Genital herpes

Valacyclovir (generic Valtrex®)

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Valacyclovir

How Valacyclovir can help you

You know your body better than anyone. And when it comes to genital herpes, your ability to recognize when an outbreak is about to occur helps you know precisely when you need treatment. There is also the option to take medicine in anticipation of planned life events. Let’s explore the different ways to use valacyclovir depending on your individual needs.

I am very sensitive to the early symptoms of an outbreak.   
If you can detect your early symptoms, the medication can stop the outbreak before it happens. And if valacyclovir can’t stop the outbreak, it may make the outbreak milder and decrease the duration.

I know when an outbreak is more likely to happen even when I have no symptoms. 
Being stressed out, more sexually active, sleeping less, and various other triggers can make outbreaks more likely. You may decide to take medicine to supress an outbreak when you know you are particularly susceptible to one.  

I want to suppress outbreaks around important events.
These events can range from starting a new job to going on a honeymoon to entering a new relationship. Your focus is to minimize the chances of an outbreak within a specific period of time.

I want to decrease the risk of transmission to my uninfected partner. 
Not only can valacyclovir decrease your number of outbreaks when used every day, but it can also reduce the number of days you shed the virus asymptomatically, which decreases the risk of transmission. Even if you’re on medication, you may still transmit herpes to your partner. You and your partner should talk about your sexual health before becoming intimate.

More on Genital Herpes

Genital herpes is a sexually transmitted infection that’s caused by Herpes Simplex Virus type 2 (HSV-2) and Herpes Simplex Virus type 1 (HSV-1). HSV-2 is the most frequent cause of symptomatic genital herpes; however, HSV-1 also commonly causes genital herpes. Genital herpes can be passed along with no physical symptoms on the skin or genital mucosa (1). And since it’s transmitted by skin to skin contact like sex, talking with your sexual partner becomes even more important. 

Genital herpes is a very common STI. The CDC estimates that about 12 percent of the population (ages 14–49) are infected with HSV-2 and there are approximately 776,000 new cases in the U.S. each year.

Frequently Asked Questions

What is valacyclovir?

Valacyclovir is an antiviral medicine that is used to treat herpes viruses, including oral herpes (cold sores) and genital herpes. For more information on valacyclovir see the Prescriber’s Digital Reference (PDR).

Valacyclovir works by interfering with the herpes virus’ ability to make more copies of its DNA. Since the herpes virus is basically just DNA wrapped in a protein coat, the inability to make more DNA means that the virus can’t replicate. The clinical outcome of this is that taking valacyclovir appropriately is effective at aborting outbreaks of oral and genital herpes, shortening the duration of an initial episode of genital herpes, suppressing outbreaks of genital herpes, and decreasing the risk of transmitting genital herpes to an uninfected partner.

How to use valacyclovir

There are two ways to use valacyclovir. It can be used at the first sign (prodrome) that an outbreak is coming on to abort an outbreak or it can be used daily as suppressive therapy to help prevent outbreaks. Your doctor will recommend dosing and instructions based on your individual case, but the following are general guidelines for patients without other health issues. If used as abortive therapy, one 1,000 mg tablet taken daily for 5 days is recommended. When used as daily suppressive therapy, the PDR (Physicians’ Desk Reference) states patients with 10 or more outbreaks per year are best treated with a 1000 mg tablet. Patients with fewer outbreaks may use the 500 mg tablet. In HIV-infected patients, 500 mg twice daily is recommended. When used daily, valacyclovir should be taken at the same time, with or without food.

Who shouldn’t use valacyclovir?

Valacyclovir should not be used if any of the following apply:

  • Hypersensitivity or allergy to valacyclovir, acyclovir, famciclovir, ganciclovir, or valganciclovir
  • Patients with HIV or kidney disease or dysfunction or who have had a kidney or bone marrow transplant should discuss this with their doctor before starting valacyclovir
  • Pregnant and breastfeeding women should discuss the use of valacyclovir with their maternity provider or their pediatrician, respectively

For a full list of contraindications and precautions, see the PDR

What are the potential side effects of valacyclovir?

The most common side effects include: 

  • Headache
  • Feeling sick
  • Dizziness
  • Vomiting
  • Diarrhea
  • Skin reaction after exposure to sunlight (photosensitivity)
  • Rash
  • Itching (pruritus)

Valacyclovir may also cause kidney and nervous system problems in some patients. These side effects are uncommon but can be serious. For a full list of side effects, see the PDR.

When should I contact my Rory-affiliated physician?

Contact your Rory-affiliated physician, and all of your healthcare providers, if you experience any new symptoms after beginning valacyclovir. If you have any serious signs or symptoms like, but not limited to, fever, seizures, confusion, or swelling, please seek out emergency medical treatment.

How does genital herpes treatment with Rory work?

We use telemedicine technology to allow U.S. licensed doctors to provide genital herpes treatments discreetly, conveniently, and inexpensively.

It starts with your online doctor visit. Your doctor needs to know about your health (e.g., your medications, lifestyle, and prior surgeries) and how genital herpes affect you.

They also need a personal ID so they know who they will be evaluating and treating. Your doctor will review your information, determine if you’re a candidate for treatment via telemedicine and, if so they will craft a personalized treatment plan.

Your treatment plan will include a great deal of information about genital herpes. It is important you take the time to read it all. You will be better prepared to manage your condition as a partner—and not just a patient.

What are the different ways to use valacyclovir?

To Treat Or Abort An Outbreak When There Are Early Symptoms (Prodrome)

Your doctor will provide dosing and instructions, but the following are generally accepted guidelines for healthy patients. At that earliest sign, take two tablets of Valacyclovir 1000 mg (for a total of 2000 mg) by mouth as the first dose. Then, 12 hours later, take 2 tablets of 1000 mg of Valacyclovir (for a total of 2000 mg) by mouth as the second and final dose. The medication is only approved for two doses and there is no evidence that medication can stop an outbreak once a lesion (sore) has appeared. The second dose can be taken sooner than 12 hours after your first dose but never before 6 hours have passed. Be sure to drink plenty of water— adequate hydration makes sure the medicine is cleared through the kidneys.

To Suppress Outbreaks When There Are No Symptoms But Outbreaks Are More Likely

Patients also learn the life circumstances or behaviors that lead to more outbreaks. For some, a lack of sleep, increased alcohol, another illness, stress, too much sunlight, irritation, or anything that can affect one’s immunity can spur an outbreak. They know when they are more likely to have an outbreak due to their circumstances. They can avoid their triggers but they also might want to take medication preventatively knowing when they are more vulnerable. Essentially they might take the medication for a week or two until the circumstance that is making them more susceptible to an outbreak has resolved.

To Suppress Outbreaks For An Extended Period

Patients can take medication when they would like to do all they can to reduce their chance of having an outbreak. This might be during a honeymoon, going on vacation, starting a new job, in a new relationship, or at any time a patient feels it is how they want to keep the chance of having an outbreak as low as possible.

To Reduce the Risk of Transmission to An Uninfected Partner

One of the most important advances in herpes treatment came with the knowledge that transmission from an infected person to their uninfected partner could be reduced. Valacyclovir not only reduces the number of outbreaks a person experiences but it reduces asymptomatic shedding. That results in fewer uninfected partners catching herpes. If a condom is worn and the medication used, the chances are reduced at least in half compared to using a condom alone. Fewer outbreaks and fewer episodes of shedding means fewer people become infected.

What type of genital herpes medication do you prescribe?

Rory-affiliated physicians prescribe valacyclovir (generic Valtrex) to treat genital herpes. When used properly, this medication can abort an outbreak at the first sign that one is coming on or lessen its severity. 

Valacyclovir is associated with a number of side effects, including rare but serious side effects impacting the kidneys and nervous system. To learn more about the safety of valacyclovir, please see this IMPORTANT SAFETY INFORMATION.

Is genital herpes medication effective?

Valacyclovir is safe and effective for the treatment of genital herpes. But getting treatment right requires you to dedicate the time to learn about your condition and work with your physician to craft the ideal, personalized treatment plan. When you do, you’ll be able to identify your specific symptoms (prodrome) and use your medication to shorten or stop the outbreak from occurring.

Valacyclovir is associated with a number of side effects, including rare but serious side effects impacting the kidneys and nervous system. To learn more about the safety of valacyclovir, please see this IMPORTANT SAFETY INFORMATION.

What are the side effects of genital herpes medication?

Please note: what follows is a summary and does not include every side effect possible.

Common side effects include headache, feeling sick, dizziness, vomiting, diarrhea, skin reaction after exposure to sunlight (photosensitivity), rash, or itching (pruritus).

Uncommon side effects include feeling confused, seeing or hearing things that aren’t there (hallucinations), feeling very drowsy, tremors, or feeling agitated, shortness of breath (dyspnea), stomach discomfort, rash, sometimes itchy, hive-like rash (urticaria), low back pain (kidney pain), blood in the urine (hematuria), reduction in the number of blood platelets which are cells that help blood to clot (thrombocytopenia), reduction in the number of white blood cells (leucopenia), increase in substances produced by the liver.

Rare side effects include unsteadiness when walking and lack of coordination (ataxia), slow, slurred speech (dysarthria), fits (convulsions), altered brain function (encephalopathy), unconsciousness (coma), confused or disturbed thoughts (delirium), kidney problems where you pass little or no urine. Lastly, watch out for a severe allergic reaction (anaphylaxis). These are rare in people taking Valtrex. Anaphylaxis is marked by the rapid development of flushing, itchy skin rash, swelling of the lips, face, neck, and throat—causing difficulty in breathing (angioedema), fall in blood pressure leading to collapse. If any of these occur, get emergency treatment immediately.

To learn more about the safety of valacyclovir, please see this IMPORTANT SAFETY INFORMATION.

Can a doctor treat genital herpes remotely?

Yes. Rory-affiliated doctors can prescribe medication and help you dial in the most effective treatment plan for your unique needs.

Rory enables doctors to use telemedicine technologies to treat genital herpes in the same way they treat patients in-person. Doctors ask you questions to evaluate your symptoms and make sure it’s safe and appropriate to prescribe cold sore medication. Your doctor will use your answers to assess your condition and create a treatment plan. That’s why it’s vital you answer each question to the best of your knowledge and ensure that every communication with your physician is truthful, accurate, and thorough.


Do I need to take a photo of my genital herpes outbreak?

No.

Are there any special groups that shouldn’t take valacyclovir?

Yes. Certain people should not take valacyclovir and others should use decreased doses of valacyclovir. Below are some important examples.

Sensitivity or Allergies: Patients with sensitivity or an allergy to any of the following medications should not use Valacyclovir: Acyclovir, Famciclovir, ganciclovir, penciclovir, valacyclovir, or valganciclovir.

Kidney Issues: Dose adjustments should be made for those with kidney impairment or issues. Decreased doses are needed as kidney impairment slows the clearing from the body of valacyclovir. The degree of impairment determines the decrease in the dosage. The PDR states, “Acute renal failure and CNS (Nervous System) toxicity have been reported in patients with underlying renal (Kidney) dysfunction who have received inappropriately high doses of valacyclovir for their level of renal (Kidney) function. Patients receiving potentially nephrotoxic (Toxic to the Kidney) drugs together with valacyclovir may have an increased risk of renal dysfunction (impairment).”

The Elderly: The elderly are more likely to have impaired kidneys so they might not clear valacyclovir from their system as efficiently as they should. This can lead to inappropriately high levels of valacyclovir, which means the elderly may need lower doses of valacyclovir. The elderly are also more likely to experience neurological side effects, including: agitation, hallucinations, confusion, delirium, and other abnormalities of brain function termed encephalopathy.

Dehydration: When patients are dehydrated acyclovir can reform as a solid in the kidney leading to kidney damage. Patients should all remain well hydrated when taking valacyclovir.

Pregnancy: While a registry that collected data on the 756 pregnancies of women exposed to acyclovir in the first trimester showed no greater occurrence of birth defects than occurs in the general population, the study size was too small to guarantee safety during pregnancy.

You should not take Valacyclovir if you are pregnant or trying to become pregnant unless recommended by your obstetrician/gynecologist or other healthcare provider.

Breastfeeding: The PDR states, “According to the manufacturer, valacyclovir should be administered to a nursing mother with caution and only when indicated. Although the American Academy of Pediatrics (AAP) has not specifically evaluated valacyclovir, systemic maternal acyclovir is considered to be usually compatible with breastfeeding…Consider the benefits of breastfeeding, the risk of potential infant drug exposure, and the risk of untreated or inadequately treated condition.”

See here for other special groups, warnings, and precautions.