Spreading HSV-1

I was recently diagnosed with genital hsv-1. I know that i contracted it from my last boyfriend thru oral sex.  I would like to start dating again but I am concerned about spreading it to others.  What are the odds of passing the disease on to a new partner since so many more people are exposed to HSV-1 as children? Is valtrex an effective treatment for HSV-1. I have only had 1 outbreak ( the original one in Feb) and I am currently not taking anything. However, I would begin some sort of treatment if it helped to stop this disease from spreading.

[H. Hunter Handsfield, M.D.]

You're asking some of the basic questions about genital herpes in general and genital HSV-1 infection in particular.  I'll answer your questions briefly, but please do some homework for more detailed information.  Good sources are the American Social Health Association (www.ashastd.org), the Westover Heights Clinic of Portland, OR (www.westoverheights.com), CDC (www.cdc.gov/std) and my former health department, where I wrote much of the herpes information myself (www.metrokc.gov/health/apu/std).

You might not have any future problem at all.  Most people with genital HSV-1 have only 1 or 2 recurrences over the next 1-2 years, and 40% have no repeat oubreaks at all; and asymptomatic shedding of the virus is much less common than for HSV-2.  As a result, genital to genital HSV-1 transmission is uncommon.  Whether suppressive antiviral therapy would further reduce the already low risk of transmission isn't known; only HSV-2 has been studied.

All in all, most likely the risk of transmission is low.  You should do your future partners the kindness of telling them you have had it, but you can honestly say that without symptomatic recurrent outbreaks, most likely you're not going to transmit it to them.  In addition, as you apparently understand already, roughly half of all sex partners you might have in the future probably are not susceptible, having already been infected with HSV-1 in childhood.

As far as future pregnancies are concerned, the risk also is low.  When you become pregnant, tell your obstetrician you history; s/he will know what to do in order to minimize the already low risk to the baby.  The greatest risk of transmission to newborns occurs when the mother first acquires genital herpes toward the end of pregnancy -- and for HSV-1, that's no longer an issue for you.

In addition to the websites above, find a provider who is familiar with herpes, and in particular with the differences between genital HSV-1 and HSV-2 infection.  The bottom line is that you're not likely to transmit it to a sex partner, and with proper management, there is no risk to your future children.

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