HSVI and risks of oral

I am about to reconnect with a past partner and we plan on having sex with condoms.  He is aware of my genital HSVI status, and he is negative on all fronts.  I had my first and only outbreak (which was quite severe) five months ago.  I was diagnosed visually, with a culture, and by blood work.   I have taken valtrex daily, even though I understand that it may not do a lot for us HSVI types.

Question:  Regarding oral sex, can you tell me what exactly he is at risk for, and how significant that risk is, if he performs unprotected oral sex on me?   I know protection is the safest bet, but considering there are no signs of an outbreak, my daily suppressive therapy, and it’s HSVI, aren’t the risks fairly minimal?  

Also, I would like to perform oral on him without a condom.  However, I am afraid of passing this on, even though I have no indication at all that I have it orally, other than the naturally inherent risk that I contracted it at the same time as genital HSV.   Can you share your opinion on this?

Any clarification and insight would be incredibly appreciated.  Thank you.

[H. Hunter Handsfield, M.D.]

Welcome to the forum.  I'll try to help.

Most likely your partner is at little or no risk of catching your genital HSV-1 infection.  Genital-to-genital HSV-1 transmission is rare, because both recurrent outbreaks and asymptomatic viral shedding are uncommon (unlike genital HSV-2).  Daily Valtrex usually is not recommended for genital HSV-1, and I doubt you need to be taking it -- but in any case, that further reduces the already low potential for transmission.  (I'm not sure what you mean about Valtrex and its effectiveness. HSV-1 is somewhat less susceptible to the drug than HSV-2, but treatment still is usually quite effective.)

As for oral sex, in theory there would be a risk of transmission to his mouth through cunnilingus. But the chance is near zero for the same reasons noted above.  Further, half of all adults have had HSV-1, so there is a 50% chance your partner is immune to a new HSV-1 infection anywhere on his body.  (He could have a blood test to know for certain whether or not he is susceptible.)

In the absence of oral symptoms, it is extremely unlikely you have oral in addition to genital HSV-1.  If you do, asymptomatic shedding also is rare and the risk of transmission zero for all practical purposes.

Bottom line:  As long as you're not having symptoms of a genital outbreak, for practical purposes there is virtually no chance of transmission.  You and your partner have no worries on this score.  Best wishes for a rewarding relationship -- don't let herpes stand in the way!

Here is a recent thread that discussed genital HSV-1 in some detail.  Please take a look at it:  http://www.medhelp.org/posts/STDs/Recently-diagnosed-with-Genital-Herpes-HSV1/show/969931

Regards--  HHH, MD