Dear Alice,

I am a gay man, and my on-again, off-again boyfriend has genital herpes on his anus. He currently takes Valtrex to manage his symptoms (his outbreaks occur about once or twice a year). I love him and want to continue our relationship, but I also want to protect myself. Would taking Valtrex (or some other viral suppressing drug) reduce the chances of transmitting the disease to me?

Dear Reader,

Asking questions and gathering information is a great first step in protecting yourself from herpes or other sexually transmitted infections. Valtrex (valcyclovir) is an anti-viral drug approved for treating initial genital herpes, recurrent genital herpes, and chronic suppressive treatment of recurrent genital herpes. In clearer terms, the drug is used to manage symptoms in individuals with herpes. The U.S. Food and Drug Administration (FDA) approved the use of Valtrex to prevent transmission of herpes to an uninfected partner.

It's unclear if your question is whether you yourself should take Valtrex to reduce the risk of transmission. Valtrex is approved for use only by individuals with genital herpes. There is no indication that it has any efficacy as a preventative medication, so the uninfected partner should not take it.

Your partner's use of Valtrex can, most likely, reduce the risk of transmitting herpes to you. There are, however, a few caveats. The FDA approved Valtrex in August 2003 for reducing the risk of  transmission from an individual with genital herpes to an uninfected partner in combination with safer sex behaviors. This includes using a condom and not having sex during an outbreak when both partners have healthy immune systems. While Valtrex can be used by someone with genital herpes for the management of symptoms, the studies that led to the approval of the drug for transmission risk reduction were conducted only with monogamous, immunocompetant, heterosexual couples. More studies would be necessary, according to the majority of the approval committee, to determine the drug's usefulness against cases of homosexual transmission or in individuals with compromised immunity. Though Valtrex is only explicitly approved by the FDA as effective in reducing herpes transmission among heterosexual, monogamous couples (because it has mainly been tested among this population), prescribing Valtrex is at the discretion of one's health care provider — many of whom who choose to prescribe the drug regardless of one's sexual relationships. You may want to encourage your boyfriend to talk with his health care provider about Valtrex's benefits in reducing transmission risk.

It's important to remember that Valtrex reduces, but does not eliminate, the risk of transmission. An important part of risk reduction with herpes is choosing when to have sex, what kind of sex to have, and using condoms. Other suggestions to reduce the chances that your boyfriend will transmit herpes are explored in some of the Related Q&As below.

Kudos for wanting to protect yourself and looking out for the best interest of you and your partner.


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