Some questions I'm seeking answers

I was recently diagnosed with genital HSV I.  Had an outbreak and culture done for I & II and came back positive for I and negative for II.  This was about 4 months ago.  I am not longer with the partner I contracted it from and do not think he even knew he had it orally (no symptoms ever).  I do not think I have it orally since I never had an outbreak other than the genital outbreak.  I have been on 500mg Valtrex suppresive therapy.  I am seeing a new partner and have been upfront with him about my diagnosis.  He has recently had a full STD screen and is negative for everything including HSV I & II.  At this point, we are not in a committed relationship and we would like to know what we can do to minimize transmission to him since he is negative at this point.  Obviously I know to avoid any contact while having an outbreak.  I'm assuming it is safe for me to kiss him and perform oral sex on him at anytime with little transmission possibility.  What is the possibility of transmission to him by him performing oral sex on me?  What is the transmission possibility if we have condom protected sex while I am not having an outbreak?  Until we know where things are going in our relationship, we do want to be very careful.  Also, do you feel in the future, it is a moral obligation that I inform partners upfront?  Thanks in advance, there is very little information available on genital HSV I and I understand there are major differences between I & II and I just want to be sure.

[H. Hunter Handsfield, M.D.]

You are correct there is little easily accessible information on genital HSV-1 versus HSV-2, largely because adequate research hasn't been done.  The information I provide below is based on common-sense extrapolation from soft data.

First, I agree it is unlikely you have HSV-1 orally.  Generally it's one or the other; being infected both genitally and orally appears to be uncommon.

Second, most herpes experts do not recommend Valtrex or other suppressive therapy routinely for persons with genital HSV-1, only HSV-2.  Mostly it probably isn't necessary, because symptomatic recurrences and asymptomatic viral shedding are infrequent with genital HSV-1 (and therefore genital-to-genital transmission probably is uncommon); and it might not work anyway, because HSV-1 generally is less susceptible to Valtrex than HSV-2 (so that if it works, it might require higher doses of Valtrex than you are taking--but it has never been studied, so the effective dose isn't known.

Third, even with no precautions, the transmission risk to your partner probably is low.  If you are like most people, you will have little asymptomatic viral shedding and may never have another outbreak.  (Of all people with initial genital HSV-1 infections, 40% have no symptomatic recurrences in the next 2 years, and most people have only 1-2 recurrences, then none.  Very different than HSV-2, which typically recurs several times a year for many years.

Fourth, the main thing that would make your decisions easier would be for your partner to be tested for HSV-1.  There is a 50% chance he already is infected with it.  If so, he is immune and you need take no precautions to protect him.  (If not totally immune, he is at least highly resistant. People rarely get second infections with the same virus type, anywhere on the body.)  In the meantime, the main thing is for your partner to have no contact with your genital area (either his mouth or penis) when you are having symptoms that suggest a herpes outbreak.  Certainly condom-protected sex would be very highly protective.

I hope this helps.  Best wishes--   HHH, MD

[becka1600]

Thank you doctor, I appreciate the information.  At this point, he has been tested for both HSV 1 & II and it was negative (herpselect test).  So, would it still be wise to use protection when I am not having an outbreak?  I'm assuming yes.
Thanks doctor.

[H. Hunter Handsfield, M.D.]

You and your partner need to learn enough about herpes--including the likely consequences (or lack of consequences) if he were to be infected--in order to decide together how important it is (or may not be) to prevent him from getting genital HSV-1.  If you want to be 100% certain he won't get infected (or as close to 100% as you can get), then yes, you should use condoms even when you aren't having an outbreak.  But if sex with condoms isn't fully satsifying--which is common for lots of people--you may decide it isn't worth it.  If it were me, I really wouldn't worry much about it.