Reducing transmission risk for Oral herpes (probably HSV1)

[Sumitbose]

I developed a cold sore about 3 months back below my lip for the first time. The doctor said it was HSV 1. I took Acyclovir for 10 days. I was not tested

My boyfriend is in a different city and we meet once in 2-3 months for a few days. I don't want to infect him at this stage. He knows about it. We are aware of the risk of any sexual contact during an outbreak. We wanted to find out about reducing risk during the asymptomatic period.

1. Can any antiviral suppressive therapy reduce the risk of transmission of oral herpes? Will it help to take Acyclovir or Valtrex for 5-7 days prior to and during the period when we are intimate? This is my most important question. I have read that the suppressive therapy is useful only for genital herpes

2. If there is no symptom, how safe is my performing oral sex on my partner? I cannot stand performing oral sex with a condom on his penis. (We would use condoms for regular/genital sex)

3. Is it important to get checked for HSV 1 or 2?

[Terri Warren, RN, Adult Nurse Practitioner]

Well, I think you might want to consider testing, just to be certain now that you've described a yeast-like infection in the vaginal area.  No harm in finding out for sure what's going on.

Terri

[Sumitbose]

Dear Terri,
Sorry for writing once more. The doctor I met saw the cold sore and said it is HSV 1. Should I get tested for the strain HSV 1 or 2. This cold sore was about 3 months back.

In terms of precautions with a negative (HSV 1 or 2), does it make a difference whether it is 1 or 2? About 4 months back, I did have a yeat-like infection on my vagina. The gynecologist did not say anything about HSV. I developed the cold sore 2 months later.

Can I go ahead with the anti-suppressive therapy without checking for the type of HSV.

As I said earlier, my partner has been tested negative after my cold sore was detected.

Thanks so much for your advice.
regards

[Sumitbose]

Thanks for your response. He has been tested negative for HSV 1 and 2. We were worried that he may have got it from me. He does not stay in the US and has been with a single partner before this. We have been seeing each other only for about a year, intermittently.

I was also surprised that I developed the first cold sore at this stage. He is obviously not the source--the results are clear. It looks like in the 15-20 intimate sessions we've had in the past year, he has not picked up the infection.

Is it possible that I picked this up  earlier (earlier relationships) and the symptom appeared for the first time last year? Is that common?

Does this clarification make any difference to the responses?

Is Acyclovir antisuppressive therapy for 5 days prior to our meeting OK?

Thanks so much for your expert opinion.

[Terri Warren, RN, Adult Nurse Practitioner]

I don't know that this is quite as straightforward as you think this is.  My first question to you is this:  were you having sex with this same partner and this same partner only when you first got this cold sore?  If yes, then it is certainly possible that you got it from him (and likely).  Do you know if this partner has ever been tested for HSV 1 and 2 infection (regardless of any history or not of cold sores?)  If not, he should be tested.  If he is also HSV 1 positive, then you are all set and don't need to worry about transmission.  If you were the giver of oral sex to him, you need to be certain he is negative for HSV 2 as well.  If your cold sore was not tested, you don't honestly know, with first infection, what type it is.  In all likelihood it is HSV 1, but with first infection, it is a little hard to say absolutely certain.

If he is not infected and is negative for both HSV 1 and 2, then you could take suppression for your HSV 1 infection, yes.  And if you only see each other once in a while, you could start a week ahead, and the risk of transmission will be reduced, we believe, though the study has not been done with HSV 1 orally.

My response to the oral sex issue depends greatly on the testing that he needs to have done to clarify what precautions actually need to be taken.

Does that help?

Terri