[Question #7691] Genital HSV-1

1 months ago
How does one explain the risks of transmission of genital HSV-1 to short-term parters?

I remember not long ago I asked about notifying partners about genital HSV1 status and how it is more about trust than transmission. Genital HSV1 is an interesting variation of herpes, because it still has the name/stigma of being "herpes" yet it is characterized by a very different set of transmission/health risks and guidelines compared to other forms of herpes, as you pointed out to me (correct me if I'm wrong):

-HSV 1 is infrequently shed from the genital tract compared to oral HSV1 (and HSV2)
-Avoiding oral sex with genital HSV1 is not necessary (why?)
-There are not yet documented cases of genital HSV1 being transmitted through intercourse
etc.

I've been good about communicating this status, except from my experience it consistently ends up creating more confusion/anxiety for short-term partners when herpes is brought up in the first place (maybe because in the short-term it comes across that it's being communicated "just in case", rather than for the sake of open communication?). 

Should I therefore avoid seeing short-term partners? I don't know if keeping my HSV1 status to myself for short-term parters, even if I were practicing protected sex, would be a good or bad idea, even with the information you provided. Could you clarify?

Thank you in advance! 

-Evan
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
1 months ago
This truly is not a black and white issue.  Some providers even say not to bother to tell people about an HSV 1 genital infection. 
You are correct that HSV 1 genital infection is rarely active, and after two years of being infected, the data shows that the shedding rate is about 4 days per year.  Are you two years out from diagnosis?
My hope is that with more casual partners, you are using condoms consistently to protect against other sexually transmitted infections. This will greatly reduce transmission to partners
Are you taking daily antiviral medicine at all?  If not you could consider doing that and/or regular condom use and then it MAY not be absolutely necessary to discuss this with casual partners.  I don't have a magic answer here and the other professionals that I know are all over the board in their advice. 
What do YOU think?

Terri
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1 months ago
That is correct, it has been a little over 2 years now so I'm hoping the shedding rate has maybe decreased as you described. 

I am practicing protected sex for many reasons and a big reason for this is I didn't fully understand the risks of spreading genital HSV1 to others until this conversation. I do have Valtrex which my doctor gave it to me upon my recent request last fall (just in case), but now after getting new antibody bloodwork which confirmed it was HSV1 (genital because that's where the lesions had occurred) and with the information you provided, this tells me my chance of having a 2nd outbreak isn't very high. Should I start regularly taking and refilling this Valtrex for casual partners? And say I theoretically saw casual partners regularly, would there be side effects from taking Valtrex that frequently (and even in the presence of alcohol) over time? I also understand that the standard pharmaceutical shelf life for a prescription is one year, so how long does it take for Valtrex pills to become ineffective (where I'd need to get a refill)?

It makes me wonder though, does genital HSV1 spreading to other partners usually happen if lesions are present or is it usually asymptomatic (from your experience)? And does the 4 days a years of shedding decrease as the years go on or is it consistent? I'm only worried about oral sex because casual partners are usually less keen to do so with a condom on (and dental dams aren't always available with casual partners). If I take Valtrex before every casual partner encounter, maybe the risk of transmitting to their oral area is not to worry about, but if I have not taken Valtrex in said instances, should I simply just avoid oral sex and stick with protected sex?

Thank you again for your help,
Evan
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
1 months ago
It is certainly not a problem to take this medication daily.  I've had patients on acyclovir/valacyclovir for 30 years without any issues at all.  This medication is activated only when the virus is active, so if it is not, it is simply excreted, unchanged. 
I think valtrex is good way beyond a year.  It is a tablet rather than a capsule so I think the shelf life is longer.
We don't have good data on transmission of genital HSV 1 to sex partners.  For HSV 2, we know that most transmission happen when there are no symptoms present so it could be similar.
If you take Valtrex prior to sex with a casual partner, that's a good idea, but you need to take it for five days before it is fully effective, so you may not want to take it that way, with little notice of casual sex? 
I don't think there is any more risk of receiving oral sex and transmitting than having intercourse and transmitting, really.  If there is a difference, it is minimal, I would say.
You are asking great questions and thoughtful ones as well.

Terri
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1 months ago
I appreciate your previous answer, that clears up a lot of confusion.

I think what I've gathered is that, moving forward, sex with casual partners should continue to be practiced protected and ideally paired with Valtrex (taken at least 5 days leading up). To clarify, is the Valtrex mainly in case oral sex occurs unprotected (for people who have had genital HSV1 over 2 years)? Or is it also because transmission during protected sex still can (and sometimes does) occur? 

I understand the data isn't very good, but in your medical experience how do partners with genital HSV1 generally give it to their partners (if it does happen)? Orally or genitally? 

Thank you again,
Evan
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
1 months ago
Taking Valtrex would only be to reduce the already very small risk of infecting someone and might be seen as an additional safety measure if you choose not to tell casual partners about your HSV 1 infection.  I think the likelihood that someone would get HSV 1 from you while wearing a condom alone (without daily antiviral medicine)  is very remote and unlikely. 
And no, I don't know of a case of my patients who transmitted HSV 1 genital infection to their partners through intercourse or through giving oral sex to someone with genital HSV 1.
I know you are struggling with what is the best medical practice and what is the most ethical practice here and it's really good that you are processing this.  It's not a straightforward issues like HSV 2 transmission so my answers are less clear cut but I think we have shared some options here about what to do about casual partners.  My best advice about that, for more than herpes reasons, is to have casual partners use condoms and antiviral medicine is probably not necessary. 

Terri
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