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Hi Terri,
I am a male. I was diagnosed with genital HSV 1 14 days ago via culture swab. It was an initial outbreak and I have tested negative for both HSV 1 and 2 previously as recently as of a few months ago so I can be confident it was an initial outbreak. I was prescribed Valtrex and finished a week’s worth of medication. The scabs have healed but occasionally I experience tingling sensations on my lower leg and minor itching on the genitals. I was with a new partner a day ago and told her my diagnosis. She proceeded to perform oral sex on me in the lower area of my genitals ie the perenium but did not come into contact with any of the areas where my lesions were on the shaft. We used a condom during sexual intercourse. There was light kissing during intercourse and I proceeded to perform oral sex on her afterwards.
1) What is the likelihood that she contracted HSV1 orally from me? She has tested negative for both HSV 1 and 2 previously so no history of cold sores.
2) What is the likelihood that the kissing could have transferred HSV1 to me orally? Am I at risk of auto inoculation given it has only been a short period since my initial outbreak and meds taken?
3) What is the likelihood that the kissing transferred the virus to me and then passed to her genitally when I performed oral sex on her?
4) What is the likelihood that sexual intercourse with a condom transferred HSV1 to her genitally?
I now understand the tingling is prodrome and there is risk given I am shedding. Your response is much appreciated. -
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It’s difficult to say anything about her transmission risks without knowing her true HSV 1 status. The thing is, that the routine screening test misses at least 2 out of 10 cases of HSV 1 if not more. That applies to her AND to you. If your screening test for HSV 1 was negative in the past, there is a reasonable chance that it missed your HSV 1 infection. Same with her. Let’s assume for the moment that this was new infection. When was your last sexual contact before this most recent partner? If you are going to have symptoms with a first infection, and not everyone does, then it is going to happen in 2-10 days, with the average being 5.5.
I think the chance of her acquiring HSV 1 orally from her giving oral sex to an area other than the penis itself ( if I am reading that correctly) then kissing you is really low. The whole combination of events here is unlikely, I think, to result in infection in her or in you orally.
I’m not worried about the HSV 1 being transmitted through one act of intercourse, with a condom.
Obviously, none of this is for certain, but I do think the risks are low for both of you to have acquired herpes – you in new place and her at all.If you want more accurate HSV 1 testing, the western blot picks up way more cases of infection.
terri
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Last encounter was 5 days before first signs of symptoms or 20 days ago. So it lines up with being a primary outbreak, assuming prior results were accurate. Does this change anything?
Really hard to say, but perhaps makes it more likely that this is new. Without an antibody test to refer back to I cannot be sure about this.
1) Do you know if shedding diminishes as days goes by since initial primary outbreak symptoms (day one vs day 14)?I doubt that there isn’t much difference in shedding between day day one and day 14. There is certainly a difference between they 14 and two years later.
2) Do you believe it’s unlikely because genital hsv1 shedding is localized to the penis? Can the virus travel easily via saliva? Just want to gather more insight why you believe it’s unlikely.
Most viral shedding in the mail occurs from the shaft of the penis, yes
3) Theoritically could I transmit from genital to oral asymptomatically?
yes
4) I’ve read that there haven’t been studies for genital to genital hsv1 transmission but you’ve said you’ve only known a handful of cases where this happened. Could it be happening but we just don’t know because hsv1 oral and genital gets lumped together in testing?
Oh yes that is certainly possible which makes it hard to answer questions accurately on this topic.
I think if she only had the tip of your penis in her mouth for a very short time the risk is truly minimal of her becoming infected.
No I do not think tingling in the arm and redness of the ear are related to herpes. If you develop blisters on your ear, we should obviously have them swab tested.
Terri
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I think we are talking about semantics here (and who knew my article was quoted in the New York Times?). Asymptomatic shedding occurs from thin skin or mucous membrane – that include the penis, rectum, labia, mouth, lips. It does not occur from legs, buttocks, belly. That skin is too thick for virus to get out. We definitely know that the main site of asymptomatic shedding in men is the penis and it is NOT mucous membrane, so I disagree with your doc on that if he is not including the penis. The reason condoms aren’t perfect is that virus can be shed from the top of the penis that is not always covered by a condom and perhaps also from the top of the scrotum.
Terri
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Asymptomatic shedding can infect someone who comes into contact with genital skin with virus present or I suppose also vaginal secretions that have passed by infected skin in the genital area. the point is that it is not only secretions but contact with the actual tissues that are shedding virus. Semen is not a good carrier of virus.
Terri
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