From the Guidelines
Preventing herpes transmission requires a comprehensive approach that prioritizes consistent condom use, daily suppressive antiviral therapy, and abstaining from sexual contact during active outbreaks. The most effective methods for preventing herpes transmission include:
- Consistent condom use during all sexual activities, which can reduce the risk of transmission, though protection is not complete as herpes can spread through skin-to-skin contact in areas not covered by condoms 1.
- Daily suppressive antiviral therapy with medications like valacyclovir (typically 500 mg once daily), which can significantly reduce viral shedding and transmission risk, especially for those with frequent outbreaks or in relationships where one partner is infected 1.
- Abstaining from sexual contact during active outbreaks, as this is when the virus is most contagious.
- Open communication with partners about herpes status, which allows for informed decisions about risk.
- Maintaining good overall health through adequate sleep, stress management, and a balanced diet, which can help prevent outbreaks in those already infected. These strategies work because they either create physical barriers to virus transmission, reduce the amount of virus present on the skin through medication, or avoid contact during periods of highest contagiousness. While these approaches significantly reduce transmission risk, it's essential to understand that no prevention method is 100% effective due to the virus's ability to shed asymptomatically. In terms of specific antiviral therapy, valacyclovir 500 mg twice daily is recommended for suppressive therapy in HIV-infected persons 1. It's also crucial for HIV-infected persons to avoid sexual contact when their partners have overt (genital or orolabial) herpetic lesions, and for HSV-2-seronegative HIV-infected persons to ask their partners to be tested using type-specific serology before initiating sexual activity 1.
From the FDA Drug Label
Reduction of Transmission: VALTREX is indicated for the reduction of transmission of genital herpes in immunocompetent adults. The efficacy of VALTREX for the reduction of transmission of genital herpes beyond 8 months in discordant couples has not been established The efficacy of VALTREX for the reduction of transmission of genital herpes in individuals with multiple partners and non‑heterosexual couples has not been established. Safer sex practices should be used with suppressive therapy (see current Centers for Disease Control and Prevention [CDC] Sexually Transmitted Diseases Treatment Guidelines)
The best strategies for preventing herpes transmission include:
- Using valacyclovir (PO) for the reduction of transmission of genital herpes in immunocompetent adults, as part of a suppressive therapy regimen 2
- Practicing safer sex with suppressive therapy, as recommended by the current Centers for Disease Control and Prevention (CDC) Sexually Transmitted Diseases Treatment Guidelines
- Discordant couples can use valacyclovir for up to 8 months to reduce transmission, however the efficacy beyond this time frame is not established
- The efficacy of valacyclovir for reducing transmission in individuals with multiple partners and non-heterosexual couples has not been established.
From the Research
Herpes Prevention Strategies
- The use of antiviral medications such as valaciclovir, famciclovir, and acyclovir has been shown to be effective in preventing herpes transmission 3, 4, 5, 6, 7
- Valaciclovir has been found to be effective in suppressing genital herpes recurrences in immunocompetent individuals, with dosages of 500 mg daily or higher recommended 3
- Famciclovir and valacyclovir have been compared in studies, with valacyclovir appearing to be somewhat better for suppression of genital herpes and associated shedding 4
- Daily antiviral therapy with famciclovir and valacyclovir has been shown to be effective in reducing both symptomatic and asymptomatic reactivation of herpes simplex virus type 2 (HSV-2) 4
- The choice of therapy may be influenced by factors such as cost, ease of dosing, and acyclovir resistance 6
Antiviral Therapy for Herpes
- Acyclovir, valacyclovir, and famciclovir are efficacious and safe for the treatment of the first episode and recurrent genital herpes 5, 7
- These agents are also useful as suppressive therapy for individuals with frequent genital herpes recurrences 5, 7
- High doses of oral acyclovir, valacyclovir, and famciclovir have been shown to speed the healing of herpes zoster, and data suggests that these agents also decrease associated acute and chronic pain in people of 50 years of age or older 7