possible exposure oral HSV-1

[barcasoccer]

My girlfriend has recurrent oral cold sores (hsv-1), thus we refrain from oral sex ( I am hsv-). However, two days ago she gave me three quick peck/kisses (less than 1-2 seconds each) in my penis after she masturbated me (I am uncircumcised and she only kissed the outside foreskin).  After she did this she realized she had a red bump/spot on her lip where she normally gets cold sores.  Even though she did not feel the normal prodrome symptoms, she was worried about it so she inmediately made me wash my penis with soap and water and take Valtrex (she normally has some for her cold sores).  I have been taking 1 g twice a day, after initially taking 2 g after the kisses.
For my sake and her sake I have several questions:

1) Was I at risk of catching genital hsv-1 from this exposure? She did not have any obvious cold sores nor prodrome symptoms that she recognized even to this day (48 hr after ) except some redness and a bump in the edge of her lip where she gets cold sores.

2) Is HSV-1 contagious before and during the prodrome symptom? She normally refrains from kissing also when the prodrome starts.

3) Can I stop taking the valtrex?

4) If she was asymptomatically shedding the virus in her lips, was I at any risk from this exposure?

5) If we start using condoms for oral sex, will this protect me? What about saliva?  We want to start having oral sex.

Thanks for your answer,

PS: I had an account but I could not remember the username and my last question was 6 months ago

[Edward W Hook, MD]

Like so much of the incorrect information, the issue of auto-inoculation is an urban myth which persists through and on the internet.  There are RARE cases of autoincouclation which occur in a small proportion of persons who exerience their initial episodes of HSV- that's it. EWH

[barcasoccer]

Dear Dr. Hook,

Thank you very much for your help. I have not had any symptoms and I am not planing on getting tested as per your advise.

I have one last question our of curiosity.  If herpes is only transmitted by direct contact with a lesion or skin, why then do people worry about auto inoculation? If i get it in my mouth, how can I transmited to my genital if my mouth can not touch them?  

Sorry if the questions seems stupid.  Thanks for your help.

I hope you have a wonderful New Year.

[Edward W Hook, MD]

I'm glad to hear that my comments were helpful- you have nothing to worry about.  EWH

[barcasoccer]

Dear Dr Hook,

Thank you very much for your reply.  That clarifies a lot.  Just to clarify, We are not worried about catching HSV 1 in the mouth,  (my parents alsonboth have hsv1, and I never worried about it). She was concerned however about eye herpes, asymptomatic shedding and this is how she got worried.  And since our doctor could not help us, she got even more worried about kissing my forehead, or near my eye, and sharing washcloths.

Have a Happy Holidays and a Happy New Year.

[Edward W Hook, MD]

If you have not had symptoms in 23 days, you almost certainly will not.  As far as further testing is concerned, I see no reason to do so (what difference would it make?).  

Your GF obviously cares for you a great deal but her worries are not warranted. HSV is not passed from person to person through transfer from the infected person to another on either person's hands or fingers- anywhere. DIRECT contact must occur for transfer to occur.  Further, if you become infected, so what?  I don't mean to sound glib about this by having HSV-1 is simply not the end of the world- over 60% of adults have the infection and if you were to get infected (anywhere) chances are that you, like most people would not have recurrences or problems.  My advice is to treat this like you would if one of you had the flu and did not want your partner to get it- avoid direct contact when she is having a recurrence and use common sense but don't allow this to interfere with what sounds like a good, healthy relationship.  I have patients whose partner has HSV-1 and who have been together and active in every way and yet have not transmitted the virus despite the passage of over 20 years.  

I hope these comments are helpful.  Seasons' greetings.  EWH

[barcasoccer]

Dear Dr Hook,

Thank you very much for your answer.  As of this day I have not had any symptoms.  Is it still possible I might show symptoms 23 days later? Do you think I should get tested in a couple of months?

The other question is to gain some information to a peace my girlfriend whom  has become anxious about possibly infecting me.  She is not worried about infecting my mouth but rather that I get on my eye or my genitals.  She is worried she might carry the virus from her mouth to her hand to my genital and infecting me, or from her mouth to her hand to my eyes.  She is also very worried that I might autoinoculate my eyes if I am asymptomatically shedding the virus from a new infection and I touch my mouth or boxer area and then touch my eyes or forehead. Is this a real danger?

She is afraid of kissing me in the forehead or in my cheeks in the account of possibly infecting my eyes if she is asymptomatically shedding. Is this also a real danger?
( in the 2 years living together she has never had any anxiety problems)

I tried talking to my primary care doc along with my gf, but he did not give any clear answers which just madej my gf more anxious.  I know this is not your field but i am trying to find some answers to peace her mind and mine.  

[Edward W Hook, MD]

2) Is HSV-1 contagious before and during the prodrome symptom? She normally refrains from kissing also when the prodrome starts.
See above. Refraining from contact will reduce the risk for transmission of HSV-1.

3) Can I stop taking the valtrex?
Yes.  the use of valacyclovir to prevent HSV acquisition by an uninfected person has never been studied so whether this helps or not is unknown but either way, even if it were going to work, it would have done so by now.  I'd stoop the valacyclovir now.

4) If she was asymptomatically shedding the virus in her lips, was I at any risk from this exposure?
Yes, see above. the risk however would be low- we'd estimate the risk of exposure to asymptomatic shedding as less than 1 in 10.000.

5) If we start using condoms for oral sex, will this protect me? What about saliva?  We want to start having oral sex.
Yes, condoms would help. condoms are not perfect but are very good protection.  

I hope my comments are helpful. EWH

[Edward W Hook, MD]

Welcome back to the Forum. good questions.  By way of background, remember that persons with HSV infections tend to asymptomatically shed the virus rather often- about 10% of the time.  Thus exposures are common yet few of them lead to transmission.  Thus when you kiss your GF, you are exposed in this way.  As for genital infection, HSV, including HSV-1 transmitted during oral sex, is more often transmitted when a person has asymptomatic shedding of the virus and lesions are not present than at the time lesions are present.  There is more virus present when lesions are present and during prodromes than during periods when asymptomatic shedding.  Asymptomatic shedding is so common that the numerical risk for transmission while asymptomatic overwhelms the risk of contact when lesions are present.

Now for your questions:

1) Was I at risk of catching genital hsv-1 from this exposure? She did not have any obvious cold sores nor prodrome symptoms that she recognized even to this day (48 hr after ) except some redness and a bump in the edge of her lip where she gets cold sores.
The answer comes down o whether this was a prodrome or not. If it was a prodrome there was likely virus present but remember, most exposures to infected partners do not lead to infection.  Even if it was a prodrome, the risk for infection was not high.

Reply continued below- space limitation. EWH