From the Guidelines
Yes, someone on prophylactic therapy for genital herpes can still experience an outbreak after sexual contact with a partner who has an active outbreak, though the risk is reduced. Common prophylactic medications include acyclovir (400mg twice daily), valacyclovir (500-1000mg once daily), and famciclovir (250mg twice daily), which typically reduce outbreak frequency by 70-80% 1. These medications work by inhibiting viral replication but cannot completely eliminate the risk of transmission or outbreaks. The herpes simplex virus can sometimes overcome medication barriers, especially during direct contact with active lesions which shed high viral loads.
Key Considerations
- The use of condoms during all sexual exposures with new or uninfected sex partners should be encouraged 1.
- Patients should be advised to abstain from sexual activity when lesions or prodromal symptoms are present and encouraged to inform their sex partners that they have genital herpes 1.
- Suppressive treatment with acyclovir reduces but does not eliminate asymptomatic viral shedding, and the extent to which suppressive therapy may prevent HSV transmission is unknown 1.
Recommendations for Management
- For maximum protection, it's advisable to avoid sexual contact during active outbreaks, use condoms consistently, and maintain daily antiviral therapy.
- The combination of medication and safer sex practices provides better protection than either approach alone, as the virus can be transmitted even when no symptoms are visible.
- Optimal management of genital herpes includes antiviral therapy and appropriate counseling on the natural history of infection, risk for sexual and perinatal transmission, and methods to prevent further transmission 1.
From the FDA Drug Label
Because genital herpes is a sexually transmitted disease, patients should avoid contact with lesions or intercourse when lesions and/or symptoms are present to avoid infecting partners. Genital herpes is frequently transmitted in the absence of symptoms through asymptomatic viral shedding Therefore, patients should be counseled to use safer sex practices in combination with suppressive therapy with VALTREX.
The answer to the question is that yes, someone on prophylactic therapy for genital herpes can still experience an outbreak after having sex with a partner who has an active outbreak, as the drug label advises patients to use safer sex practices in combination with suppressive therapy to reduce the risk of transmission. The label also states that genital herpes can be transmitted even in the absence of symptoms through asymptomatic viral shedding 2.
From the Research
Genital Herpes Outbreaks and Prophylactic Therapy
- Genital herpes is a lifelong condition that can cause recurrent outbreaks, and prophylactic therapy is often used to suppress these outbreaks 3, 4.
- However, even with prophylactic therapy, it is still possible for someone to experience an outbreak if they have sex with a partner who has an active outbreak 5, 6.
- The risk of transmission can be reduced with the use of suppressive antiviral therapy, condoms, and avoiding sexual contact during outbreaks 4, 5.
- Studies have shown that daily suppressive therapy with valacyclovir can reduce the risk of transmission of HSV-2 by 48-75% 5.
Transmission Risk and Prophylactic Therapy
- Asymptomatic viral shedding can still occur even with prophylactic therapy, which can increase the risk of transmission to uninfected partners 5, 6.
- The use of condoms and safe sex practices can help reduce the risk of transmission, but no intervention can completely eliminate the risk 4, 5.
- Prophylactic therapy can help reduce the frequency and severity of outbreaks, but it is not a guarantee against transmission or outbreaks 3, 7.
Management of Genital Herpes
- Antiviral therapy is the primary treatment for genital herpes, and it can be used to treat outbreaks or suppress them 3, 7.
- The choice of therapy depends on various factors, including cost, ease of dosing, and acyclovir resistance 7.
- A comprehensive management plan for genital herpes should include education on safe sex practices, the use of condoms, and the importance of suppressive antiviral therapy 4, 5.