Oral HSV, IGM and valacyclovir

[westover2015]

Hi Terri,

Thank you so much for running this forum.

I’m a 27 yo female that has sex with females. I recently started seeing someone new and have kissed and had unprotected oral sex with them. After a recent encounter – I developed strep throat symptoms (as did she) and I went to the doctor – who gave me antibiotics after an exam (no throat culture or rapid strep was done). A few days later, I developed what appeared to be canker sores on my inner lip, and had severe gum bleeding/pain (she did not). Since this didn’t seem like strep anymore, I did some research and found it could be a primary oral herpes outbreak (herpetic gingivostomatitis). I decided to follow up with a dentist, who, along with his colleagues, werent quite sure it was herpes vs another virus/bacterial infection – gave me more abx and some magic mouth wash. I started improving the next few days, but it was nagging at me that I didnt have a definitive answer. For the record, my sex partner reports she has never had symptoms of herpes orally or genitally.

I decided to get an STD screening from my primary provider 2 weeks after the encounter, and had the following results:
IGG hsv1 & 2- both negative
IGM hsv1/2 – 2.86
GC/Chlyamidia – negative
ulcer culture – negative (it was still visible but was in the healing process…)
rapid hiv – neg

I know IGM can be inaccurate, but with my presentation it seems to me that before this encounter, I had no herpes, but after this encounter, I probably have oral hsv-1. I’m planning on doing an IGG follow up at the 12 week mark to be sure, but in the meantime I have the following questions:

My provider prescribed me valtrex to take if I want, and I started a daily dose of 500mg a few days ago. I’m wondering – will that interfere with my antibody production/IGG test results down the line? Should I hold off on taking it until my second IGG is back if im asymptomatic so as to not impede my body from producing antibodies?

Should I remain not engage in oral sex with this partner until 12 weeks to insure I dont also get genital hsv-1 while my body is still producing antibodies? (that is to say – if this is hsv-1, after 12 weeks I understand my risk of contracting genital hsv in addition to oral hsv is very low – but in the meantime I’m probably still at higher risk, right?)

I understand that many, many people have oral hsv-1, but I am concerned about transmitting it to future partners through oral sex. There isnt much, if any, research about same-sex couples and oral hsv to genital transmission – but all in all I read that hsv-1 is increasingly a cause of new genital herpes cases. In your experience, would you recommend taking daily valtrex for oral hsv-1 to reduce oral to genital hsv-1 transmission, or is that overboard?

Thank you so much for sharing your expertise and taking the time to read my questions.

[Terri Warren]

Yes, antiviral medicine can interfere with antibody production and if you want the most accurate future test, it is essential for you to know that piece of information.

So she was the giver of oral sex to you and your to her both? So she kissed you and gave you oral sex and you are wondering if you continue to have her give you oral sex if you would then get genital HSV 1 in addition to the oral HSV 1 you think you might have? Would you not have been at risk the first time? You might be asking if you happened to not get it the first time should you avoid receiving oral sex so if you didn’t get it the first time you might get it now? If you think that might be the case then yes, I would avoid receiving oral sex from her till you figure out what is going on here. Has she been tested for HSV 1? If not, that should be strongly considered, just to see who is at risk for what. Remember that the screening test for HSV 1 is not great and misses 25% of cases when compared to the gold standard western blot.

If you do turn out to be HSV 1 positive (and you could, based on your description but not a slam dunk), you could take daily antiviral medicine to reduce the risk of transmitting it to someone who does not have it, yes.

Terri

[westover2015]

Hi Terri,

Thank you for your previous response. It’s been about 5 months since my possible exposure to HSV 1, and I am going to go in for repeat IGG testing (my initial IGGs were negative around the 2 month post exposure mark).

Because I am with a new partner, I’ve been taking valtrex 500mg daily for about 4 months. I’ve never shown any symptoms.

I’m wondering how much valtrex use will affect my IGG results. Can I stop taking it a couple weeks before testing and expect an accurate result, or do I have to be off valtrex for months to get an accurate IGG? Thanks!

[Terri Warren]

The problem is that the IgG screening test misses one out of four HSV 1 infection, compared to the gold standard western blot (it is far better for HSV 2). And if you’ve been taking Valtrex continually yes, it can definitely alter your test results. Taking Valtrex daily based on an IgM test is an error because of this complication. You need to be off Valtrex for at least 3 months from the time of possible exposure to the time of testing.

Terri

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