Valacyclovir for Treating Herpes: What to Know

If you have been diagnosed with genital herpes, your doctor may recommend taking a prescription medication called valacyclovir. Please continue reading to learn more about this antiviral medication.

What causes genital herpes?

The Herpes Simplex Virus (HSV) causes genital herpes. Two types of herpes simplex viruses can cause genital herpes infections - HSV-1 and HSV-2. However, most of the time, genital herpes is from HSV-2. HSV-1 usually causes cold sores (fever blisters).

Genital herpes is quite common. According to the CDC, approximately 12% of adults between the ages of 14 and 49 years have this sexually transmitted infection in the US, but most people do not have symptoms and do not know they are infected.

What are the symptoms of a herpes outbreak?

Symptoms begin 2-12 days after you are exposed to the virus. HSV infections typically cause bumps and blisters in the genital area or mouth. These blisters can rupture and leak fluid, forming painful ulcers. The ulcers can leave behind scabs when they heal. Outbreaks of genital herpes can cause pain and itching in the genital area. There can also be pain with urination and urethral and/or vaginal discharge.

In addition, the first herpes infection can be associated with flu-like syndrome with fever, chills, body aches, headache, and enlarged groin lymph nodes.

You might develop warning signs a few hours to a few days before herpes outbreaks. These are called prodromal symptoms and include pain in the genital area and tingling or shooting pains in the lower body.

Why do some people get recurrent genital herpes?

There is no cure for a genital HSV infection. Once you get infected, it is a chronic, lifelong infection. Genital herpes recurrences are common after the first infection. Some people have many recurrent outbreaks, while others only have a few. Usually, the maximum number of outbreaks of genital herpes occurs in the first 12 months. Over time, herpes outbreaks become less frequent, less severe, and shorter in duration.

Medications can help to ease the symptoms during herpes outbreaks and lower the risk of giving the herpes infection to sexual partners.

How do doctors treat genital herpes?

Randomized trials have indicated that the following three FDA-approved antiviral medications provide clinical benefits for genital herpes: acyclovir, valacyclovir, and famciclovir.

Valacyclovir is the prodrug of acyclovir. This means that once valacyclovir starts being absorbed in the gastrointestinal tract, it converts to acyclovir, the active drug, in the liver. Valacyclovir is designed this way to aim for better oral absorption. As a result, valacyclovir requires less frequent dosing than acyclovir. Famciclovir is also absorbed well.

The usual adult dosage of valacyclovir for the first episode of genital herpes is 1 gram by mouth twice a day for 10 days. Taking valacyclovir within 48 hours of the first signs of symptoms is recommended for the drug to be the most effective.

Daily suppressive antiviral therapy may be prescribed for recurrent genital herpes to reduce the frequency of the recurrences. Episodic therapy may be given during herpes outbreaks to shorten the duration of the lesions. Topical antiviral therapy (creams and ointments) has shown some benefits in providing symptom relief, such as decreased lesion count, size, and pain. However, the Centers for Disease Control and Prevention (CDC) states that oral antiviral therapy is preferred over topical antiviral therapy.

How contagious is herpes if I take valacyclovir?

Studies have found that once-daily suppressive therapy with valacyclovir can significantly reduce the risk of transmission of genital herpes in monogamous heterosexual couples where one partner has clinical symptoms of genital herpes and the other partner is at risk of getting the infection. However, taking valacyclovir does not completely eliminate the risk of virus transmission to sexual partners. Using condoms can lower the risk. Avoiding sex during an active outbreak can help protect partners.

How long does valacyclovir take to heal herpes?

Oral valacyclovir starts working as soon as you take the first dose. However, it can take up to 10 days or more for the herpes blisters to heal and your symptoms to go away even after valacyclovir treatment.

For the best results, start treatment at the first sign of a herpes outbreak. Take valacyclovir exactly as prescribed by your healthcare professional. Do not stop taking the medicine before your doctor tells you, even if symptoms are gone.

How long after treatment of genital herpes can I have sex?

If you have a herpes outbreak, wait at least 7 days after the sores have completely healed and the scabs have fallen off before having sex.

The herpes virus is present in blisters, ulcers, and the fluid that oozes from these lesions. HSV shedding also occurs from the lining and fluids in the mouth, vagina, and rectum. Viral shedding can be present even with no symptoms or active blisters.

The virus spreads to sexual partners through vaginal, oral, and anal sex. Oral herpes, which is caused by HSV-1, can spread from the mouth to the genitals through oral sex. This is why some people have genital herpes from HSV-1.

While the sores are healing, avoid touching them to prevent spreading of the infection to other parts of your body and other people. If you touch your genitals or herpes sore, wash your hands with soap and water right away.

What should I avoid while taking valacyclovir?

Here are some precautions while taking valacyclovir:

Allergic Reactions

Tell your healthcare professional if you have ever had an allergic reaction to valacyclovir, acyclovir, or any other medications.

Drug interactions

There can be possible drug interactions between valacyclovir and other medicines. Give your healthcare provider a complete list of your other drugs before starting valacyclovir.

Medical history

Talk to your doctor about the risks versus benefits of taking valacyclovir if you have a history of liver disease, kidney disease, or HIV infection. Pregnant women and women who are breastfeeding should talk to their doctor before taking valacyclovir.

Missed dose

If you miss a dose of valacyclovir, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the next dose according to your regular dosing schedule. Do not take a double dose to make up for a missed dose.

Storage

Store the valacyclovir oral tablet at room temperature, safely out of reach of children and pets.

Is valacyclovir hard on the body?

Like most medications, valacyclovir can cause adverse effects. Common side effects of valacyclovir include nausea, vomiting, diarrhea, abdominal pain, upset stomach, and constipation. Tell your doctor if these side effects are severe or do not go away after a few days.

Rarely, valacyclovir can cause more serious adverse events. Call your doctor immediately if you develop a skin rash, itching, fever, yellowing of the skin or eyes, confusion, or blood in the urine.

Is it safe to take valacyclovir daily?

Daily suppressive therapy with valacyclovir is safe for recurrent episodes of genital herpes. It is usually prescribed if you have recurrent outbreaks more than six times a year. Episodic treatment may be repeated as necessary. Valacyclovir is used in people with a healthy immune system as well as immunocompromised patients. However, this medication may not be safe for people with certain medical conditions, for example, liver or kidney problems.

5 things to know about valacyclovir

Besides treatment of genital herpes, valacyclovir is also used to treat cold sores caused by HSV-1, shingles, and chickenpox caused by the varicella-zoster virus,
Generic valacyclovir is equally safe and effective and usually less expensive than brand name Valtrex.
Valacyclovir works by preventing the herpes virus from making copies of itself.
You can take valacyclovir with or without food.
You only need to take valacyclovir twice a day (acyclovir dosing is 3-5 times a day).