Transmission with frequnt outbreaks

[bebebabe1]

Hello Dr.

I have had HSV2 for 20 years and have had an increase in outbreaks in recent years. Location varies, back of thighs, buttocks,chest and vagina. The lesions are pimple like and never turn into vesicles. Sometimes they present in a straight line along the nerve path. I'm on a very high does of Valtrex, 1G twice a day, prescribed by my Dr. to get this under conrol (for about the past two months). I have had a type specific blood test and am positive for type 1 and 2.

I'm in a new relationship and have told my boyfriend. He seems thus far supportive and of course wants to know how to limit his risk. He has HSV1. My questions are how risky is it for him to perform oral sex on me, and what are his risks given my unique (I seem to be in the minority here) recurrence pattern??
Also if you have any thoughts on the dosage of Valtrex and duration I would be interested in hearing them.
Not to thread jump  but I read about a new vaccine in clinical trials...ImmunoVEX HSV2. All of us hope it comes to market sooner than later!

Thank you for all you do.

[Edward W Hook, MD]

I applaude your concern for your partner.  Anxiety and stress can certainly increase the frequency of recurrences in some people.  On the other hand, resistance is vanishingly rare (less than 1% in person such as you) and nothing you have mentioned suggests that your virus is drug resistant.  

The best samples are from fluid-filled viesicles but you can get good culture specimens from ulcers as well

EWH

[bebebabe1]

Thank you for you response. Is it possible for herpes to become chronic over time due to stress, anxiety or another trigger? The valtrex seems to help some. Is there a way to see if the virus has become drug resistant? Soemtimes the pimples will be on both sides of my body in the same location. To get a good sample/culture does the pimple (usually they have a light white center) need to have visable fluid? Finding an educated Dr. has been a challange. So far my neurologist seems the most knowledgable. He did blood work including checking my immune function-all was normal.
I'm excited about my new relationship and more so about him understanding but worry about keeping him safe. Are there positions that are safer? I also feel a lot of burning and tingling all over-anxiety maybe because I'm so worried about infecting him?? Appreciate your thoughts and wish I lived on the west coast.

[Edward W Hook, MD]

The situation you describe is rather unusual and may bear further evaluation by your doctor. The reasons that I say this include:

1.  For herpes to be recurring in variable locations (chest, thighs, buttocks, genitals) is most unusual, particularly when they are that widespread.
2.  For valacyclovir, particularly in the dose you are taking, to not have more effect is also unusual.
3.  Over decades of infection it is the tendency for herpes recurrences to diminish in frequency, not increase.  

For these reasons, if you were my patient, the first thing I would do is reappraise the diagnosis.  I would stop the valacyclovir and verify using culture or PCR that what you are experiencing is HSV. That your blood test is positive for HSV-1 and HSV-2 does not mean that what you are experiencing is HSV.  There are other dermatological processes which might be causing this.

If it is indeed HSV and the valacyclovir is working then I would continue taking it.  As for the questions you ask:

1.  Without lesions, the risk to your BF from performing oral sex on you is low but not zero.  His HSV-1 offers some protection and the transmission through this route is rather uncommon.  The risk, or course, could be virtually eliminated through use of dental dams.

Hope this helps.  You may also want to pose your question to MedHelp's herpes community site.  The personal experience available through it is enormous and may help you in this rather peculiar situation.  EWH