Risk of transmitting HSV-1 genitally from female to male

[Southern_bella]

I was just recently diagnosed with HSV-1 genital herpes.  My partner and I were both tested for STD's before becoming intimate, but they didn't test for herpes.  My partner has informed me that he gets cold sores once or twice a year, so we assume this is where I got it from.  Neither of us knew HSV-1 could be spread from cold sores until now.  He has been my only sexual partner since we got tested and thought we were both "clean".  

My first outbreak was not that bad.  I didn't have fever, swollen lymph nodes, anything except some ulcers mainly on my left outer labia.  At the same time I had a group strep B vaginal infection so I believe without the group B strep the HSV-1 outbreak would have been even smaller.

Here are my questions:

1)  What is the likelihood of transmission of HSV-1 genital herpes from female to male, assuming I am on Valtrax suppressive therapy and don't have sex during future outbreaks (hopefully I won't have any) ?  

2)  Would the percentage in question #1 change if condoms are used and by how much?

3)  What is the likelihood of transmission of HSV-1 genital herpes to the mouth of a future partner?  I have read that it's more easily transferred from the mouth to the genitals, since the mouth is its preferred site.  I wonder about the opposite, transference from genital to mouth via oral sex.

Thank you so much for taking the time to answer my questions!

[Terri Warren, RN, Adult Nurse Practitioner]

The same basic principles apply.  If your next partner has cold sores, the situation is the same.  If they don't, then I would recommend getting them tested to see if they might be infected and not know it.  If they are negative for HSV 1 and 2, then it may be good for you  to take daily antiviral therapy to reduce the risk of infecting them.

Terri

[Terri Warren, RN, Adult Nurse Practitioner]

I wouldn't worry about transmitting HSV 1 genitally to your current partner.  Since he has a history of cold sores and likely infected you, as you describe, he is highly unlikely to get HSV 1 in a new location on his body.  

As you may already know, HSV 1 is infrequently shed from the genital area.  Taking daily Valtrex will probably reduce that infrequent shedding by half and condoms will also reduce the risk of transmission.  We don't have good statistics about the reduction of transmission with HSV 1 as we do with HSV 2, but suffice to say, significantly less.  

Genital to mouth transmission is unlikely due to the infrequent shedding of HSV 1 from the genital tract, but isn't zero.  However, when thinking about risk, it is probably much riskier to receive oral sex from someone with HSV 1 orally then to give oral sex to someone with HSV 1 genitally.  Does that make sense?

Terri

[Southern_bella]

Thank you, Terri.  Yes, it makes perfect sense.

Although my current partner and I are only intimate with one another at the current time, I wonder about future partners and if the above answers to my questions would change.  Could you give me some info to my questions with regards to future partners?

Thanks so much, Terri!