Suggest Treatment For Cold Sore Outbreak

Posted on Tue, 19 May 2015

Medically reviewed by Ask A Doctor - 24x7 Medical Review Team

Tue, 19 May 2015 Answered on

Mon, 8 Jun 2015 Last reviewed on

Question : Hi, on occasion (once a year) I get a cold sore outbreak. I have been tested thoroughly and have only a positive for HSV 1. My girlfriend is negative for HSV 1 and HSV 2. She has asked that I take a daily therapy Antiviral Medication to reduce the risk of infecting her through oral sex. I am in perfect health and am concerned about my risks but want to be safe. Which medication would you recommend?

Answered by Dr. Panagiotis Zografakis (40 minutes later)

Brief Answer:
You can use valacyclovir

Detailed Answer:
Hello,

regarding oral sex, the herpes virus may be transmitted to her even if you don't have any visible lesions on your mouth because of the viral shedding. Drug therapy reduces viral shedding and reduces a lot the risk for contracting herpes. Avoiding sexual contact when prodromal symptoms have occurred is another way to reduce the risk but it's not enough by itself. Prophylactic valacyclovir (500mg once per day) helps with viral shedding but I would recommend avoiding sexual contact when prodromal symptoms of cold sores or full-blown cold sores have occurred. Please keep in mind that although the drug reduces viral shedding it can't totally exclude transmission, so caution is advised when there is suspicion of HSV reactivation.

Valacyclovir has been studied for HSV-2 but the same drug is used for HSV-1 as well. Regarding HSV-2 valacyclovir is considered grade I evidence which means that its efficacy is very well documented.

I hope I've helped!
Kind Regards!

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Panagiotis Zografakis (21 hours later)

Thank you sir. I have a follow-up question what do you think about Acyclovir 400mg? I have taken this before and it seems to work well with my body but obviously I don't know the long-term effects. My concern is taking a medication with the smallest risks or side effects to me and still offering her the greatest protection.

Answered by Dr. Panagiotis Zografakis (35 minutes later)

Brief Answer:
they have similar safety profiles

Detailed Answer:
You're welcome!

The safety and efficacy profile of both drugs is similar, so you can choose any of them. Acyclovir 400mg twice a day or Valacyclovir 500mg once a day. Please note that these drugs have no FDA approval for this use (long-term suppression of herpes labialis) , although this regimen has been sufficiently studied against herpes viruses.

Kind Regards!

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar