[Question #5485] Monogamous mix of HSV1 and 2...what's safe?

22 months ago

Hello, I am a male age 54 involved in a monogamous relationship with a female age 49. I was recently IgG tested positive for HSV-1(index 21.5) and HSV-2 (index 8.35). She was also recently IgG tested positive for HSV-1 only (index 16). I have had cold sores on lip and nose since childhood. I have had no known genital outbreak but I understand that it is common for such to go unnoticed or that I may not have had an initial outbreak yet. She has never had a known outbreak of any kind. I started taking suppressive daily 500mg valacyclovir after these findings since my known oral outbreaks are fairly infrequent.

It is my understanding that it should not be possible for either of us to re-infect the other with HSV-1 (is this correct?). It very much concerns us though that I might infect her with HSV-2. We know that barrier free intercourse is too risky but would like to know about the safety of oral sex without dams or condoms in our situation.

·       Is cunnilingus relatively safe given that my oral infection is likely HSV-1 and she already has antibodies to HSV-1?

·       Should I be PCR typed the next time I have an outbreak or is it safe to assume my oral outbreaks are HSV-1 and my positive HSV-2 test indicates genital herpes?

·       Can you comment on the relative safety of her performing fellatio on me given our profiles?

Thanks!

Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
22 months ago
You are correct about HSV 1, since you both have this.  The likelihood of getting this in a new location is EXTREMELY unlikely. 
Cunnilingus is safe.  There is a small risk of her acquiring HSV 2 orally if she is the giver of oral sex to you without  a condom.  It is low because HSV 2 does not like the oral area and also because she already has oral infection and that MAY offer her some protection against getting  a second type orally - that has been speculated but not confirmed with research.  I don't think it is necessary for you to get a PCR of any oral outbreak, I think it is safe to assume your HSV 1 positive test is due to your history of cold sores.  If you have any sort of genital or anal outbreaks, I would recommend that you get that swab tested so you can start to recognize outbreaks, if you have any, which you may not.
And I definitely agree with your decision to take daily antiviral medicine to cut the risk of transmission by almost 50%
Please let me know what other questions you may have

Terri
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