Oral HSV-2

[unhappycamper84]

I have a few questions regarding oral sex. I have read that if a couple where the male has HSV-2 and the female is both HSV-1 and HSV-2 negative does nothing more than avoid sexual contact during outbreaks, the female has an 8% chance of contracting HSV-2 genitally in any given year. However, if the male takes 500 mg of Valtrex daily, that percentage is reduced to about 4%. I have also read many times that contracting HSV-2 orally is somewhat rare, and that even if it is contracted, once the outbreak goes away, a second outbreak usually never occurs. And I guess this is because HSV-2 prefers the genitals instead of the mouth??? Anyway, my first question is if I take 500 mg of Valtrex daily and my girlfriend performs unprotected fellatio on me only a couple of times per month, wouldn't the chances of her contracting HSV-2 orally be something of a long shot? And I know there are plenty statistics pertaining to the likelihood of transmitting HSV-2 genitally (i.e. 8% chance to male to female transmission without suppressive therapy, 4% chance of transmission with suppressive therapy), but I haven't read about the probability of transmission of HSV-2 orally. Do studies on this topic exist? Also, if she does happen to contract HSV-2 orally, she could take Valtrex to alleviate the symptoms and shorten the length of time the outbreak would be present, correct? I've read that the recommended dose to treat oral HSV-2 is a bit different than the dose to treat genital HSV-2. What would this dose be? And how long should the oral outbreak last if Valtrex is taken immediately upon noticing the first signs of the outbreak?

[unhappycamper84]

I have also read that once you become infected with HSV-2, it is pretty much impossible to spread the virus to another part of your body (autoinoculation) after your immune system has built up enough antibodies.  So couldn't an uninfected partner technically protect herself from genital HSV-2 infection by contracting the virus orally from her infected partner?  Then she would never really have to worry about HSV-2 again because, as mentioned before, the virus rarely ever resurfaces if contracted orally.

This leads me to my last question.  It is about HerpeVac for women.  What I wouldn't give to be able to go to a clinic and have my girlfriend vaccinated for HSV-2!  When will the results for the last phase of the trials be published?  And is it reasonable to expect this vaccine to be available to the general public within a couple of years?  Is there any possible way we can get it before it is approved by the government (i.e. more clinical trials)?

[Terri Warren, RN, Adult Nurse Practitioner]

Your numbers are approximately correct.  And you are correct about HSV 2 being an infrequently recurring and shedding infection.  And yes, HSV 2 prefers the genitals to the mouth, for sure!   If you take daily therapy, yes, her risk of getting herpes orally is low.  I have no statistics on how unlikely it is, however.  There are no studies on that topic.  If she did get HSV 2 orally, she could definitely take Valtrex to reduce the symptoms and shorten the duration of her outbreak.  The dose to treat recurrent cold sores is 2 grams of Valtrex, then 12 hours later, another 2 grams.  But that's recurrent disease, not first episode oral infection.  We have no studies on that, but if it was my patient that acquired first episode HSV 2 orally, I would treat with the genital herpes first episode dosing - 1 gram twice a day for 10 days.  And yes, it works best when taken right away at the first sign of symptoms.  

You've been doing your reading, good for you!
Terri

[Terri Warren, RN, Adult Nurse Practitioner]

You are correct about autoinoculation being unlikely after first episode infection.  Your idea for protecting her genitally has certainly been raised before as a possibility.

The results of the vaccine for women are a ways away, we don't have any idea yet if it is effective, and no, she can't get it now.

Terri