Monique Rainford

I certainly appreciate readers' questions based on my last article on herpes and I will attempt to answer as many of them as possible.

Should I take Valtrex?

Dear Dr Rainford:

Thank you for your article. My partner tested positive for HSV-1 and HSV-2 and has regular outbreaks despite taking 500mg of Valtrex. He has just increased his dosage to 1g. I have tested positive for HSV-1 but have never had outbreaks.

My husband's doctor believes I should also be taking Valtrex due to 'shedding'. Both my infectious disease doctor and my gynaecologist disagree and do not want to put me on Valtrex. Do you have any thoughts on this? Can you recommend a specialist in the New York City area that we could go to? Thank you so much for your help.

Dear Reader:

Based on your letter I assume that you have been tested for HSV-2 and you are negative.

There is evidence that being positive for HSV-1 provides some protection against infection with HSV-2. Valtrex has been proven to reduce the transmission rate of HSV-2 between HSV-2 positive persons to their negative sexual partners in heterosexual relationships. This effect appeared to be much stronger in reducing male to female transmission rather than female to male transmission.

Reduces transmission

I have not come across any information which specifically suggests that Valtrex reduces the transmission of HSV-1, therefore, the current medical evidence does not seem to suggest that you need to take Valtrex and I agree with your doctors.

New York City has several renowned medical teaching hospitals and I suggest that you could consider a specialist in this area from the faculty of one of these hospitals.

Did I infect my girlfriend?

Dear Dr Rainford:

I read your article about women and genital herpes. My girlfriend had her first known outbreak while we were dating. I have always had night fever (HSV-1) as a child but never genital herpes.

Is it possible that during oral sex I may have infected her? She was devastated when she discovered that she had genital herpes and thinks that I may have infected her. I don't have oral sex with her during my outbreaks though I know it can be transmitted even when I don't have an outbreak. She has long since adjusted to having the virus and we are still together and I hope to marry her soon, so it's not about who is to blame but I would like to know how likely is it that I in fact infected her.

Dear Reader:

Unfortunately, HSV-1 causes about 10 per cent of genital herpes and it can be transmitted through oral sex. You are correct in recognising that the virus can be transmitted whether or not you have an outbreak.

If she desires, you and your girlfriend could be tested for both HSV-1 and HSV-2. If you both test positive for only HSV-1, it is possible that you may have infected her. However, this can only be known with certainty if she was certain that she was negative before your relationship and had no other exposures. If either or both of you test positive for HSV-2, the determination becomes more complex.

I would strongly suggest that you both discuss the matter with your doctor before you proceed with any tests. I am glad that you are still together and wish you the best for your relationship.

Dr Monique Rainford is a consulting obstetrician and gynaecologist; email: yourhealth@gleanerjm.com.