Question:
My girlfriend has tested positive for genital HSV-1 and I am awaiting my results right now. As far as I remember I don’t recall ever having cold sores, and neither does she so we are a bit confused as to how she could have gotten it.

If my blood test comes back that I am HSV-1 positive as well, what does this mean for me? I haven’t had any symptoms of any kind. Does this mean that I am in anyway immune to catching HSV-1 genitally, or is it still possible for my partner to transfer HSV-1 to my genitals?

If my results come back negative, than that means that I will run the risk of catching herpes from my partner. I have read that with HSV-1 the outbreaks are very few and you may get them once a year and maybe even never in span of a lifetime. Is this true? What are my risks for catching it from her? How often does viral shedding occur with genital HSV-1?

What do you recommend my partner does for treatment of HSV-1 genitally? I’ve read a lot about Valtrex; should she be taking this right now daily or when she feels an outbreak coming on? She is not sure whether Valtrex is something she should be taking because she has no idea what it feels like for an outbreak to come along because of the way her “first OB” was. It was barely an outbreak, and just a small bump on her labia that was tested and came back positive. She had absolutely no other symptoms that have been described. This may be a silly question, but since her so called “first outbreak” was as little as it was and that apparently the OB’s get lesser in intensity as time progresses, does that mean that she will never have a larger scale outbreak in the future? And if this is the case, does that mean the amount of viral shedding that occurs for her will be greatly diminished? What other type of treatment do you recommend?

As for prevention of transferring HSV-1 to me what are my best options for this. Regarding sex, will we need to always wear a condom to prevent, or with HSV-1 is the risk low enough that it does not matter as much? I know it is selfish of me but I have always enjoyed unprotected sex to start and then to put a condom on during sex, is this no longer an option for me? And if this is the case I feel like there is going to be so much anxiety that it is going to be hard to have sex normally again. Things like whether or not I can touch her at all with my genital region even if there is no penetration is an issue I feel. Oral has always been something that me and my partner has enjoyed, is this still possible with HSV-1 genitally, going both ways? What are some methods of prevention of herpes transfer during sex that you recommend?

Answer:
Ok, a few questions here! Let's go down paragraph by paragraph...

The most likely way that your girlfriend caught HSV-1 on her genitals was through oral sex with someone who had HSV-1 (cold sores), whether this was from you or someone else. If it's from you, you didn't necessarily have to show signs of an outbreak in order to spread the virus to her. The herpes virus causes something called "viral shedding," which is the activity of the virus on skin cells even when there are no noticeable symptoms present.

If it turns out that you have HSV-1 in your system, but it's not on your genitals, then you are not at all immune to catching HSV on your genitals. Again, skin to skin contact with your partner's genital area would pass it on to you. There are some indicators that HSV on the genitals may not be QUITE as likely to transmit to partners, but the risk is always there, especially with unprotected sex.

First, your partner should speak to her own doctor about an antiviral med such as valacyclovir and see what they say. Studies have definitely shown that valacyclovir helps to reduce the transmission risk for partners. But you both need to talk about it as a couple, as well. If she would be paying the full price for the medication, it would get quite expensive. If she doesn't need the medication for her own symptoms, she would be taking it entirely to prevent spreading it to you. Would you be willing to help her manage the costs of the drug? Is it worth it to you?

Also, the amount of viral shedding has absolutely nothing to do with the severity of her symptoms. Some people have no symptoms at all, ever, but can still spread the virus. Viral shedding occurs even when there are no outbreaks, so it's not diminished or increased based on outbreaks. Also, it's not true that she will NEVER have a more severe outbreak in the future, since outbreaks can be triggered by things like stress, poor diet, and illness. But it may be a sign that if she stays healthy, she can help minimize her outbreaks without drugs.

As for your question about unprotected sex and it "not mattering as much" with HSV-1, that is entirely up to you. The risk is still there, and condoms do help to reduce that risk. However, you may have to decide which is more important to you - the sex you enjoy or not catching HSV-1.

(based on original question by user bobthebuilder)