1) Would you still recommend a western blot or is there generally enough agreement with the results of the supplemental/reflex test? Is my score good enough to substitute for it?
There is good agreement between people who get a negative inhibition assay and subsequently get a negative western blot. And those with values above 4 who are just accepting that they are infected should read this and get a blot!
2) Back to my forever positive HSV1: how should I handle with a new partner given that this diagnosis is very common? Presuming she is negative for both herpes versions, is it ok for her to give me oral sex, but not ok for me to return the favor, knowing it could morph into genital herpes for her? Should I stay on Valtrex in order to minimize any shedding associated with HSV1? Is this concern even an issue or am I in overkill land now?
Given that half the population has HSV 1, and probably higher in your age group, many of your future partners will also be infected, though many won’t know it. My OPINION is that before you give oral sex to a partner, you should tell them that you have the cold sore virus and let them make up their mind about taking the risk of acquiring it.