LAST EDITED ON Oct-16-13 AT 06:45 PM (CST)
I wanted to relate to you a potential treatment for preventing HSV-2 transmission that no doctor or drug company will tell you about, but which appears to be highly effective in allowing you to regain your sex life.
I've read in various medical research publications, including the New England Journal of Medicine (e.g., NEJM 2010;363: 2587-2599), that HIV sero-discordant couples (i.e., where one has HIV and the other does not) have substantially reduced their risk of transmission (i.e., 44% in one study) by BOTH taking the anti-HIV medicines. Because the transmission of HSV is not completely dissimilar to that of HIV, it stands to reason that a similar strategy (officially known as Pre-Exposure Prophylaxis or PrEP) would work for those infected with HSV-2.
I have searched the literature with the help of my girlfriend, who is negative (and who has studied virology), and we cannot find a single analogous study for discordant couples with HSV. Notwithstanding this, we have elected to pursue this strategy for HSV and with effective results. Specifically, we are both taking herpes medication as part of a suppressive strategy to prevent the transmission of HSV-2 from me to her. We have been doing this for more than 5 months and without condoms, and she remains negative. I have been taking generic acyclovir twice daily, while she has been taking valacyclovir once daily, but the strategy should work with one or both taking either of these drugs. The dosing, which has been approved by the FDA for HSV-2 positive patients on suppressive therapy, is as follows: for acyclovir, it is 400 mg every 12 hours, and for valacyclovir, it is 500 mg every 24 hours. It is important to adhere to this dosing regime (i.e., do not forget to take your medicine at the right time), so as to prevent transmission and also to prevent the development of a drug-resistant strain of HSV-2.
While the research data on suppressive therapy for HSV-2 amongst discordant couples (appearing in the New England Journal of Medicine in 2004) was very encouraging, this PrEP strategy would appear to be even more effective in preventing HSV-2 transmission and, in our case, offers that effectiveness even without a condom. Not that I would recommend not using one for a host of reasons, but it seems to be the case that adding the anti-viral protection to the uninfected person likely reduces the risk of infection to the point where the condom might be superfluous. Why Glaxo, who ran the 2004 study appearing in the NEJM, has not run a study using their drug (Valtrex) in a PrEP treatment strategy is beyond me. But I've decided not to wait for them or anyone else to do it, and I've been very pleased with the results, as has my girlfriend.
Now for the DISCLAIMER: Because there have been no studies done on this PrEP strategy, this is an off-label use of the drugs, and it is not approved by the FDA. As such, you are assuming great risk of unwanted transmission by following this strategy. I am not a doctor and cannot recommend as an expert this strategy for others, nor intelligently calculate the odds of it working for you. In other words, I cannot say that my experience will translate into success for you for a variety of reasons. For example, my profile of outbreaks (i.e., less than two per year even without suppressive therapy) could be unrepresentative of your risk for transmission, or my asymptomatic rate of viral shedding could be totally different than yours. So I must highlight this huge CAVEAT EMPTOR to my suggestion that anyone else pursue this PrEP strategy for HSV-2.
Having said this, while clearly stating that I am not recommending that you follow my example, I nonetheless wanted to pass along this information to you, since it has allowed me to regain my sex life, and because it is based on sound science in the related area of HIV infection, where FDA-approved studies have been done. Even if Glaxo (the maker of Valtrex) or Teva (a maker of generic acyclovir) have apparently elected not to undertake studies of HSV transmission prevention using a PrEP strategy, you should not be denied the opportunity to further reduce the risk of transmission of HSV-2 to your uninfected partner--especially since the side-effect profile of these drugs appears so benign. If you and your partner are willing to take the risk, you might also benefit from this important preventative strategy discovered in a related field.
One last note: it could be difficult to procure a prescription for acyclovir or valacyclovir from your physician for the uninfected partner, since this is an off-label usage. I can only recommend that you be persistent and ask around. There are doctors out there that will help you.