[Question #3915] HSV1 Transmission Prevention

32 months ago

Dr. Handsfield, I appreciate your willingness to answer some questions on a subject matter with conflicting information and differences of opinion. I’ll try to be as brief as possible. My girlfriends has HSV1 orally. I am a male and negative for both HSV1 and HSV2. I understand that over 50% of the population has HSV1 and it’s not a big deal at all, however I would like to do all I can to prevent the acquisition of HSV1 both orally and genitally. We have a great relationship and are very open with communication. She wants to do everything she can do to prevent transmission as well. We engage in unprotected oral, kissing, and everything else. For me, the more data and understanding = less anxiety about this. Less anxiety for me = less UNcomfort to her. I also feel like these answers will help a lot of people.Here are my questions:

 

  1. She is open to taking daily suppressive therapy. Money is not an issue. How much Valtrex should she take daily, and what is your estimate ( I know that there is no hard data on this so just looking for guesstimate) of the reduction in viral shedding orally? I hear 9-18% without suppressive therapy. Is it correct to assume this would be cut in half?
  2. After she has a cold sore on her lip, how long should we wait to kiss etc. after the skin heals completely?
  3. If she feels a cold sore coming, but it never appears, how long should we wait to kiss etc?
  4. If she does have a cold sore appear, but it does not break, then it disappears, how long should we wait to kiss etc.
  5. What do you expect the transmission rate to be during contact w/ virus during viral shedding? Assume deep kissing and oral sex for 3-5min.
  6. Can shortening the duration of oral sex, reduce the potential of transmission? Assume under 1min rather than 5min?
  7. Does the fact that she has had HSV1 orally since she was a young child influce viral shedding percentages?
  8. Do you still feel that transmission is 1% when exposed to the virus? Are there variables that can influence this such as broken / thin skin?
  9. Does washing after oral have any influence on transmission?

 

Thank you.

Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
32 months ago
  1. She is open to taking daily suppressive therapy. Money is not an issue. How much Valtrex should she take daily, and what is your estimate ( I know that there is no hard data on this so just looking for guesstimate) of the reduction in viral shedding orally? I hear 9-18% without suppressive therapy. Is it correct to assume this would be cut in half?
People with symptomatic recurrent oral herpes shed virus on about 25% of days.  Valtrex likely reduces viral shedding by about half.

  1. After she has a cold sore on her lip, how long should we wait to kiss etc. after the skin heals completely?
The thing is that people can give off virus even when they have no symptoms, so that question is tough to answer.  I would certainly wait until new skin has replaced the cold sore.
  1. If she feels a cold sore coming, but it never appears, how long should we wait to kiss etc?
Again, that's not a question we can answer, given asymptomatic shedding.

  1. If she does have a cold sore appear, but it does not break, then it disappears, how long should we wait to kiss etc.
See above

  1. What do you expect the transmission rate to be during contact w/ virus during viral shedding? Assume deep kissing and oral sex for 3-5min.
We do not have any data on your question, I'm afraid.

  1. Can shortening the duration of oral sex, reduce the potential of transmission? Assume under 1min rather than 5min?
Again, no data.   We do know from our studies of genital infection that the more exposure you have, the more risk there is for infection so I would assume that shorter oral sex would result in less risk.

  1. Does the fact that she has had HSV1 orally since she was a young child influce viral shedding percentages?
Again, we don't know that.  That is true with genital infection in most people, yes, that they shed less over time.

  1. Do you still feel that transmission is 1% when exposed to the virus? Are there variables that can influence this such as broken / thin skin?
I think the risk is higher than 1%.  Certainly broken skin in the genital area increases the risk of infection

  1. Does washing after oral have any influence on transmission
Again, we have no data, but it certainly couldn't hurt.  We don't know how quickly infection happens after someone is exposed to the virus

You should be aware that the IgG test for HSV 1 misses 30% of infection compared to the gold standard western blot so even if you test negative for HSV 1 on the IgG test, it may well have it wrong.

Terri Warren
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32 months ago
I was hoping for Dr. Handsfield or Dr Hook would answer since i have read a lot of their past commentary and guestimates, and the shedding numbers and transmission numbers you mention differ than what they have mentioned before in the past. Is it possible that one of them could advise on my questions below?  I’m happy to submit a fresh question. Please advise. 
31 months ago
Hi Just touching base to see if Dr. Handsfield or Dr. Hook would comment. I'm happy to submit a new question. Also, i'm not looking for statistical data, just best guess based on the knowledge base. Please advise whether i should submit a new question.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
31 months ago
I asked Dr. Handsfield to take a look at this post and he agrees with my responses to you. 
He does remind you that life is full of risks, that this is a minor infection that's very common.
And I would remind you the IgG test misses 30% of HSV 1 infections based on a study we published last year, looking at several hundred patients, so you could actually be infected after all and worrying without reason about this. 
I don't know what shedding statistics are different than what Dr. Handsfield quoted.  Remember that oral HSV 1 and genital HSV 1 have very different shedding patterns and rates - very different.  HSV 1 truly prefers the oral/facial area vs the genital area and sheds far more often there, especially in a person with recurrent cold sores.

Te4rri
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