Transmission Question

[Molly3]

Thank you in advance for your assistance.  I am a 32 year old female and was diagnosed via culture with genital HSV 1 one year ago.  I received it from my boyfriend at the time  by receptive oral sex.  I had one outbreak at the time and have had not others to date.  I do not think I have it orally because I had my first outbreak in the genital area and have never had a cold sore or any other mouth sour of any kind.  I am in a long distance relationship at the moment (he is in the military).  Due to the distance, we have decided that our relationship will most likely not become exclusive.  I have told him about my diagnosis and to date we have had oral mutual sex and stimulation but not penetrative vaginal or anal sex.  He was recently tested for all STDs to be proactive which all came back negative including HSV I & II.  Because of our distance, we have decided to be very careful when we are together and when we do decide to have sex as to hopefully not pass my genital infection to him.  My question is how effective would condoms be in protecting against transmission?  I know it is not 100% from what I've read but we're trying to gauge a strategy.  Obviously, I would not have any contact if I were having an outbreak.  My doctor did prescribe me Valtrex at the time of my initial outbreak and since then, I have not taken it.  Do you think it would be a good idea for me to take this now for prevention purposes?  Due to the distance, we do not see each other very often.  I have read most of what I can get my hands on regarding genital HSV 1 but all research and data seems to be more geered toward HSV2.  Thank you for any help and advice you might be able to offer.    

[Edward W Hook, MD]

Congratulations on the knowledge you've gained about genital herpes due to HSV-1 and on the way you and your BF are approaching it.  As you already know, genital herpes due to HSV-1 is not readily transmitted genitally because there are fewer outbreaks and less asymptomatic shedding.  On the other hand transmission does infrequently occur.  I would recommend 100% condom use and would have faith that this would reduce your chances of transmission to him to near 0.  Taking valacyclovir starting several days before you get together would further reduce your risk but to be honest, the added protection would be quite small.  Condoms should be sufficient.

Hope this is helpful.  EWH

[Edward W Hook, MD]

The reduction in transmission frequency with valaciclovir suppressive therapy has not been studied for HSV-1 because the transmission rates are sufficiently low to start with that it would be very difficult to study (would take enormous numbers of study participants).  For HSV-2 it is about 50%.  Sorry there aren't more data.  EWH

[Molly3]

Thank you so much doctor, yes, this information is very helpful.  Just one additional question.  If at some point we were to not use condoms.  With Valtrex daily, what is the transmission % for HSV1.  I do not find this information anywhere.
Thanks agian.