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First, thank you so much for this site and for this forum! I have several questions, if you like please take them in turn and I will purchase more time as needed.
I was recently diagnosed with HSV-1 by viral culture from a lesion on my penis. I had a negative blood test 8 months ago (HSV 1&2 IgM <.91). I am primarily concerned now with transmission to my primary partner. She had a negative blood test about a year ago, and has shown no symptoms. She will be getting another blood test when possible. I understand there is little real data on the transmission of HSV1, but once my outbreak is over, we need something to go on…
1) Understanding there is no firm data, practically speaking, how worried should we be about genital-genital or genital-oral transmission when symptoms / prodromes are not present? I have read from you and others that genital-genital HSV1 transmission is almost unheard-of, but what do you actually suggest partners do when one has HSV1 G and the other has no HSV at all? (Vacyclovir, condoms, nothing?)
I ask both short- and long-term. I understand I am fairly likely to get another outbreak, and then increasingly unlikely after that. I also understand that an absence of outbreaks is not necessarily an absence of viral shedding, but I do presume that as the risk or frequency of outbreaks diminishes, the same happens with shedding.
2) If you do consider there to be significant risk of me transmitting the HSV1 virus from my genital area, does the fact that my outbreak was on the head of my penis make it unlikely that I could shed the virus from elsewhere in the groin? (i.e. are condoms a pretty sure bet for protection?)
3) My research indicates I most likely got this from receiving unprotected oral sex from someone with a history of cold sores. Whenever I got the virus, there would also have been heavy kissing. Did I most likely contract the virus orally as well, should I refrain from kissing for a period of time? The last partner I had besides my primary was 2 months ago.
4) I understand that it is possible to carry the HSV2 virus for a long time, and pass it to others, all without symptoms. Is this also true for genital HSV1? In these cases, does the person still develop antibodies? Or could I (or my partner) have had this virus for a long time, dormant, despite negative blood tests over the years?
5) Finally, do you have any advice on contacting my previous partners. Should I contact everyone I have been with since my last test (8 months)? I ask for the sake of informing people who may be infected or at risk, not out of a desire to find the source of my own infection.
Thank you so much for this.
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1) Understanding there is no firm data, practically speaking, how worried should we be about genital-genital or genital-oral transmission when symptoms / prodromes are not present? I have read from you and others that genital-genital HSV1 transmission is almost unheard-of, but what do you actually suggest partners do when one has HSV1 G and the other has no HSV at all? (Vacyclovir, condoms, nothing?)
I don’t think you need to be terribly worried about genital to genital transmission, though it can happen. I think you know that we do not have any data about transmission of genital HSV 1 to a sex partner. What you should do about transmission is a little bit up to you and your partner. Some people are much more worried about this than others. If your partner is very concerned about getting a just this from you th I would suggest daily suppressive therapy and condom use. I am a little bit concerned about your testing since you got IgM testing rather than IgG testing and IgM testing is notoriously poor. I’m wondering what kind of testing your partner got to determine that she is not infected with HSV 1. Remember that the ELISA screening test that is traditionally used, the IgG tes,t misses about one or two out of 10 cases of HSV 1 infection. The most reliable test for HSV 1 antibody is the herpes Western blot available through the University of Washington.
I ask both short- and long-term. I understand I am fairly likely to get another outbreak, and then increasingly unlikely after that. I also understand that an absence of outbreaks is not necessarily an absence of viral shedding, but I do presume that as the risk or frequency of outbreaks diminishes, the same happens with shedding.
It is generally true that the rate of herpes virus shedding in the genital tract decreases over time. However because of the infrequency of HSV 1 sheddingin the genital tract, we do not have specific data about whether or not shedding increases over time or decreases over time with HSV 1 infection.
2) If you do consider there to be significant risk of me transmitting the HSV1 virus from my genital area, does the fact that my outbreak was on the head of my penis make it unlikely that I could shed the virus from elsewhere in the groin? (i.e. are condoms a pretty sure bet for protection?)
Viral shedding can occur anywhere from the genital tract not just the penis. Virus is not really shed from the groin but it can be shed from the top of the penis, the top of the scrotum and from the anus. Condoms certainly do reduce transmission but again they are not perfect.
3) My research indicates I most likely got this from receiving unprotected oral sex from someone with a history of cold sores. Whenever I got the virus, there would also have been heavy kissing. Did I most likely contract the virus orally as well, should I refrain from kissing for a period of time? The last partner I had besides my primary was 2 months ago.
Yes the most common source of genital HSV 1 is receiving oral sex from someone who has a HSV 1 oral infection. It is impossible to say whether you acquired this orally or not. Again it needs to be a decision between you and your partner how careful you want to be about the whole HSV 1 transmission issue. In my personal opinion refraining from kissing when you’ve never had a cold sore seems a little bit of overkill.
4) I understand that it is possible to carry the HSV2 virus for a long time, and pass it to others, all without symptoms. Is this also true for genital HSV1? In these cases, does the person still develop antibodies? Or could I (or my partner) have had this virus for a long time, dormant, despite negative blood tests over the years?
Again because of the in accuracy of the ELISA test it is possible that you are your partner could’ve had this for a long time and it has not shown up in blood antibody test.
5) Finally, do you have any advice on contacting my previous partners. Should I contact everyone I have been with since my last test (8 months)? I ask for the sake of informing people who may be infected or at risk, not out of a desire to find the source of my own infection.
I honestly don’t think it is necessary to contact all of your partners in the past eight months to tell them about your HSV 1 infection. More than half of the population in the US between the ages of 14 and 49 have HSV 1 and so it is likely that some of those people already have HSV one on their own. Because the test that we have to look for it isn’t great I think the whole exercise might be one of futility. I know you are trying to be very thorough and you can certainly inform people if you wish.
Terri
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I guess I understand there are just no real answers with regard to HSV1 genital to genital transmission… the risk seems to be very small, but still there. Do you consider the risk of HSV1 genital-oral to be the same, or more or less possible than genital-genital?
I honestly just don’t know.
I understand your hesitancy to give direct advice about HSV 1 transmission. By way of contrast, how do you advise couples where one has HSV2 G and one has no HSV? What is the level of transmission risk, and do you have strong opinions about how to mitigate it? You have said previously you have seen “a handful” of HSV1 genital-to-genital transmissions. How many have you seen with HSV2?
How many times have I seen someone with HSV 2 transmit the virus the someone? Hundreds of times. I advise these couples that daily antiviral therapy, condom use and awareness of symptoms are all ways to reduce the risk of transmission. Some couple do everything, some do nothing.
It makes sense that the same practices that can reduce the risk of HSV2 transmission could further reduce whatever that base risk of HSV1 transmission is, theoretically by the same percentages, but still nothing is perfect. Speaking of which, do you agree with these base numbers I have found? A) The risk of male-to-female transmission of HSV2 genital for discordant couples is about 10% per year. B) Condoms can reduce this 10% by 30-50% (to 5%) C) Suppressive therapy can reduce the risk by a further 50% (to 2.5%)?
I don’t think you can make that extrapolation. and yes, I totally agree with your statistics.
Terri
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