HSV 1 Viral Shedding

[DoMaBo]

My husband is tested positive for genital HSV 1 on a viral culture swab test. His primary outbreak occurred about 3 months ago at the anus. A later non specific IgG test showed that there were HSV IgG antibodies detected in his blood sample (evidently the HSV Type specific serology is not available through the Ontario Public Health Laboratories; neither does this test show the level of antibodies present) . The same non specific IgG test showed no antibodies present in my blood sample.

After a lot of reading I am still unclear about the viral shedding process. Both our family doctor and the nurse at the STD clinic told us that shedding occurs at the site of the original lesion only.

However, my reading would suggest that while shedding would indeed occur about the lesion if he were symptomatic, asymptomatic shedding could also occur from microscopic breaks in the skin wherever there are mucous membranes or thin skin including the area of the penis, the testicles or the anus, but only about 5% of the time. The virus could then be transmitted and infect me through mucous membranes in the vagina or mouth. This would mean that my performing oral sex on him, or even outer-course would be fairly low risk but possible. Is this correct?

I also understand that the chances of the HSV 1 virus shedding in his mouth are very small. This would make his performing oral sex on me low risk. Is this true?

I also understand that taking an anti viral as a suppressive therapy would further reduce the risk. Is that correct?

[Terri Warren]

Your understanding of the facts is correct- his physician is incorrect. Except the testes rarely shed because the skin is very thick on the scrotum.
Antiviral therapy does reduce both shedding and the frequency of outbreaks.
If he had antibody present at the time of the first outbreak, this is not a new infection. But because of the test that was used, I don’t think we can be certain that the antibody is from HSV 2 or HSV 1 or both.

Terri

[DoMaBo]

My husband’s primary outbreak occurred around the beginning of June at the anus. He tested positive for HSV 1 on a viral culture test taken mid – June. The non specific IgG test was done the beginning of August and showed positive for Herpes. While we could not find a place to do a type specific Eliza test, we found one in late September which would do an Immunoblot. The results of that were HSV – 1 Indeterminate; HSV – 2 Negative. So it would appear he does not have HSV 2. He has not had a second outbreak.

I do not have the virus. I do not particularly want the virus.

We have had a variety of professional advice. My gynecologist has said that I would be well protected if my husband takes suppressive anti-viral therapy and that would be her advice. My husband’s therapist said he should not take anything; we should wait to see if and when he has another outbreak. The doctor at the lab said the chances of infection were very low and we didn’t need to use protection. The STI clinic suggested using a condom, but this is difficult because his erection is not particularly firm… he is 75…and ensuring a condom stays in place is challenging.

If I were your patient, what would be your advice? So far we have avoided penetrative sex, unclothed genital contact, and female on male oral sex.

[Terri Warren]

Just so you know, the antibody test misses about 30% of HSV 1 infections, so you may or may not be infected. To find out whether you are or are not infected, it would benefit you to do the western blot but you may not want to go that far with this. How long have you been having sex prior to this diagnosis? Sounds like you have not been using condoms, correct?

So my advice: get the western blot to see if you are infected.
Decide how much you don’t want to get this (I personally have never seen someone transmit HSV 1 through intercourse.) He can start on antiviral medicine and perhaps not using condoms.

Your information on viral shedding is right on.

Terri

[DoMaBo]

Thank you Terri,
We have been married for many years. About 20 years ago, my husband had a series of encounters with male sex workers. When I became aware of this, we were both tested for STI’s (negative) but herpes was not included. With counselling and an agreement to maintain a monogamous relationship, we resumed our sex life and did not use condoms. Over the years the frequency dwindled and we were not sexually active for 10 – 12 months before the diagnosis (June 2018). At this time, he admitted he had been involved with a number of men over a number of years, most consistently over the past five years, participating in sexual massage, the giving and receiving of oral sex, and outer course including genital to genital contact. He used no protection. There was no anal penetration. It is possible there was a previous herpes outbreak in Feb … he had a rash on his penis for which he was given an antifungal cream for a yeast infection. He was given an STI screening at that time, but again, no herpes. So he only knows for sure he was positive for HSV1 in June when the anal lesion appeared.

I recognize, it is possible he has had HSV1 for some time and I have been exposed to it. Also possible, he more recently contracted it while we were not sexually active and I have not been exposed. We have been trying to track down a lab in Ontario or Quebec which would perform The Western Blot Test to clarify my status but have had no success. Even if there is a 30% chance I may already be infected with the virus and the test results show a false negative, there is still a 70% chance it is correct, and I do not have it.

You said you “personally have never seen someone transmit HSV 1 through intercourse”. How then is genital HSV1 usually transmitted in your experience? Does the fact that studies show genital HSV1 to shed on average about 5% of the time mean that you have a 5% risk of contracting the infection, or is the risk less than that?

[Terri Warren]

Usually HSV one that is a genital infection has been transmitted through oral sex. His history must be very disturbing for you and I’m sorry you’re going through this. Yes, we believe that HSV one is shed I’m about 5% of the days which means it is shed about 18 days in the year. The risk is not 5%. In order to contract herpes through intercourse, you would need to be having intercourse unprotected on the day that he was shedding and since this happens quite infrequently, the risk is not great. The closest location to Ontario were you could have your blood drawn is probably Fargo North Dakota unless you could find a provider in Ontario who would agree to draw your blood spend it down and you could ship it to the University of Washington. Alternatively, you could find some place cheap to fly to in the US Billy can arrange for a blood draw there. Are you considering restarting your sexual relationship with your husband? If the answer is yes, that’s fine, but I would encourage you to ask him for an HIV test and probably to be screened for other sexually transmitted infections before you restart the relationship

This is your final post on the subscription. If you have more questions, feel free to renew.

Terri.

• This reply was modified 4 years, 2 months ago by Terri Warren.

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