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oral sex, antiviral resistance
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The STD Forum is intended only for questions and support pertaining to sexually transmitted diseases other than HIV/AIDS, including chlamydia, gonorrhea, syphilis, human papillomavirus, genital warts, trichomonas, other vaginal infections, nongonoccal urethritis (NGU), cervicitis, molluscum contagiosum, chancroid, and pelvic inflammatory disease (PID). All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.

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oral sex, antiviral resistance

(1) I'm a female with HSV-2 using daily medication. My partner is negative. Recently, he performed cunnilingus on me; we then kissed for a minute or so. I then performed oral sex on him. Is there a possibility that the virus was somehow transferred from my vaginal fluids, to his mouth, then to my mouth, then back to his penis? Did I put him at risk in doing this?

(2) I've used acyclovir 400 mg once daily for a couple of years, only because I didn't have a partner and one pill daily completely eliminated my prodromal symptoms and outbreaks. When I met my current partner 4 months ago I began 400 mg twice daily and have continued with that dosing schedule. I have read some comments about antiviral resistance and wonder if I somehow messed up my resistance by using the medication in this manner.

(3) Also, if my partner were to take acyclovir before or after sex, would a superdose of two 400-mg tablets be advised? I understand there are no  data on this issue, but I'm reading more and more about the negative partners using medication, usually a Valtrex.

This is a great website--thanks for any responses.
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I'll go straight to your questions:

1) Such indirect transmission is really a stretch and seems highly unrealistic.  I wouldn't worry about it.  In any case, since you're taking antiviral therapy, any theoretical risk is even lower.  

2) Antiviral resistance of HSV is uncommon, and tends to occur primarily in people with profound immune deficiciencies (mostly people with AIDS).  And it probably occurs mostly in people who take the drug intermittently, e.g. on and off several times over a year or more.  And if your HSV-2 strain were to become resistant, the first sign would be reappearance of herpes outbreaks (in you) that do not respond to treatment.  That said, to be safest it probably is best to stick with 400 mg twice daily.

3) You're right, there are no data on whether or not antiviral therapy would protect your partner.  It makes sense and my guess is that it would work, but no such research has been done.  

Thanks for the thanks about the forum.  Best wishes--

HHH, MD
7 Comments
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So if I had a one night stand with a random person of unknown status, would it be worth taking herpes antivirals after? If so for how long? A week?

I guess this i a tricky question with no data available, but what is your view?

Thanks.
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Definitely nobody should take antiviral therapy after a suspicious exposure.  In animal research studies, treating BEFORE exposure usually protects against infection taking hold.  But when treatment is AFTER exposure, even by only 1 hour, infection is not prevented.  This is one reason why there has been no research on this strategy in humans.

For this reason, the advice I gave barn babe--the guess that such treatment might help prevent transmission--only applies when a partner is known to have herpes and drug is already circulating in the bloodstream before sexual exposure occurs.  Afterward it's too late (assuming the animal data in fact apply to humans).

HHH, MD
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So if one was going on a holiday - hoping for sun, sea and sex, it would make sense to take antivirals in the couple of days leading up and during the holiday so that the drug is in the bloodstream and thus prevent potential infection?
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Englishman, if you are practicing safe sex with partners of unknown status, you are for the most part protected in these "casual" encounters. Condoms work great against herpes and are probably 100% protective with HIV. One or two encounters with someone while using a condom probably isn't going to put you at risk for very much. Someone can correct me if I'm wrong here, but taking a Valtrex for a protected casual sex  encounter is sort of like putting out a lit match with a fire extinguisher.  Might be a bit of overkill.
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Thank you for the thorough response, Doctor.  I didn't mean to overlook your replies.

I appreciate it. Thanks.
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I appreciate your point, but if it offers better protection than it is worth considering from my point of view. The question is -ould it work? The doc implies that it would, although no data is available. Thus combining anti-virals with effective condom use means that HPV/Molluscum remains the only STD you could get (and a slim chance at that).
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A related discussion, Herpes and Condoms was started.
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