HSV1 Gential Infection Questions about transmission/safe sex

[St.Bernadette]

Hello Doctor,

I have read through your very informative responses but still have some lingering questions about my HSV1 infection.

I was diagnosed this week via culture with an HSV1 infection around my anus that I'm guessing I got from oral sex. My boyfriend is in the process of getting a blood test for herpes but we suspect that he does not have any infection as he has no history of cold sores/lesions.

I am currently taking acyclovir to treat this outbreak and I am on my third day of treatment at 400 mg, three times daily. Here are my questions:

1. Is my dosage of acyclovir enough? I still feel a little itchy and noticed I still have bumps in the shower. How long will it take to clear up?

2. How long should I wait after this outbreak to have sex with my boyfriend again? I am very concerned about infecting him.

3. How likely is it that I will pass my HSV1 to his genitals or to his mouth if he gives me oral sex? Should we be using condoms everytimes for sex and a dental dam for oral sex?

4. Is suppresive therapy an option for me if my boyfriend tests negative for HSV1? Is suppressive therapy typically covered by insurance?

5. If my boyfriend tests positive for HSV1 do we need to take any precautions during sex? If he has cold sores can he still get HSV1 infection on his genitals from having sex with me?

Thank you for your commitment to this forum.

[H. Hunter Handsfield, M.D.]

I'll assume your anal HSV-1 infection is accurate.  But be certain the testing was done properly.  Initial anal herpes in a woman due to HSV-1 would be uncommon.  (You don't actually say your gender, but the context makes me think so.  If you're a gay man, HSV-1 might be a better bet.)

1) Presumably you're still taking treatment for the initial episode.  That dose is fine.

2) Once any open sores are healed, you are not likely to be infectious.

3) Most likely your boyfriend is immune, since more than half the population has HSV-1.  He can have a blood test to know. If he is already positive, you don't need to worry about it.  And as I said, asymptomatic shedding of HSV-1 is uncommon.  So if there is any risk at all (between your outreaks), it is very low.

4) Most people with genital or anal HSV-1 do not need suppressive therapy with acyclovir or anything else.  Most such infections do not recur frequently and asymptomatic shedding and transmission are uncommon.  But it certainly is an option, and probably would be covered by insurance.

5) See above.  People already infected with a particular HSV-1 type are very resistant (often completely immune) from catching it again, on any part of their body.

Good luck--  HHH, MD

[St.Bernadette]

thank you for your response.

i had my testing done at a very reputable GID unit at one of the major hospitals here in Boston, so i probably think they're accurate.

the boyfriend is working to get tested. 2 or 3 places we've called do not do the blood test for herpes anitbodies. we're calling a few more places today.

thanks again for your response.

[traversingtheworld]

If you don't mind, would you be able to post the Boston locations that you find that do the blood tests?  I live here in Boston, and have recently been exposed to herpes and am trying to figure out what my next step needs to be.  I do need to get tested, but don't know where to go yet.  Thanks and good luck!

[St.Bernadette]

Planned Parenthood in Boston will do it.

Greater Boston Center
1055 Commonwealth Avenue
Boston, MA 02215-1001
Phone [phone]

good luck!