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genital hsv1

Hello 29 year old female here diagnosed with genital hsv1 10 months ago. My question is in regards to transmission risks. I wanted to know in percentages please what are the odds that I could transmit my infection to an uninflected male if we do not use condoms but I am put on a daily antiviral? Also, I have heard that hsv1 is less susceptible to valacyclovir therefore  a higher dose might be needed. Is it okay for me to take 1g everyday? I am just concerned about how taking this dose everyday would affect my body as in my liver/kidneys. Please Dr Handsfield I would greatly appreciate your advice! Thank you!
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207091 tn?1337709493
Unfortunately, Dr. Handsfield no longer answers questions here. I think you probably found an old question of his?

In any cause, hsv1 hasn't been studied as thoroughly as hsv2 has, in regards to ghsv1 transmission. We do know enough to tell you that you are probably overthinking this.

It's true that some people may have better results for hsv1 on famvir, another antiviral, but that's in regards to outbreak frequency, not shedding. Shedding hasn't been studied for hsv1 and anitvirals.

So this is what we do know:

Shedding rates: (and you can find all this in the herpes handbook - https://westoverheights.com/herpes/the-updated-herpes-handbook/)

HSV 2 genital 15-30% of days evaluated

HSV 1 genital 3-5% of days evaluated
HSV 1 oral 25% of days evaluated

HSV 2 oral 1% of days evaluated

We also know that ghsv1 generally results in far fewer outbreaks than ghsv2, and many people never get another outbreak after their first. That, combined with the lower shedding rates, means lower transmission.

So for transmission rates. We don't know the exact transmission rates for ghsv1, but here are the rates for ghsv2, and if your math is better than mine, maybe you can extrapolate some figures.

Ghsv2 transmission, female to male, over the course of a year, assuming sex 2-3 times a week:

Only avoiding sex during an outbreak - 4-5%

Adding condoms OR daily suppression - 2-3%

Adding condoms AND daily suppression - 1-2%

So do you need a daily med? Medically and statistically, probably not. Will it hurt you? Nope. You don't need a higher dose of valtrex (or acyclovir, which is cheaper and just as effective, but that's a twice a day dose, so for most, it comes down to cost vs. convenience).

How do you know your partner is not infected? 90% of those who are infected don't know they have it because they've never had any symptoms. Given that half of the adult population has it, your partner should ask for a type specific IgG blood test to know for sure. If he has it already, he can't get it again.

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