Anti Viral Medication - 'must be taken over a long period of time'

[Gemms28]

I am a HSV1 and HSV2 negative female and have recently started dating a HSV2 positive male. He was upfront and truthful with me about his diagnosis. I have been looking into treatment/prevention options so that I can be comfortable in continuing and furthering the relationship. 

I keep reading that daily suppressive therapy (ie daily meds) can significantly reduce the likelihood of transmission to partners than non-medicated persons....however I also read that 'medication must be taken over a long period of time' 

No where does it really specify what the 'over a long period of time' actually means. Does this mean - it doesn't start to reduce the likelihood until youve been taking it daily for a while? does it mean it only continues to work if you do take it daily etc. 

Further, this is also quite possibly a silly question - but for myself who is currently negative, is there a benefit of me taking anti-viral meds in order to attempt not to get the infection? (to be fair, it probably wouldnt be prescribed by a doctor without a diagnosis but the question is worth asking). 

The positive male in question has advised he has had this diagnosis for approximately 9 years and used to take daily meds however stopped roughly 3 years ago and has not had an outbreak since. With this being the case, would it still be beneficial for him to start taking them again, if for no other reason than to assist in my protection? 

Thanks! 

[mr_hopp]

Hey there @Gemms28,

You’re asking some great questions about HSV-2 and the use of antivirals in a discordant couple (where one partner is positive and the other negative). Let’s break this down!

When people mention that medication must be taken over a long period of time, they’re referring to the fact that antivirals for HSV are most effective when taken consistently, especially as suppressive therapy. This doesn’t mean that the medication isn’t effective immediately; rather, its best effect on reducing viral shedding and therefore transmission risk accumulates over time with consistent use. It takes around 5 days before the medication starts having an effect on decreasing asymptomatic viral shedding to protect partners.

As for you, as someone who’s currently HSV negative, taking antiviral medications prophylactically (before exposure or diagnosis) isn’t standard practice and might not be recommended by most healthcare providers. The reason is that these medications are typically reserved for treating or preventing outbreaks in those who are already infected or have a high chance of becoming symptomatic.

For your partner, even without outbreaks, he can still have asymptomatic viral shedding. Resuming daily antiviral therapy would reduce the risk of transmission even if he’s asymptomatic (by at least 50%). The decision to restart medication is something he should discuss with his doctor, considering both his health and the potential benefit to you. But overall, all antiviral medications that are prescribed for herpes are well-tolerated for most people even over the long term. (I for one have been taking twice daily acyclovir to protect my wife for many years.)

Ultimately, the best strategy for you two might involve a combination of his antiviral use, you both being informed about the signs and symptoms of HSV outbreaks, and possibly avoiding contact during times of prodrome.

You’re taking a proactive and caring approach by educating yourself and considering these factors in your relationship. That’s commendable. Remember to have this dialogue with healthcare professionals who can provide personalized advice for both of you.

Take care and best of luck with your relationship!