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STDs (Expert Forum)
Are condoms and Valtrex necessary for genital HSV1
Answered by
University of Washington
Seattle - WA
This forum is for questions and support regarding STD issues such as: Chlamydia, Crabs (pubic lice scabies), Gonorrhea, Hepatitis (viral), Herpes, HPV, Molluscum Contagiosum, PID, Rectal Infections, Syphilis, Trichomoniasis, Warts, Yeast Infection.All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.
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Are condoms and Valtrex necessary for genital HSV1
by coppola, Aug 22, 2006 12:00AM
Dr. H, Thanks for your commmitment to this forum. It has helped me understand and deal with my current situation. There is an overload of information about herpes in the internet, but I have found this forum particularly helpful.
My situation is that I have known for at least two (probably three) years that I was seropositive for HSV1. I have assumed it was an asymptomatic oral infection and did I not give it further thought. The source of this information was a type specific antibody test from a few years ago, but I don't recall the brand or any other information about the test.
Recently, I had unprotected receptive anal sex with a partner who told about 7-8 weeks past exposure that he had tested seropositive for HSV1 and 2. About week after he told me (8-9 weeks post exposure), I developed a lesion on/near my anus. I had a swab for a culture 5 days after I first noticed the lesion and a swab for a PCR test taken 2 more days later. The culture was postive for "herpes" and the PCR was postive for HSV1 only. Because my Dr. had some concerns about the length of time after I noticed the lesion until the swabs were taken, a Western Blot was done. Maybe overkill, but at least I know for sure that it is genital HSV1, but not HSV2.
Until I was told about my partner's HSV infection, I never had any recallable/noticeable symptoms of HSV. I expect that my recent exposure was not the source of the infection, but from something years ago. I am wondering if the stress, worry and guilt after being told about the recent exposure was enough to make me noticably symptomatic. I have only notice symptoms around my anus. Other than the lesion I described, there have been some acne like bumps/sores in the same area, but nothing on my penis or testicles.
Here's the questions:
(1) Can I assume that HSV1 infection is not from my recent partner?
(2) During asymptomatic viral shedding of HSV1, does it shed only in the location of the infection? In other words, I assume that my infection is the result of someone rimming me or another (distant) unprotected anal sexual encounter. If my anus is, in fact, the site of the infection, do I shed HSV1 from my penis? Is it possible my anus is not the site of the infection, but I was only symptomatic there?
(3) Does Valtrex help prevent HSV1 shedding?
(4) All in all, the bottom line questions are: Can I stop using condoms with my female partner? What are the chances of infecting her given my histroy? Will Valtrex help? Should she be afraid to give me oral sex?
Thanks in advance for your help.
My situation is that I have known for at least two (probably three) years that I was seropositive for HSV1. I have assumed it was an asymptomatic oral infection and did I not give it further thought. The source of this information was a type specific antibody test from a few years ago, but I don't recall the brand or any other information about the test.
Recently, I had unprotected receptive anal sex with a partner who told about 7-8 weeks past exposure that he had tested seropositive for HSV1 and 2. About week after he told me (8-9 weeks post exposure), I developed a lesion on/near my anus. I had a swab for a culture 5 days after I first noticed the lesion and a swab for a PCR test taken 2 more days later. The culture was postive for "herpes" and the PCR was postive for HSV1 only. Because my Dr. had some concerns about the length of time after I noticed the lesion until the swabs were taken, a Western Blot was done. Maybe overkill, but at least I know for sure that it is genital HSV1, but not HSV2.
Until I was told about my partner's HSV infection, I never had any recallable/noticeable symptoms of HSV. I expect that my recent exposure was not the source of the infection, but from something years ago. I am wondering if the stress, worry and guilt after being told about the recent exposure was enough to make me noticably symptomatic. I have only notice symptoms around my anus. Other than the lesion I described, there have been some acne like bumps/sores in the same area, but nothing on my penis or testicles.
Here's the questions:
(1) Can I assume that HSV1 infection is not from my recent partner?
(2) During asymptomatic viral shedding of HSV1, does it shed only in the location of the infection? In other words, I assume that my infection is the result of someone rimming me or another (distant) unprotected anal sexual encounter. If my anus is, in fact, the site of the infection, do I shed HSV1 from my penis? Is it possible my anus is not the site of the infection, but I was only symptomatic there?
(3) Does Valtrex help prevent HSV1 shedding?
(4) All in all, the bottom line questions are: Can I stop using condoms with my female partner? What are the chances of infecting her given my histroy? Will Valtrex help? Should she be afraid to give me oral sex?
Thanks in advance for your help.
Doctor's Answer
by H. Hunter Handsfield, M.D., Aug 22, 2006 12:00AM
, Aug 22, 2006 12:00AM
On statistical grounds, you were right to assume (initially) that your HSV-1 infection was oral, not genital. However, the frequency of genital area (including anal) HSV-1 has been rising in recent years, and it might always have been more common than assumed in past decades.
1) Since you were HSV-1 positive at least 2-3 years ago, it is clear you were not infected by your recent partner. Superinfection with a new strain of the same HSV type is believed to be rare.
2) Asymptomatic genital and anal shedding have been studied primarily for HSV-2, with only limited research on HSV-1. The HSV-2 data indicate that subclinical shedding can be quite a bit more widespread than the symptomatic outbreaks are. For example, someone with genital recurrences can have anal or cervical shedding, and vice versa. However, nobody can predict the specifics for any particular person. My guess is that you shed asymptomatically more often from the anal area than genital, but there is no easy way to know for sure.
3) Antiherpetic therapy has not been systematically studied in anogenital HSV-1 infection. It is reasonable to suppose it works. However, HSV-1 is less susceptible to valacyclovir and related drugs than HSV-2 is, so larger doses might be needed. Overall, the frequency of anogenital HSV-1 shedding is much less frequent than for genital HSV-2. Considering all these factors, the balance between the inconvenience, cost, and benefits of suppressive treatment isn't all that clear.
4) The first and most important thing about your female partner is for her to be tested. If she is positive for HSV-1 (which is likely, since half the population has it), you need not worry about transmission; in that case she is immune, or at least highly resistant, to a new HSV-1 infection. Even if she is susceptible, the likelihood is she will still be at low risk, because of the infrequency of asymptomatic shedding of anogenital HSV-1, and most couples in your situation don't go to the trouble of antiviral therapy or use of condoms, and most couples would not avoid oral sex. But there are no certainties, only probabilities.
I hope this helps. Regards-- HHH, MD
1) Since you were HSV-1 positive at least 2-3 years ago, it is clear you were not infected by your recent partner. Superinfection with a new strain of the same HSV type is believed to be rare.
2) Asymptomatic genital and anal shedding have been studied primarily for HSV-2, with only limited research on HSV-1. The HSV-2 data indicate that subclinical shedding can be quite a bit more widespread than the symptomatic outbreaks are. For example, someone with genital recurrences can have anal or cervical shedding, and vice versa. However, nobody can predict the specifics for any particular person. My guess is that you shed asymptomatically more often from the anal area than genital, but there is no easy way to know for sure.
3) Antiherpetic therapy has not been systematically studied in anogenital HSV-1 infection. It is reasonable to suppose it works. However, HSV-1 is less susceptible to valacyclovir and related drugs than HSV-2 is, so larger doses might be needed. Overall, the frequency of anogenital HSV-1 shedding is much less frequent than for genital HSV-2. Considering all these factors, the balance between the inconvenience, cost, and benefits of suppressive treatment isn't all that clear.
4) The first and most important thing about your female partner is for her to be tested. If she is positive for HSV-1 (which is likely, since half the population has it), you need not worry about transmission; in that case she is immune, or at least highly resistant, to a new HSV-1 infection. Even if she is susceptible, the likelihood is she will still be at low risk, because of the infrequency of asymptomatic shedding of anogenital HSV-1, and most couples in your situation don't go to the trouble of antiviral therapy or use of condoms, and most couples would not avoid oral sex. But there are no certainties, only probabilities.
I hope this helps. Regards-- HHH, MD
Is your assumption that coppola is HSV1+ anogenitally only or do you think he is HSV1+ both orally and genitally?
ebro: Those are not symptoms of herpes. (No ongoing discussion, please; thread jump.)
HHH, MD
His biggest concerns are the general fear that he may contract something that scares him, but more specifically that we will not be able to have oral sex without him being concerned about contracting my HSV-1 orally. Although we are fairly serious, he is also afraid that if things don't work out with us, he may contract something he will have to explain to someone else some day.
Until reading your response above, my plans were:
1) get him to get tested, as he's likely to have antibodies that will protect him (fingers crossed!!)
2) go on suppressive therapy to decrease likelihood that I'd transmit, whether or not he has antibodies.
3) Use condoms fanatically
4) angst over oral sex, not sure if it is safe or not.
I wasn't even sure if suppressive therapy would protect him, but I'd go to the expense and effort just to increase both of our comfort levels.
If he doesn't already have antibodies, what do we do from there? Is there any way to completely minimize his risk, or is it at that point just a question of whether he will contract it sooner or later, and whether it will attach "north" or "south?"
At some point it did occur to me that from a practical standpoint, based on what I've read, the best protection from him getting genital HSV would be for him to get it orally and build up antibodies naturally...as so many adults have it anyway. Ironic, huh?
Do you have any additional guidance to offer me, other than your prior message to the previous questioner? Would your answer be different based on my gender being different than the prior questioner (or some other factor), regarding condoms and antivirals?
It seems that it would be irresponsible to not use condoms and antivirals, even if they only decrease chances of transmission by a few percentage points...
Thoughts?