Dr. Handsfield,
Thanks for your insight. Just for two minor points of clarification for other readers and archival purposes -- she actually was molested around 5 or 6 years old.
Secondly, we have been having unprotected sex for well over 6 years. For the first year of the relationship, we used condoms.
Unfortunately, it appears my general practitioner is a bit misinformed -- he said there is a 99 percent chance I'd eventually get it and it's like "Russian Roulette" (very comforting and great bedside manner - won't be seeing him again).
After reading your posts, along with Anna Wald, Terri Warren and Dr. Hook's, I am a bit more comforted.
It's too bad many doctors are unaware of the differences of HSV-1 and 2 and just start guessing.
The diagnosis isn't going to change anything -- when she said she might have herpes before I was ready to take on HSV-2 if necessary. Now, a few years later, and a bit older, I am suffering from depression and anxiety, but am doing my best to deal with life's pressures.
All of my other questions are just anxiety-based, so I will spare you from having to tell me to chill out. :-)
Appreciate your help and insight, and if you do care to tap me for future references or case studies around this, I'd be happy to keep you in the loop.
Glad to be of help, and happy to hear you are more acclimated to the herpes situation than I first understood. Thanks for the thanks about the forum.
Welcome to the STD forum. I'll try to help.
Although it is true that most symptomatic genital herpes recurs fairly frequently, that applies primarily to HSV-2. Genital HSV-1 infections usually recur infrequently. In the first 2-3 years after onset of genital HSV-1, about 40% of persons have no recurrences at all and most of the rest have just 1 or 2 recurrences. But the potential for recurrent outbreaks probably continues indefinitely, and that's probably what's going on here.
As far as transmission to you, either orally or genitally, I really don't think you should worry about it. Unlike genital HSV-2, there is little asymptomatic shedding for genital HSV-1, so that transmission when she isn't having an outbreak is unlikely. You have been having regular sex with your partner for over a year, without getting infected, so obviously the chances are fairly low. If you should become infected, either orally or genitally, most likely you would not have frequent outbreaks. Finally, since you will be on the alert for early symptoms, you could get prompt and effective treatment.
To the specific question:
1) Genital to genital HSV-1 transmission appears to be pretty rare, presumably because both outbreaks and asymptomatic viral shedding are infrequent. In 30+ years in the STD business, I have never knowingly seen a case of genital HSV-1 that was acquired by genital sex. So I suspect the chance you'll catch your partner's infection are well under 50%, maybe nearly zero.
2) For all the reasons above, I doubt condoms are necessary. As for anxiety relief, that seems an overreaction. But it's something for you to discuss with your partner.
3) Yes, that is indeed a "crazy hypothesis". Most people with oral herpes have no symptoms at all, and those with recurrent cold sores usually have them only once or twice a year. And just as for genital herpes, they can be effectively prevented or treated with antiviral therapy.
4) Probably yes, but there are few data on this.
5) So talk to a physician and take a prescription for valacyclovir (or other antiherpes drug) with you when you travel. Whether treatment is "really needed" depends on severity. But treatment normally is recommended, especially for initial infections.
In summary, you are overreacting to this situation, especially if this is an important relationship that would otherwise become permanent. Herpes, especially HSV-1, should never be permitted to interfere with love, romance, and rewarding sex. If I were in your situation, knowing what I know, I would not alter my sexual practices or the relationship in any way, except to avoid either genital or anal sex if and when your partner has another genital outbreak. That may never happen.
Please discuss this reply with your partner and make any and all decisions with her active participation.
Best wishes---- HHH, MD