Herpes Spread to Mouth During Primary Infection

[mcorazza]

Hello,

I’m so glad that you make this service available to people! My name is Michael, and my question is about whether you think it’s likely that I spread HSV-1 from my genital area to my mouth given the information I provide below.

In November of 2020, I was diagnosed with HSV-1 in the genital area. I was infected by my partner at the time, who also suffers from HSV-1 in the genital area. My primary outbreak lasted for 4-5 weeks. It consisted of two back-to-back outbreaks. The first was confined to the pubic area, with no symptoms on the penile shaft. The second outbreak, which occurred roughly 20 days after the first, involved lesions in the pubic area and penile shaft.

Keeping that in mind, here is the coital act I am concerned about: One or two days into the onset of my symptoms, I was experiencing redness and irritation in the pubic area, and no symptoms on the penile shaft (I hadn’t yet realized I’d contracted herpes). During this time, there was a day my partner performed oral sex on me and kissed me on the mouth immediately after. For me, it is unclear whether this represents a high-risk situation for transmission. On one hand, though my pubic area was irritated, there were no symptoms on my penile shaft at the time, and no symptoms developed on my penile shaft until roughly 20 days after the coital act (recall that symptoms on my penile shaft only occurred during the second outbreak in the 5 week period. I really want to emphasize this point, because to me this suggests that there might have only been viral shedding in the pubic area and not my penile shaft at the time). This could indicate that even if there was viral shedding on my penile shaft at the time of coitus, it was minor enough not to have been infectious via the mouth of my partner. On the other hand, as you know, viral shedding is especially high during an initial outbreak, and it is at least conceivable that areas on my penis harbored a high enough viral load for transmission.

[Terri Warren]

It is conceivable, given the situation, that you also acquired this orally, but without a lesion, it isn’t possible to know. If you get any oral lesions, you should have them swab tested.

I am assuming you had the lesions on the penis swab tested to know that you have HSV 1?

[mcorazza]

Yes, I had the lesions swabbed and tested positive for HSV-1.
This leads me to another question: In an article published a while back, “HSV-1 DNA in Tears and Saliva of Normal Adults” (H.E. Kaufman et. al.), it was found that 98% of the subjects with oral herpes shed HSV-1 DNA at least once over the course of the 30-day study. The study was conducted by instructing the subjects to swab their mouths twice a day–Once upon rising, and again in the evening.

In order to better understand the likelihood of an infection in my oral cavity (I am aware that this won’t provide definitive proof), I plan to mimic the procedures undergone by the subjects of the study and request 60 swabs from my doctor.

Do you think this is worth doing? Also, if I am unable to arrange this with my doctor, is this a procedure you would be willing to offer at your clinic?

[Terri Warren]

You could do that, sure. The swabs should be PCR or NAAT swabs, not culture. And they are expensive. But you could certainly do it. And if your doctor won’t, then, yes, I could. But as I said, they are expensive! With me, they are $150 each.

Terri

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