Should I get tested for HSV I?

[Confused79]

I am a 30-year-old female who has been tested for Herpes many times. Fortunately, a year after my last sexual encounter, I've received negative IGG results for both HSV I and II.

I am now dating a man who just received negative IGG results for HSV II, but positive results for HSV I. Unfortunately, we didn't know his status until after we engaged in unprotected oral sex (three or four times). I asked him about symptoms after he got his results, and he said he has a history of occasional cold sores. Fortunately, he did not have any noticeable outbreaks when we engaged in oral sex. However, he is not taking Valtrex.

So, I have a few questions:

(1) Should I be tested for HSV I? It's been 8 days since my last encounter. I've noticed burning sensations outside my vagina, but no sores. I don't know if the sensations are psychosomatic or a yeast infection or a possible HSV I outbreak.

(2) If I get tested and are positive for HSV I, should I assume I have it genitally? Then what?

(3) Since HSV I is so common (so it is likely a future partner will have it) yet I haven't currently been diagnosed, how am I to approach oral sex in the future (since my last test revealed I had neither I or II)? Realistically, I can't see myself using dental dams. So, am I to resign myself to avoid oral sex until I'm with someone for the long haul (in which I would know that I would be likely to get HSV I at some point)? Or, ask my partners to take daily Valtrex (which seems a little unfair if it's just for a cold sore on the lip a few times a year)?

[Terri Warren, RN, Adult Nurse Practitioner]

1)  We don't have data on that question
2) Again, we don't have data on the genital to genital transmission of HSV 1.  If you are with a partner who is negative for both HSV 1 and HSV 2, taking antiviral therapy would definitely reduce the risk of transmission to a partner.

Terri

[Confused79]

Thank you, Terri. This herpes virus is very complicated.

Two quick follow-up questions:

(1) If my partner does not decide to take Valtrex and he has only one to two outbreaks a year, how high is my risk for getting HSV I if we avoid sexual activity during his outbreaks?

(2) If I test for HSV I later and receive a positive result, you indicated that I won't know where I have it (as long as I continue to have no symptoms in either area). If that is the case, let's say it would reside in my genital area. So then, what is the risk of transmission of HSV I from genital to genital area without the presence of outbreaks (assuming I'm with another partner who does not have either HSV I or II)? Would you recommend taking antiviral therapy?

Thank you again.

[Terri Warren, RN, Adult Nurse Practitioner]

Its too soon to be tested for HSV 1.  I would wait, and if you continue to have sex with him, remember that the date for future testing is a moving target.  

Again, too soon to test, but if it is positive when you do test, and you have neither cold sores nor genital symptoms, you could have it either place, no way to know where.

If you want to receive oral sex with the lowest possibility of getting HSV 1 genitally, you need to either use barriers or have your partners take antiviral therapy, that's correct.  Everything else presents some risk, even if there are no symptoms.  But you need to weigh the risks against the benefits here, yes?

Terri