of labor should have a cesarean delivery to reduce the risk for neonatal HSV infection.
Acyclovir 400 mg orally 3 times/dayORValacyclovir 500 mg orally 2 times/day
Other Ways Of Getting Herpes And How Likely They Are
As mentioned earlier, herpes is mostly transmitted via skin-to-skin contact .
There is a small theoretical risk of herpes transmission via other routes, such as sharing utensils, friendly kisses and hugs, clothing, etc. The real-world risk of this is considered to be very low.
In the table below, we summarize the estimated likelihood that herpes will be transmitted by various routes.
| Sex | |||
|---|---|---|---|
| Unknown | Unknown | 0% | 0% |
*Please note: The risk of herpes transmission varies from person to person because various factors affect that risk:
- Number of sexual partners
- Sexual orientation
Also Check: The First Sign Of Herpes On Mouth
The Cost Of Treatment
The cost of antiviral medication to treat genital herpes varies based on the specific antiviral you are prescribed and choose to use. The average cost of brand-name antiviral for a 30-tablet supply is $545.45, compared to $116.72 for generic retail prices. Valacyclovir appears to be the most expensive of the three antivirals, whereas Acyclovir is the least costly.
Cost Comparison of Brand-Name Vs Generic Antivirals
|
Antiviral |
Brand Name Average Retail Price Based on First HSV-2 Episode Dosage CDC Recommendation Above |
Generic Brand Average Retail Price Based on First HSV-2 Episode Dosage CDC Recommendation Above |
|---|---|---|
|
Acyclovir |
Source: GoodRx
Can Women Who Have Sex With Women Get Genital Herpes
Yes. It is possible to get genital herpes, or any other STI, if you are a woman who has sex only with women.
Talk to your partner about her sexual history before having sex, and ask your doctor or nurse about getting tested if you have signs or symptoms of genital herpes. Use a dental dam during oral sex and avoid sexual activity during an outbreak.
Recommended Reading: Which Virus Causes Genital Herpes
Read Also: Do Condoms Protect You From Herpes
If You Have Genital Herpes Already Can It Be Spread To Other Parts Of The Body Such As The Arms Or Legs
No. Genital herpes cannot be transmitted to another part of your body such as your arm, leg or hand after the first infection occurs. If you have genital HSV II, you will not get HSV II at another site in your body. The immune system produces antibodies that protect other parts of your body from infection. However, there are cases where a person has multiple site infections from the same virus. This is usually acquired at the time of the first infection. For example, if someone has never had herpes but then has oral and genital sex with an infected partner, they can acquire the infection at both sites.
Is There A Cure Or Treatment For Genital Herpes
There is no cure for genital herpes. However, daily use of antiviral medicines can prevent or shorten outbreaks. Antiviral medicines also can reduce the chance of spreading it to others.
Though several clinical trials have tested vaccines against genital herpes, there is no vaccine currently available to prevent infection. One vaccine trial showed efficacy among women whose partners had HSV-2, but only among women not infected with HSV-1. Efficacy was not observed among men whose partners had HSV-2. Another trial testing the same vaccine showed some protection from genital HSV-1 infection, but none from HSV-2.
Recommended Reading: How.long Can Herpes Lay Dormant
Herpes Suppressive Therapy: 6 Points To Know About Daily Valtrex
Unfortunately, there isnt a cure for herpes. However, doctors sometimes prescribe Valtrex to be taken every day in order to prevent outbreaks and lower transmission rates. Using antiviral medications like Valtrex every day is known as herpes suppressive therapy.
Medically reviewed by Gerard Sison, PharmD on Nov. 26, 2018
Depending on the severity of a case of herpes, doctors may prescribe one of two methods for managing symptoms:
Herpesyl is a 100% natural blend that targets and eliminates herpes virus in the body.
Positive Singles is a safe, supportive community to meet others with HSV! Dating profiles, blogs, support groups, and active discussion. Avoid the awkward herpes talk.
- Intermittent treatment consists of taking an antiviral drug when you experience an outbreak to lessen the severity of symptoms and shorten their duration.
- Suppressive therapy consists of taking a regular dose of antivirals every day whether you have an outbreak or not. The purpose is to not only prevent outbreaks, but also to reduce the likelihood of transmitting herpes to a sexual partner.
Some Important Facts Affecting The Risk Of Herpes Transmission
- Herpes is transmitted through skin-to-skin contact
- The first outbreak is the most contagious
- There is a greater statistical chance of passing herpes when youâve been recently diagnosed whether you have symptoms or not
- Herpes infects skin areas that are thin and moist because itâs easier for the virus to penetrate those areas. For that reason, females are three times more likely to be infected than males
- Younger people having casual sex are more likely to contract herpes
- HSV-1 in the genital area recurs less often than HSV-2
- Being positive for HSV-2 gives some protection against getting HSV-1. The opposite is not true
- If a person with one type of herpes acquires a different type, the flare-up symptoms are milder
- Sex toys should not be shared. But if they are shared, they should be cleaned with water and soap before being used
Recommended Reading: What Temperature Kills Herpes Virus
About Herpes Suppressive Therapy
If you opt for suppressive therapy, one of the most common antiviral medications is Valtrex, or valacyclovir. Another commonly prescribed medication goes by the name of Zovirax, or acyclovir. Valacyclovir and acyclovir can be considered close cousins as they are chemically similar.
Read on for the details about how effective suppressive therapy is and how it can affect transmission rates. Well also go over dosing and side effects of this medication. Note: This isnt a substitute for medical advice. You should always consult your doctor to determine whats right for your health.
Is There Any Resistance To Genital Herpes Medication
Resistance to drugs that treat genital herpes even after 20 years of use is very rare. Herpes medications may not work as well in patients who are very immunosuppressed and have been treated with these drugs for a long time. Each individuals response to treatment may vary. In some cases, patients may need more drugs to suppress their viral outbreaks than others.
You May Like: Can You Treat Herpes With Antibiotics