September 6, 2017 at 11:09 am #20625
My wife and I are both HSV-1 positive orally with occasional cold sores since we were children. We’re both immunocompetent and keep valacyclovir on hand to manage outbreaks, which happen roughly once every couple years. We have an open relationship and before engaging in sexual activity with new partners, everyone gets tested, including HSV testing. We’ve both always tested HSV-1 positive, HSV-2 negative via blood tests.
I have one partner currently besides my wife. She tested positive for HSV-1 two years ago when we first started dating, although she couldn’t recall ever having an outbreak. We assumed it was either asymptomatic or happened when she was too young to remember.
About two weeks ago, my girlfriend and I had sex while she was having some vaginal discomfort, but we stupidly assumed this was from a long bike trip we’d just finished. We always use condoms, and did this time as well, but about two days later I noticed an itchy, red bump right at the base of my penis at the pubic bone just beyond where the condom would protect. We both went to urgent care for swabs, which came back positive for active HSV-1, negative for HSV-2; mine via culture and hers via PCR.
We’re assuming my girlfriend always had a genital infection and just never had or noticed previous outbreaks. However, the worry is that I managed to get it from genital to genital contact, despite having HSV-1 orally for 30 years and also using a condom.
How concerned should my wife and I be that I can now pass this on to her genitally, assuming I stay on a suppressive dose of valacyclovir and avoid sexual contact during outbreaks? My wife and I don’t use condoms and are about to start having children, so our biggest concern is the risk of my infecting her genitally. We consider ourselves knowledgeable about STIs and everything we’d read or heard makes transmission like this sound practically impossible. But my situation proves otherwise, so now we’re much less certain.
September 7, 2017 at 6:29 am #20636
You are correct in thinking that this is a rare experience indeed. But as always, I never say never as I have seen this happen once in my practice and have heard about it happening on this forum two other times.
I can’t tell you for sure that she won’t get it genitally, obviously, but I can say that genital HSV 1 sheds virus quite infrequently (and probably less because you already have an immune response to this virus). On the other hand, oral HSV 1 sheds on 25% of days measured, and if you are the giver of oral sex to her, that risk is greater than intercourse.
There are just no guarantees here – only statistics that tell us approximate risks. I’m sorry I cannot give you better advice about this but I think this risk is so minimal that you should not spend a lot of time worrying about it or changing your behavior. Certainly, it would be wise to avoid intercourse without a condom when an outbreak is present.
September 12, 2017 at 7:10 am #20741
Hi, thank you for helping ease our minds; we’re trying to remind ourselves that the risk is lower than oral sex, which is already a part of our relationship. It’s just a matter of letting emotions catch up to facts, but it’s very helpful to get validation of those facts, too.
As a follow up, can you help me understand how I should approach episodic dosing? I understand the recommended doses are 500mg twice a day for 3 days for genital outbreaks and 2g twice a day for 1 day for oral outbreaks. But why are they different? I’ve read some papers testing different dosages for episodic outbreaks orally and genitally, but nothing that compares the two recommended treatments against each other.
After this initial series of genital outbreaks calms down, I’m expecting that I will often have outbreaks in both locations at the same time due to similar systemic stressors. When I have outbreaks simultaneously, which episodic treatment should I use to tackle both outbreaks?
Also, I’ve read a few things that say using antivirals right from the start can make things worse in the long run. The theory is that by suppressing the initial outbreaks, your immune system doesn’t mount a strong response to the virus which limits the amount of antibody and T cells your body will produce to keep things in check going forward. Is there any truth to this and have you seen any actual studies testing this theory?
September 21, 2017 at 8:15 am #20791
I actually recommend the 2 grams then 12 hours later 2 grams again for episodic treatment of genital herpe as well. I find it very effective when taken at prodromal symptoms.
I don’t agree that taking antivirals early in infection make a difference in the long run. There is just no science to that. What we do know is that if you take antivirals daily from the very start of a new infection, it will take longer to make an antibody response but the medicine is basically taking the place of the immune response during that time so it’s a wash.
October 4, 2017 at 2:27 pm #20983
Hi, I have two questions for my last post.
First, my wife recently had her physical and her type-specific IgG blood test came back at 49 for HSV-1. In our experience, the tests always read “>5” and don’t give a specific level, but the test her doctor gave her did show the level. She’s had HSV-1 orally for many years, but her doctor said that her “unusually high” result could mean that she was recently re-infected with HSV-1. Based on our research, there is no evidence this is the case. In your experience, is there any information at all to be taken from the actual IgG level in the ELISA test? Does her having such a high result mean anything?
Second, the internet is awash in advice on diet and lifestyle changes that supposedly impact outbreak and prodrome frequency, but I cannot find any research on any of this, even though most websites claim “current research shows…” Is there any value at all to taking lysine or olive leaf extract, while avoiding sugar, acids, and high arginine foods, etc? Is any of it backed up by research or is this all just folklore?
October 10, 2017 at 9:54 am #21047
That’s total BS. I have seen many many people with numbers that high and it means only that the person has a well established infection, nothing else. Period.
There is no data suggesting that any food or diet behavior has any impact whatsoever on herpes outbreaks or shedding
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