Valtrex...again....(and acyclovir too)

Thread view:

Enable EMail Alerts

Start New Thread

Thread rating:

Joe - 26 Jan 2004 22:31 GMT

Okay...so I finally saw a doctor, at a free STD clinic,
who seemed to know what the hell she was talking about.
However, I was disheartened to hear, yet again, that she
believed it was a completely useless endeavor to bother
determining whether I had genital HSV1 or HSV2. Her basic
opinion was that there is a risk to a partner either way,
and that even if the transmission rate is different it shouldn't
alter one's philosophy of dealing with the disease. This was disatisfying,
but at least her opinion was an informed one (or seemed to be). She said I
could get the culture again after another outbreak and answer
these specifics.

Now, regarding Valtrex, she was under the impression that Valtrex
was designed primarily for *treatment*, not for instantaneous suppression.
She recommended acyclovir (Zovirax) to deal in-the-moment with a
new outbreak, and said that Valtrex was best used to help suppress
recurrent outbreaks and reduce the likelihood of asymptomatic shedding.
This flies in complete contrast to view of the dermatologist I saw, who
recommended Valtrex (1 day's worth of dosage, 4000 grams) to deal
with an outbreak, and didn't mention acyclovir at all, as if its
utility had been eclipsed by the newer technology of Valtrex.

So what's the deal? Yes yes, I do understand that we're all different
and perhaps one medication is better for me than another, whatever
the context (i.e. whether to help quell an outbreak or for long-term
treatment). But does this lady have the story straight? Is acyclovir
the anti-viral generally used to stem an outbreak, and Valtrex the
one used for between-outbreak treatment? Or can either of them be
used for either purpose?

Help!

Thanks,
J

Reply to this Message

Grant - 26 Jan 2004 23:25 GMT

Hi Joe,

If you had cancer, would the doctor say, "Oh, it doesn't matter what kind
you have. You just do what we tell you...."

What a crock.

Did you ask your doctor to call the lab and have the culture typed?

Did your new doctor know anything about the blood tests that will type your
herpes for you?

Acyclovir is the generic, I believe. You need to take a lot of it in a day
whereas with Valtrex, you can take fewer pills because they made the
delivery mechanism more efficient. Or something like that. Tim can tell
you more about that. Acyclovir would be difficult on suppression because of
the number of pills you would have to take daily to equal what one valtrex
would be. At least I think that's how it works. I don't take them, so I
don't keep that information in my head.

ar

> Okay...so I finally saw a doctor, at a free STD clinic,
> who seemed to know what the hell she was talking about.
[quoted text clipped - 30 lines]
> Thanks,
> J

Reply to this Message

Joe - 27 Jan 2004 22:40 GMT

> Hi Joe,
>
[quoted text clipped - 4 lines]
>
> Did you ask your doctor to call the lab and have the culture typed?

I'll do just that, Grant. Thanks for the motivational kick. The crap
these doctors have been feeding me is truly remarkable. I'm suffering
in part because I've been pretty healthy all these years (up until the
HSV), and have had no need for doctors other than the occasional physical
and HIV tests. So, I have no regular physician who I can trust for
good advice.

I'd love to be armed with more specific information. Is there a name
for the blood test that determines HSV type? I'd like to ask for that
specifically so that they don't have recourse to suspect that I'm misguided.
Also, can this blood test be done at any time, regardless of whether it's
a flare-up period? Or do they have to use the actual culture taken from
an OB period? I'm a bit confused about the nature of the test and what
they need from me (besides blood, I assume...).

Thanks,
J

Reply to this Message

Grant - 27 Jan 2004 23:16 GMT

Hi Joe,

Where do you live?

All the blood tests will test for type. There are the Elisa tests and a
new one whose name I can never remember - but it's very accurate.....but the
best one is the Herpes Specific Western Blot. You can actually get this one
yourself with just a signature from the doctor. But it takes some doing.
Just demand it. They can't refuse to give you the test you want.

You have to wait 12 - 16 weeks after exposure to the virus to have the test
run. The blood test measures the amount of antibodies in your body and it
takes that long for them to build up.

I believe that Mike and I just recently answered these blood test questions.
I don't know if it was for you or someone else, though. It would have been
in the last month. You can check it out and find Mike's post for the name
of the good test I can't remember.

ar

> > Hi Joe,
> >
[quoted text clipped - 22 lines]
> Thanks,
> J

Reply to this Message

M2slo2cht@nospam.invalid - 06 Feb 2004 04:27 GMT

On 1/26/04, 4:31pm, ccr1633 wrote:

>believed it was a completely useless endeavor to bother
>determining whether I had genital HSV1 or HSV2. Her basic
>opinion was that there is a risk to a partner either way,

If that's her opinion, I don't think she's given "risk assessment"
much thought. Meaning, by knowing your type, and the status/type of
your partner, you can get a pretty good idea of whether the risk to
your partner is unacceptably high or infinitesimally small. For
instance, if you have genital type 2 and your partner is totally hsv
negative, the risk of transfer is higher (possibly to high,depending
on a number of other factors, but that's up to your partner to decide)
than if you have genital type 1 and your partner has a history of
fever blisters (in which case your partners risk would be pretty low,
especially if she's been infected for quite a while. ... oh btw, 80%
of the US adult population is infected with oral hsv1). So it makes no
sense at all to not have any and all the status/type information you
can find out about yourself and your partner.

>and that even if the transmission rate is different it shouldn't
>alter one's philosophy of dealing with the disease.

There's a lot more to consider than just bottom line transmission
rates.

>She said I
>could get the culture again after another outbreak and answer
>these specifics.

Good. A culture will nail down the type of the outbreak. And it
wouldn't hurt to get a blood test as well, just to see if you're
dealing with both types even though it wouldn't give you any location
information. We can give you a couple of different options for blood
tests. Just ask (or look a little further back as Arlyn suggested).

>she was under the impression that Valtrex
>was designed primarily for *treatment*, not for instantaneous suppression.

It's for either one. A lower dose every day for suppression, or if
outbreaks are infrequent, as a treatment for an outbreaks only. In the
latter case, the sooner you start taking them the better. In fact,
most people can feel an outbreak coming on a couple of days before it
hits (aches, tingles, that sort of thing, known as prodrome) and if
you start taking an anti-viral right away, it's possible to avoid the
outbreak altogether.

>She recommended acyclovir (Zovirax) to deal in-the-moment with a
>new outbreak, and said that Valtrex was best used to help suppress
>recurrent outbreaks and reduce the likelihood of asymptomatic shedding.

Nope. They're both used for both purposes. Acyclovir is less expensive
and requires more pills per day than Valtrex, but they're similar
meds. Some people have better response to one than the other but you'd
just have to try them both to find out which one works best for you.
The only widely known study of antivirals effect on asymptomatic
shedding was done using Valtrex. Theoretically, acyclovir should have
the same effect but there's not enough money in it for the
manufacturer to make a similar Acyclovir study worth while.

>didn't mention acyclovir at all, as if its
>utility had been eclipsed by the newer technology of Valtrex.

Valtrex is fine for people who can afford it or have insurance. More
convenient too. One pill a day vs three (acyclovir) for suppression.
And fewer pills per day to treat an outbreak too. So that'd be the way
to go if you can't keep up with when you're supposed to take your next
pill.

>But does this lady have the story straight? Is acyclovir
>the anti-viral generally used to stem an outbreak, and Valtrex the
>one used for between-outbreak treatment?

Nope.

>Or can either of them be used for either purpose?

You got it ;-)

M2

Reply to this Message