Genital HSV 1 with prior oral infection

[aqua214]

Hi Terri, I’ve got an interesting situation that I hope you can help shed some light on. If not, I think you’d at least be interested.

In December 2014, I had intercourse with my ex-wife, whom I share a child with. She performed oral sex on me, but I did not on her, as she was menstruating at the time. Exactly one week later, she developed lesions on her labia. In early January she was diagnosed with genital herpes, got a swab test of the lesion and it came back positive for HSV type 1. At the same time, I got a type-specific IgG test, and it came back positive for HSV 1 only. (HSV1 >5.0; HSV2 <0.9)

Here’s the twist: we both had confirmed prior oral HSV 1 infections. I know this to be true–in my case, from previous IgG tests (I can’t actually remember the last time I had a cold sore, but my last STD test was August 2014), and in her case, recurring cold sores going back at least 6 or 7 years. She would get cold sores at between 2-4 times a year, including an outbreak in October 2014. I have never had any apparent genital outbreaks.

She has since had a genital recurrence in February, this time with lesions around her anus. Of course, before the results were in, this caused us both a lot of anxiety and suspicion. We both have had other sexual partners since our divorce. She is absolutely convinced that I infected her (because of her first outbreak 7 days after our encounter), despite my insistence that the likelihood of me passing HSV1 genitally to her is incredibly slim.

The only reason I even ask your advice is because I hold out hope that perhaps we might get back together at some point in the future. That, and after spending so much time learning about this virus, I find this situation to be rather unique and scientifically interesting.

So here are my first questions:

1) Is there a possibility that her swab test was flawed and she actually has HSV 2? I’m not sure what type of test it was. I plan on getting another type specific IgG in another week or so as I understand it sometimes take 8-12 weeks to develop antibodies for HSV. It has been nearly 10.

2) It’s possible that I am infected with HSV 1 both genitally and orally without showing any apparent symptoms. But what are the odds that I could have passed genital hsv 1 to my partner even though she had a prior oral infection? Have you ever seen or heard of such a thing happening in your years of experience?

3) Assuming she was infected with HSV 1 both orally and genitally at the same time in the past, why didn’t she ever have an apparent outbreak? Why two outbreaks now, out of the blue, and with little time between?

[Terri Warren]

1. I doubt that her swab test was flawed though I have seen it happen, yes. I follow up antibody test wouldn’t be a bad idea.
2. It is possible that you have HSV 1 both orally and genitally, yes. But the odds of you transmitting it to her if she already had an oral infection are very slim indeed. She could certainly have had HSV 1 genitally prior to this encounter. She could have acquired HSV 1 orally and genitally at the same time prior to this encounter. I have only seen one case in 32 years of someone acquiring a new HSV 1 infection genitally after a confirmed oral swab. When you say cold sore, you mean on the outside of the mouth, right, not a canker sore on the inside of the mouth?
3. I don’t have an answer for that, honestly. But we certainly see it happen = people are infected for years and then start breaking out with no known trigger.

If you want to get back together, the herpes should not be an issue at all in that situation.

Terri

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