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Antiviral Suppressive Therapy Uses?


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I’ve read that daily antiviral therapy can help reduce the possibility of transmission to a non infected partner. Is this because suppressive therapy reduces the number of outbreaks? Or does it actually decrease the chance of contracting the virus during sex? Or is reduction in the chance of contraction just due to reduced outbreak numbers but not how “infectious” the virus is? 
 

For example let’s suppose my girlfriend who is now HSV-2 positive and I have have sex each day for a week. If during this week she is asymptomatic but not on daily antivirals. Would I be more likely to contract her virus during this time than say if she and I had sex each day for a week, she was asymptomatic, but also was on a daily antiviral? I hope that makes sense. Thanks so much. 

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Hi!!! 

That is such a great question!!

First, let's define some key terms: asymptomatic and asymptomatic shedding. If someone is asymptomatically shedding, the virus is active and is actively shedding and can infect a partner. If someone is asymptomatic to herpes, it means they do not show symptoms of herpes and cannot tell when they are about to have an outbreak or when they have one (they see no sores, or sores are in a location invisible to the eye). 

Antiviral Medication & How It Works:

Antiviral medication often is misunderstood, as it doesn't make the virus "disappear" or "die", but instead reduces the likelihood that the virus would "wake up" from being dormant.  Because it inhibits the virus's ability to become active, which would result in shedding and more likelihood of transmission to a non-infected partner, the answer to your question is transmission would be less likely in scenario B than in scenario A. 

Honestly, I myself had to do some research in order to find out exactly how herpes medication helps someone who is taking it. Each medication is slightly different, but here are their functions in the human body, and the source where the information was found.

Acyclovir/Zovirax: "The mechanism of action of acyclovir involves highly selective inhibition of herpes virus DNA replication," which means it helps stop the virus from multiplying. "Prophylactic oral adinistration of acyclovir at dosages of 400 to 800 mg per day for 1-2 years led to complete supression of recurrences of genital herpes in approximately 60 to 90% f subjects. Unfortunately, recurrence rates returned to pretreatment frequencies aftr discontinutation of acyclovir."

Source: * This source is older, so I am unsure if newer data would show different information than above * but it is one of the only ones I could find. https://link.springer.com/article/10.2165/00003495-198937030-00002

Valtrex/Valacyclovir (which is converted into acyclovir when taken): This is really interesting!! See the attached photo to see the percent of parters of those with HSV-2 who ended up getting HSV-2 while their partner was on Valtrex. Note: "seroconversion" in the chart refers to partners who got it asymptomatically (they didn't show symptoms of having caught it but their blood results came back positive for having caught it). Read the full FDA Drug Sheet here:  Source: https://www.accessdata.fda.gov/drugsatfda_docs/label/2005/020487s007rel2_lbl.pdf

Famciclovir/Famvir: (Check page 12): https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/020363s037lbl.pdf

Basically, herpes antiviral medication can significantly help in reducing the likelihood of herpes transmission from one partner to another, even if they are asymptomatic. Asymptomatic shedding and symptomatic shedding are still producing the same result (shedding). The difference is it's harder to know when you are shedding asymptomatically.

An Example: Let's say there are two people, Jane and Paul.

Jane has one painful genital herpes HSV-2 outbreak each month. She gets burning and tingling before her outbreaks. Each outbreak has between 7-10 sores. She starts taking antiviral suppressive medication to help reduce her outbreaks and help her reduce transmission risk to her girlfriend. Jane has her baseline data of burning and tingling, and the number of sores per one outbreak per month to use to compare to when evaluating if the medication is working.

Paul also has genital herpes HSV-2, but he does not get symptoms. He does not know how many outbreaks he has had, or his warning signs that an outbreak is coming on. He doesn't get sores, so he doesn't know if he is having an outbreak when the virus is actively shedding. However, he decided to go on suppressive medication, since it still can help reduce his "invisible outbreaks" and rate of viral shedding should he have one. Things may be harder since he won't be able to tell if the medication is working, since he doesn't have baseline data like Jane does. 

For both people, the risk of passing herpes onto their partner exists. 

I hope that this helps you! I am so sorry if it is confusing. I am not a doctor or medical professional, but of course she should talk to her doctor and or OBGYN about if there are any studies on antiviral medication and asymptomatic herpes, and if this would be right for her. 

Also, anyone who has asymptomatic herpes and is on/has taken suppressive medication, please join in and offer your advice or experiences. It would be so appreciated! ❤️ Thank you!

Blessings! 🙂 

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Ok so if a person has symptoms of herpes including cold sores they are symptomatic. Additionally, they are capable of asymptomatic shedding of the virus even during times when they themselves are not having an outbreak or showing symptoms of their infection. Am I understanding correctly? So this would mean my girlfriend could still transmit the virus to me even if she currently has no symptoms of her infection when we have sex? I think I understand now. 

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Hi!! 

Yes, herpes can be spread even when there are no sores or symptoms. That's why it's such a common virus, and most of humanity has it! 

Because this makes a lot of people worry, especially those who tend who have no or little warning signs prior to outbreaks or are completely asymptomatic, they take suppressants to help lower the occurrence that the shedding could occur.

I hope that helps clear things up!!! 

 

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It does thanks. I’ve read a couple studies where researchers explained that daily antivirals reduce the extent and frequency of asymptomatic shedding and subsequent viral load carried in vaginal fluids. Thus reducing the chance of spreading the infection. 

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