Oral HSV-1 and transmission

[sharon_732]

Hello,

I am having my first cold sore outbreak, and I’m awaiting results from tests to see if it’s HSV-1 or HSV-2 (I have been tested for both previously; all prior results were negative).

My boyfriend and I are breaking up for the time being (it’s early in the relationship) while we both digest the information, do research, and mull over whether it makes sense for us to be together. He has had no outbreaks but is getting tested to see if he has antibodies for either HSV strain.

I guess what we’re both wondering is…if it turns out that we both have HSV-1 antibodies, how does that impact the likelihood of transmission? We are both concerned that I could give him HSV on his genitals via oral sex. Any advice appreciated.

He previously was in a relationship with someone who got cold sores since childhood, but we are both more concerned about it in my case because the infection seems to be new, and I have read that one is more likely to be frequently contagious/shedding the virus between outbreaks in the first year or two after infection. I realize asymptomatic viral shedding will always be a factor, but I have just read that it’s much more frequent in the first year or so.

Thank you so much.

[Terri Warren]

I’m a little confused – have you been kissing someone else new besides this new person? If not, then isn’t this new infection from him? If he already has HSV 1, then he won’t get it in a new location. The screening test for HSV 1 misses 25% of infections so him testing may or may not capture his true HSV 1 status. So basically if you are both infected with HSV 1, after the infection is well established, which takes about four months (this applies to you), then you or he would be extremely unlikely to get the same type (HSV 1) in a new place on your body.

Terri

[sharon_732]

Thanks, Terri-

You’re right, there’s a missing piece of information here.

I am not certain that I contracted HSV-1 from my most recent boyfriend. We had only been together a short time, and in my reading about the virus, I discovered that an initial outbreak can present as gingivastomatosis (sp?). In March, I had horribly painful swollen gums on the right side of my mouth. This was concurrent with a strep throat infection, so at the time herpes did not cross my mind.

I was with a different partner at that time, and it seems likely that I was infected near the end of that relationship. Unfortunately, I did not get re-tested for HSV when I went for testing in May–I went to Planned Parenthood which does not routinely test for it. Nor does my current PCP (I had even more recent bloodwork, but again not for HSV). So I have no conclusive evidence to date the infection.

For the sake of my recent boyfriend, I am assuming that I was infected before we started seeing each other. He is still planning to get the serum test for HSV-1 and -2 antibodies, and I suppose we may discuss our future plans from there.

Thanks again, and if you have any additional comments, they are indeed quite welcome.

[Terri Warren]

I guess my concern here is that you boyfriend might get the screening test for HSV 1 and if it is negative, then he will assume he is not infected which may or may not be correct. The best test for HSV 1 antibody is the western blot so if either of you really want the best HSV 1 info, that is the test. Are you waiting for a swab test from a lip lesion?

Terri

[sharon_732]

Ok, I see. That’s good to know. I’ll share this thread with him so that he has that information.

I had a swab taken from the lesion (2 days after blistering started), but I also submitted blood for some kind of serological test. I just don’t know what kind it was–hopefully the lab results will list that?

If not, I will try to find a facility that does western blot, which I assume is also a blood test if it is accurate for asymptomatic folks.

Thanks again so much, your advice is very reassuring.

[Terri Warren]

There are only two ways to get the western blot done in the US – one is to contact the University of Washington directly they can ship you a kit, you can have your provider draw your blood and spin it down and then ship it back to UW or our clinic can order the test for you at a lab near you.

Be certain of two things: 1) that the swab, if positive, is typed (HSV 1 or 2) and 2) be sure the blood test is an IgG, not an IgM. IgM is very inaccurate and the CDC strongly recommends against it.

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Terri

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