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Acyclovir vs valacyclovir

About 6 months ago I was tested positive for HSV-2. I have had several outbreaks since then, but they were all pretty minor (1-2 sores). I was taking Valtrex daily for about a month and a half, but I developed what appeared to be cystic acne the whole time I was on it. As soon as I stopped, my skin cleared up, but I had another outbreak, so I went back on it and my skin started to break out again. I've never read anything about that being a side effect, but it was the only explanation. I talked to my doctor about this and she told me to try acyclovir instead. Now I'm starting to take 400 mg once a day.

My main concern is to lower the risk of infection in my new partner. I haven't yet told him that I have herpes, but when I do I want to be able to say that the risk of transmission is very low (when combining daily suppressive drugs and condoms). I read a lot of statistics about Valtrex, but not as many about Acyclovir. Are both drugs just as effective in preventing transmission? Also, should I be taking 400 mg twice a day instead of once? My doctor has been down playing the issue a lot and only gave me the prescription to take it daily bc I asked her to.

Any advice/information would be greatly appreciated! Thank you!
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I believe (though I could be wrong) valacyclovir is the only drug that is approved by the FDA for suppressive therapy, because it's the only drug that has had an FDA registered clinical trial performed for this purpose. However, it is well documented that valtrex and acyclovir perform very similarly. Valtrex is actually converted into acyclovir by the liver, so essentially, the two drugs act the same way in the body to suppress the virus. If acyclovir improves your quality of life, I would stick with it and explain the similarities to your partner - they are well documented and I expect you can find information in scholarly journals that supports the suppressive activity of acyclovir. The benefit of valtrex is that it can be given at a higher dose and only once per day.

However, all studies with acyclovir that have had similar outcomes to valtrex have been with twice daily dosing. So, I think you would be right to have your doctor prescribe that schedule for you.

Also, I had a doctor who wouldn't even prescribe me suppressive or episodic therapy even though I had a positive blood test and symptoms that I was sure were related to herpes. After months of being strung along with her trying to rule other things out (unsuccessfully), I found a doctor who took my condition seriously and prescribed me valtrex. If you don't think your doctor is taking this seriously, then maybe try seeing someone else. I think there is a tendency in the medical community to downplay the diagnosis, because of the stigma associated with this disease. I appreciate that, but at the same time, it does need to be managed responsibly and you need to find someone who will be on your side to make that happen.
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Avatar universal
That makes a lot of sense and would clear up a lot of my confusion about the different statistics I've found. Thank you! I also decided I'm going to go to a new doctor and ask for the acyclovir twice daily dosing. Good thing for the internet...
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