herpes transmission

[threearmed]

My wife of ten years recently had a bout of acute HSV infection with typical symptoms:  sores in mouth and vulva, painful urination, vaginal discharge, muscle aches.  The diagnosis was confirmed by a lab.  I have no symptoms and was tested with a blood test and am negative for HSV 1 and 2.  My wife claims to have been faithful and I believe her, but how likely is it to get Herpes (the doc didn't tell her type 1 or 2) from a source other than sex?  I'm staying with her either way so don't feel you have to protect our relationship.  Also, she responded well to Valtrex and we have been using condoms now but I really enjoy giving her oral sex. How likely am I to get infected doing this if she is on Valtrex and has no symptoms?  I have no interest in the dental damn thingy as the smell/taste is a good part of the enjoyment.  Thanks in advance

[Edward W Hook, MD]

Thanks for the clarification.  This makes it clear that your wife has genital herpes.  It would be helpful to know which virus and I wish her doctor has requested typing.  I doubt that her oral lesion was HSV and suspect it was  a coincidental finding.

If your wife has genital HSV-1 there is little risk that you would acquire oral HSV from performing oral sex on her or for that matter, genital HSV either since genital HSV-1 tends to be less infectious for sex partners than genital HSV-2.  If her infection is due to HSV-2 your risk for infection is higher.  The risk of transmission of infection is statistically higher during the first year a person has HSV than later because both recurrence and asymptomatic viral shedding from the site of infection are more common during the first year of infection.  After that both the recurrence and asymptomatic shedding rates tend to decline a bit.  Her risk of transmission can be reduced by avoiding sex during recurrent outbreaks, through condom or other barrier use and if she takes suppressive (daily) therapy with antiviral medication such as acyclovir or valacyclovir.  Suppressive therapy has been shown in studies to reduce the risk of transmission of infection by over 50%.

As far as were she got her infection, it was most likely through sex.  Some people who get HSV do not have their initial outbreaks right at the time they become infected but some time later.  I just don't know if it could happen years after acquisition of infection.

Hope this all is helpful to you.  EWH

[Edward W Hook, MD]

Welcome to the Forum.  While much of what you say is typical of HSV, there is one point which raises a "red flag" for me- it is VERY unusual for a person to have a first episode of genital herpes simultaneously at the mouth and the genitals.  On the other hand, there are a number of medication reactions and other illnesses we more than one site can be involved simultaneously.  To pursue this a bit further, can you tell me what sort of lab test was used to confirm her diagnosis.  If it was a culture or PCR test it is difficult to argue with but if it was a blood test she could have some other illness and have coincidentally been found to have a positive HSV blood test.  I will follow with more comments once I have your reply.  EWH

[threearmed]

You've been a great help.  Thanks

[threearmed]

It was a culture swab (virus isolation?) from a sore on her vulva.  She only had a single sore in her mouth and that was not tested.