[Question #5738] Hsv1 questions

20 months ago
Good morning,

I have a present diagnosis of hsv1 (since 2012 at least). Today I woke up with what I believe to be a fluid filled blister on my lip. I went to urgent care to swab it for confirmation (though the doctor and I both believe it is a cold sore). Assuming it is an hsv1 cold sore, I started to treat it with valcyclovir this morning. I’ll complete the dosing tonight. 

My questions are- what is your recommendation for waiting to 1. kiss someone on the lips and 2. engage in oral sex, to minimize risk of transmission? I’m in the early stages of dating someone and haven’t yet had the conversation about hsv1. 

I have another question- do you have any insight/opinion on getting the shingles vaccine as a way to possibly reduce recurrent outbreaks? I tend to find myself taking valcyclovir around 5 times/year (I think more in summer, but I should probably start tracking better), and I’ve heard/read up about this...

Thanks!
20 months ago
Hello - following up on my question. Thanks. 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
20 months ago
There is no reason to think that the shingles vaccine would give you any benefit at all in terms of herpes control.  It would probably be better to begin daily use of the antiviral medicine to reduce the risk of transmitting to someone else via kissing or giving oral sex (to someone who does not have HSV 1).  If your partner also has ever had a cold sore, then they are infected and this should not be a realistic worry.  We know that people who have HSV 1 orally and have recurrent cold sores shed virus on about 25% of days measured, with no antiviral medicine.  And this can happen when you do or do not have symptoms.  So I can't give you a timetable for waiting to kiss someone after an outbreak or give oral sex.  Hopefully, your partner will already be infected with HSV 1 and not be an issue for the two of you

Terri
---
20 months ago
Thanks- some follows up  questions:

Are you equally as likely to infect another person who is hsv1 negative when your symptoms are present as you are when they’re not? Are these  infection chances different with lip to lip contact vs lip to penis contact?

So if I’m understanding right: people who got the virus and maybe had a cold sore once but never again, are not likely to (or won’t ever) transmit the virus to someone else?

Also, is it possible to have a cold sore on the side of the mouth then immediately after have another one surface in the center of the lips? I took the valcylovir for the sore I had initially and now I feel tingling in a different part of my lips so I’m concerned.

Also can you possibly delete the comment where I wrote my response check-in so that I may have the full 3 response chances.

My swab came back negative but I also popped the blister before it was swabbed (thinking it was pimple) and perhaps there wasn’t enough fluid for the culture to be positive.

Thank you for your help and insight.


Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
20 months ago
We know that people are shedding virus when they have an outbreak, so that's a given.  But we also know the people can shed the same high levels of virus when they don't have an outbreak.  We don't know the risk percentage by location, no.
People who have ever in their life had a cold sore shed virus, just less often than people who have recurrent cold sores.
It is possible to have outbreaks in more than one location but that's not common
I'm not counting that note ;-)
And cultures are not as sensitive as PCR swabs - don't know for sure which type of swab you had done.

Terri
---