March 30, 2015 at 3:07 am #5771
I am female who was recently diagnosed with HSV1 in my genitals. I have read a lot regarding this condition and the chances for recurrences and have a few questions. My doctor told me most people never have a recurrence and that it is okay to not tell a future sexual partner if lesions are not present. Is this true? Can a future partner get HSV1 on his mouth by giving me oral sex if he has never had a cold sore before? How rare is genital to genital transmission?
March 30, 2015 at 2:15 pm #5773
I wish we had more firm data to respond to your questions, but HSV 1 genitally has been studied far less than HSV 2 has. So I can tell you what my experience from 33 years in practice is and what my colleagues report as well.
My experience is that people with HSV 1 do recur certainly less, but some people do have recurrence patterns that more closely mimic HSV 2, though not often. We do know that if a person with HSV 1 genital infection doesn’t have a recurrence in the first year after infection that there is an 88% chance that they won’t have another one. The first year may not be representative of years to come, if the individual IS having recurrences in that time. Normally, if there are to be recurrences, they will be infrequent – the average is .7 recurrences per year.
A future partner could get HSV 1 from giving oral sex to you but that isn’t likely because HSV 1 sheds less frequently. The flip side of that is that 56% of people between the ages of 14 and 49 have HSV 1 already, so if someone has it already (either they report a history of recurrent cold sores or simply test positive for HSV 1 antibody), they are extremely unlikely to get it from you genitally.
As for telling, that’s considerably more complicated. Some experts think disclose should happen with every new partner, others disagree. I would say that if someone tells you they get cold sores, disclosure isn’t mandatory, no, because they aren’t really at risk. But if that is unknown or hasn’t come up or they deny having cold sores, then I think you would be better off disclosing that information and suggesting that any future partner be tested. That’s just my opinion, mine is not the only good one for sure.
March 31, 2015 at 2:15 am #5782
Thank you so much for your reply, I appreciate the time and information provided.
I would be more comfortable having the conversation beforehand, because I feel that I would want to know the information (and wish I had known/understood the risks before I was exposed in this case) if I was on their side of things. I fear that most men won’t understand my case and will think I am lying or have GHSV2 because it seems pretty unknown for this to happen, or at least I had no idea what the risks were until I was diagnosed and did all my research.
Are the statistics true that GHSV1 sheds between 3 – 5% of the time for everyone? Or is that for people that have GHSV1 that presents like GHSV2?
In your previous answer you said they are “extremely unlikely” to get it from me genitally. Is that in general? Or if they have tested positive for HSV1? I thought if they tested positive for HSV1 antibody, they can’t get it from me either orally or genitally? Or was your statement about testing positive for HSV1 antibody related to the answer to my question about transmitting it orally to them during oral sex? When you say it “isn’t likely” to transmit this orally to someone giving me oral sex, what constitutes “not likely”? I deal with data for a living, so statistics make more sense to me.
April 3, 2015 at 7:51 pm #5851
Sorry, your note slipped away from me.
Yes, the shedding rate you list is correct. That’s an average.
If they test positive, no, they are extremely unlikely to get it from you genitally. I’ve learned never to say never in this business but this is about as close as it gets to never in my book. If they do NOT have HSV 1 there is a very small chance that if they gave you oral sex, they could get it on their mouth. I say very small because HSV 1 rarely sheds genitally.
April 12, 2015 at 10:24 pm #6085
Thanks Terri. Your response also slipped past me. So, how have you counseled patients on disclosing this in the past given these statistics? Would you say that, before any foreplay/hooking up, I should ask them to get tested by blood test to see if they have HSV-1? That way, if they test positive, we know the chances are super super slim for them to contract this from me both genitally and orally?
I also want to make sure I am understanding this correctly…if they do NOT have HSV-1 and have never had a cold sore, there is a very small chance they could get it on their mouth by giving me oral sex? And the same with genitally if we have unprotected sex? I know you said if they test positive for HSV-1 it’s extremely unlikely they would get it genitally from me, I just want to make sure I am clear before I encounter this conversation with someone.
Lastly, since this is a new diagnosis for me, would you recommend I wait awhile to see if symptoms come up again? I would love to be in that 88% of people that have a one time occurrence, but if I am not, don’t I risk exposing someone to this more? I just don’t want to put someone else in the position I have been put in.
As always, appreciate all the help.
April 13, 2015 at 1:58 pm #6095
The opinions of experts vary on this. My opinion is that it would be good to disclose this before having intercourse. And I would encourage your partners to be tested, not just for concerns about HSV 1 but other STI’s as well, including HSV 2!
Yes, if they are negative and give you oral sex, there is a very small chance they would acquire HSV 1 genitally. And the same is true about intercourse, yes.
I don’t know that you need to wait to see what happens. It is likely that you will shed a little, even if you don’t have any outbreaks, so that’s not going to be the defining thing in terms of transmission. The issue about outbreaks is more about your comfort than it is about transmission.
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