HSV-2 Transmission Probability

[DW56]

I am 57 yrs old and approximately 15-20 yrs ago developed a herpetiform lesion on my lower lip about 5 days after performing cunnilingus. It currently recurs annually with a significant prodrome ( enough so that I can start Valtrex priour to the eruption).
Now the second part of the history leading to the query. I am now dating a woman who says she contracted HSV-2 (traditional location anatomically) about 15-20 years ago. She has had only 2 outbreaks in the ensuing period of time. And, her last was "a long time ago."
1) Is there any immune protection in my case for infection?
2) Can I take Valtrex as a prophylactic measure?
3) How long does one need to be on Valtrex for it to be effective?
4) Am I over reacting?

[Terri Warren, RN, Adult Nurse Practitioner]

In order to know if you have immune protection (I like that term!), you will need to have an antibody test done to see if your infection is HSV 2 or HSV 1 or both.  I would encourage you to do that so you and your potential partner will know exactly what the risks are here.  

If she has HSV 2 and you do not, then she is the one that should take antiviral therapy to protect you, not the other way around.  If you have HSV 1 and she has HSV 2, then you are vulnerable to her HSV 2 but she is not vulnerable to her HSV 1.  

You are most certainly not overreacting!  You both need to know where things stand on who is infected with what.  This is a completely normal discussion to have.  I commend you for approaching this in a thoughtful and careful way.

Terri

[Terri Warren, RN, Adult Nurse Practitioner]

Very interesting.  You have HSV 2 and hSV 1 infection.  Where these infections are we cannot know.  The fact that you developed a lip lesion after giving someone oral sex suggests that it is possible that you have HSV 2 infection orally.  However, just so you know for the future, I would suggest that the next time you get a cold sore on your lip, don't treat it but rather go get it swab tested to determine the type of virus.  Don't treat before you are able to get it swab tested.  PCR testing is better than culture swab testing.  At any rate, if you do have oral infection and she has genital infection, you are highly unlikely to get HSV 2 genitally if you already have it orally.  But I wouldn't assume that you necessarily have it orally without testing out that idea.  

And this reflects just one more reason that IgM testing cannot sort out new from old infection, right?

Terri

[DW56]

The tests returned with both HSV-1 and HSV-2 positive for both IgG and IgM. Both indwx values were over 6.0. Remember, I've never had any lesion below my lower lip. Am I protected from contracting genital herpes/lesions?

[Terri Warren, RN, Adult Nurse Practitioner]

If you have antibody to HSV 2 (that has an index value of greater than 3.5 and does not need confirmation), that means that you already have HSV 2 infection and won't get hers again.  Let me know.

Terri

[DW56]

Thanks Terri. I
My IgG/IgM tests are "in the lab." GIVEN that I have antibodies for each and the only manifestation I've ever had was a buccal / labial lesion, am I at risk for contracting genital HSV2? Or, do I have "immunoprotection?"