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Subject: "(maybe) get your sex life back..."     Previous Topic | Next Topic
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arete
Member since Oct-16-13
2 posts
Oct-16-13, 12:45 PM (CST)
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"(maybe) get your sex life back..."
 
   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.

Good luck!

A


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Maggieddd1
Member since Feb-9-13
14 posts
Oct-16-13, 05:59 PM (CST)
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1. "RE: (maybe) get your sex life back..."
In response to message #0
 
   My ex-boyfriend and I were together for 10 years. I am HSV2 positive he is negative. I never took antivirals or used condoms and he never got it. So I'm not sure your five month record proves the antivirals are working or just the fact that maybe it's just not the "plague" that everyone makes it out to be.


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arete
Member since Oct-16-13
2 posts
Oct-16-13, 06:38 PM (CST)
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2. "RE: (maybe) get your sex life back..."
In response to message #1
 
   LAST EDITED ON Oct-16-13 AT 06:47 PM (CST)
 
Maggieddd1, I appreciate your response, but I think you have to separate risk from outcomes. If you have unprotected sex without viral therapy or condoms, the transmission rates are as follows: women to men is about 4% per year, while men to women is about 10% per year. This does not mean that your situation of 10 years without transmission is impossible, but your case may not be representative for the average discordant couple. Perhaps you and your ex-boyfriend just got lucky. What I am arguing is that based upon the analogous scientific data from HIV research, it would seem that one can substantially reduce the risk of transmission BEYOND what was already observed in the 2004 Valtrex study, which itself reduced the risk of transmission by 75%.

There are a lot of people on this and similar forums because the transmission of HSV-2 is meaningful in the number of new cases reported each year. I take your point that such people are unnecessarily stigmatized and made to feel as though they are carriers of a plague, which is hardly the case, but the transmission risk remains real.

This is why I am trying to get out information that strangely has been overlooked by the CDC, drug companies and doctors, even though it is well documented for HIV, another virus that is transmitted sexually and that has some similarities to HSV that are relevant to this discussion.

I want to make clear that while my "success" so far is not definitive proof--that would require the kind of study I am perplexed has not occurred--I nonetheless strongly believe that my strategy has significantly reduced our risk of transmission to well below the already-encouraging rate found in the Valtrex study. Both of these transmission rates are far below that which you and your sero-negative ex-boyfriend would have faced during your ten years of fortunately-non-transmitting sexual relations.

I write this because I do not want people to be confused between outcomes and risk. I hope this response helps to clarify this issue.

Thanks again!

A


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Maggieddd1
Member since Feb-9-13
14 posts
Oct-20-13, 07:12 PM (CST)
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3. "RE: (maybe) get your sex life back..."
In response to message #2
 
   It is encouraging and certainly couldn't hurt. I certainly would be open to give it a try in the future


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Maggieddd1
Member since Feb-9-13
14 posts
Oct-20-13, 07:14 PM (CST)
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4. "RE: (maybe) get your sex life back..."
In response to message #3
 
   I should add that my outbreaks are on my lower back/upper buttocks and only occur every few years. Maybe that helped our odds


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