Valacyclovir Prophylaxis for wrestling

Question from provider --
Is there evidence to support using valacyclovir prophylactically for wrestlers? (prevention, NOT suppression)

Study analyzed the use of valacyclovir over a 10 year period (2003-2012) in participants at a 28-day wrestling camp in Minnesota for collegiate wrestlers
(Not a RCT) but looked at comparison of outbreaks of herpes gladiatorum from HSV-1 infection between subjects using valacylovir for prophylaxis or not using prophylaxis
3-4% had a known history of HSV-1 infection
29.8% seropositive for HSV-1
use of valacyclovir for prophylaxis --> ~87% reduction in outbreaks
started treatment 3 days before the start of camp and continued treatment through the end of the camp (28 days)
valacylcovir was dosed at 1 gm once daily
subjects also required to take other precautions such as daily skin checks and showers after physical contact
2793 total subjects over 10 years  --> 224-334 subjects annually
23. 1 outbreaks/year on average vs. 3.6 outbreaks/year during study (majority of outbreaks occurred in those not using antiviral prophylaxis)
~1 outbreak/year among the users of antiviral prophylaxis

of the total subject sample size, 2221 available for individual data assessment over 8 year period
71% on prophylactic antivirals
67 with a known history of HSV-1, of these, 9 had outbreak (13.4%)
only 1.1% of total had outbreak with no history of HSV infection

conclusion:
higher usage of prophylactic valacyclovir correlates with reduced number of outbreaks
valacyclovir suppresses seroconversion and reduces shedding of virus
team-wide usage of antiviral prophylaxis is appropriate
proven more efficacious than acyclovir 400 mg BID

Reference:
Prophylactic Valacyclovir to Prevent Outbreaks of Primary Herpes Gladiatorum at a 28-Day Wrestling Camp: A 10-Year Review

Anderson, B. J. MD; McGuire, Dennis P. PhD; Reed, Megan DC ATC; Foster, Monique M.Ed ATC; Ortiz, Deanna ATC

Clinical Journal of Sport Medicine  

Issue: Volume 26(4), July 2016, p 272–278

 

Recommendation: recommend antiviral prophylaxis with valacyclovir

dose --> unsure (the study used 1 gm once daily, but the FDA approved dose for SUPPRESSION is 500 mg once daily