Hi Dr. Terri,

I recently changed my primary care provider and tested positive for HSV-1 and HSV-2 on a blood panel. I’ve never had noticeable herpes symptoms (no lesions/sores) and no known exposures. My partner and I have been in a monogamous heterosexual relationship for the past 7 months with unprotected sex. He has tested negative for HSV-1 and HSV-2 three times.

Given this mismatch, I’d really value your guidance on:

1. Testing accuracy & next step:

   • Do you recommend a confirmatory Western Blot , I have had Roche Test thrice and tested positive

2. Risk reduction for a discordant couple

   • Besides abstinence, what is the best current strategy to reduce transmission from me to my male partner? I have never had any symptoms and in the 7 months we have had unprotected sex he has tested negative?

3. Oral sex & HSV

   • Is oral sex safe if I have no symptoms?

Hi Terri,

Thank you so much for your thoughtful and detailed response—I really appreciate the clarity.

I want to make sure I’m understanding you correctly:

1. Testing / Western Blot
   Based on my repeated positive Roche results and the low false-positive rate you mentioned, it sounds like you feel a Western Blot is not necessary at this point and that my results are most likely accurate. Please let me know if I’m interpreting that correctly.

2. Oral Sex Clarification
   Regarding oral sex, I wanted to clarify: if I am on daily valacyclovir suppression and I have never had symptoms, is it reasonable for:

   • me to perform oral sex on my partner, and/or

   • for my partner to perform oral sex on me
     with reduced risk? I understand there are no absolute guarantees, but I want to be sure I’m accurately understanding the relative risk while on daily antivirals.

3. Daily Valacyclovir Prescription
   My primary care physician does not feel suppression is necessary since I’ve never had symptoms. However, given that I’m in a discordant relationship and want to be proactive about reducing transmission risk, are you able to prescribe daily valacyclovir (e.g., 500 mg daily) for suppression?

Thank you again for your guidance. This information has been incredibly helpful as we try to make thoughtful, informed decisions together.

Warm regards,

Hi Terri,

Thank you so much for your clear and thoughtful response. I really appreciate you taking the time to explain this so thoroughly.

That’s very helpful regarding the Roche test and oral sex risk, and I understand now why suppression still makes sense even for those without noticeable symptoms.

As a follow-up, I wanted to ask:

• Are there any common or notable side effects I should be on the lookout for if I start daily antiviral therapy?

• Do you generally advise valacyclovir (generic) or Valtrex (brand), or are they essentially equivalent in effectiveness and tolerability?

Thank you again, this guidance has been incredibly helpful as I navigate the next steps.

Warm regards,