GHSV1: taking suppressive therapy or not?

[Westerby]

I'm a 33 year old man with genital HSV-1. I was diagnosed via swab about 4 years ago. I had one primary outbreak and then another, milder episode about six months later.
Last year I began to get some fairly persistent areas of dry skin on my penis. Never blisters or lesions or anything painful. But I had never had dry skin on my penis before having herpes. I went to see my dermatologist many times to show him the dry skin, and he insisted that it was NOT a herpes outbreak. He said it was just dermatitis. But I remain slightly skeptical. He gave me some prescription moisturizer, which did help. But it still tends to come back time to time. My dermatologist also said that HSV-1 genital herpes in men my age tends to "go away." (I think what he meant was that it doesn't reoccur.)

I'm attempting to start dating again, and I'm just paralyzed with fear about giving herpes to someone else. (I'm virtually a social hermit these days.). The dry skin potentially being an type of outbreak bothers me a lot. I've never been on suppressive therapy before.
Here are my questions:
1.)  Is valtrex worth my while or not? I keep reading that people do not prescribe daily valtrex to people with genital hsv1, but would it help at all?
2.) If I have no symptoms I assume I am also shedding asymtomatically  Does taking valtrex daily reduce asymtomatic shedding in men with genital hsv1?
3.) If I use daily valtrex and condoms, what are the chances of me giving herpes to a girl who doesn't have HSV 1 in either place? Have you ever seen a case where someone contracted genital HSV1 from a guy who was wearing a condom and using valtrex? What about using valtrex and NOT using a condom?
4.) Have you seen many cases over years of genital to genital HSV1 infecting?
5.) If I dated a girl with genital HSV2, would I have a lesser or greater chance of catching that strain also? If she uses valtrex? Could I catch hsv2 orally from her by performing oral sex?
Many thanks...

[Terri Warren, RN, Adult Nurse Practitioner]

No, I don't think so.  Herpes looks nothing like dry skin, except perhaps when a sore is healing at the very end.  That's not what you are describing.

Terri

[Westerby]

Terri,
Thanks for the response.
Regarding my dry skin episodes I mentioned in my post. Despite my dermatologist's prognosis that it's just dry skin, do you think it could be a mild outbreak presenting itself? Have you ever seen that?
Thanks

[Terri Warren, RN, Adult Nurse Practitioner]

Valtrex reduces the risk of transmission of HSV 2 by half - should be just about as good for reducing the risk of transmitting HSV 1 as well.  We do prescribe this for daily use with people who have frequently recurring cold sores and also for people who have HSV 1 who have partners who do not have HSV 1 (either oral or genital).

You will shed some asymptomatically, but not a lot.  We don't have studies on the reduction of specifically HSV 1 genitally, but we do know that it reduces viral shedding of oral HSV 1.  

Again, we don't have the studies you are asking for on this topic.  I have not yet seen a patient who acquired HSVs 1 from a male using Valtrex and condoms, no, and I don't expect to.  I have also not yet seen a patient who contracted HSV 1 from someone who has genital HSV 1 and is taking Valtrex daily, no.

I have seen rare cases of HSV 1 genital to genital transmission, but I have seen them, yes.

Again, we don't have studies on this question.  However, we do have some evidence to suggest that your risk of getting HSV 2 is reduced due to your HSV 1 genital infection, but I wouldn't assume you are safe by any means.  If she uses Valtrex for her HSV 1 infection, your risk of acquiring HSV 2 from her is about 2% per year.  You could acquire HSV 2 orally by giving her oral sex, but that is uncommon.

Terri