Herpes transmission rate during an outbreak

[Annie35]

My long distance boyfriend and I recently starting having sex (not often since we don

[Mlpokn]

What can you tell me about the transmission risks from a female with genital hsv-1  to an uninfected male partner during oral sex? Keep in mind that the female is not sexually active during outbreaks and takes valtrex  How much does the use of dental dams reduce transmission risks?

[OOOMG]

One thing I wonder about is that if a partner caught HSV2 orally (for which the symptoms are mild I understand), would that then mean that they could not catch the infection genitally??

[Jeremy44]

Most herpes cases are spread by people who do not know they have it. I.E. they did not know and therefore did not take the precautions necessary to prevent the spread. Using a condom right makes the chance of spreading it very slim, and plus you are on Valtrex, which helps. Herpes is spread by rubbing into the skin, meaning there has to be skin exposed AND vigorously rubbed into, to spread the infection, which is why most primary cases are on the sexual organ itself (tip of penis or inside of vagina). I wouldn't worry to much about it. Just try to be careful and you should be alright.

[Annie35]

I forgot to mention I'm taking Valtrex daily for supressive therapy.  I had increased my dosage and was taking 1000-1500mg a day for the few days my boyfriend was in town.

[H. Hunter Handsfield, M.D.]

I cannot accurrately assess the risk; there simply are no data.  Having an outbreak makes the risk high, and you probably were quite infectious when you had sex.  But using a condom reduced it.  Being on valtrex might have reduced the risk as well, but that's really not known--i.e., there are no data on whether or not transmission risk is lower when an outbreak occurs on valtrex versus someone not on valtrex.  Also, what do you mean by 'He is not infected'?  If that was based on a blood test for HSV-2, then he clearly is susceptible--but that in turn would vary based on whether or not he has HSV-1, which probably reduces the risk of HSV-2 if exposed.  (Assuming HSV-2 is the cause of your infection, not HSV-1.)  He doesn't need a cut to get herpes if exposed.  There is some small risk of oral HSV-2 infection, but that's not very common; the mouth seems to be somewhat less susceptible.

Putting it all together is impossible; nobody in the world can put the risk into percentage terms.  It's not highly likely, but certainly possible.  Your partner needs to be on the alert for symptoms, and should get checked if that happens.

Sorry I can't be more precise.  Best wishes----  HHH, MD