Oral hsv2 transmission

[whatnow]

Hello. I’m a 52 year old, single, heterosexual male, hiv negative. Thirty years ago in 1985 I developed a dime sized open sore just my upper lip. This occurred a few weeks after I performed oral sex on a new female partner. Just prior to the oral sex I had shaved my face very closely. We also engaged in unprotected vaginal intercourse. I went to a dermatolgist after the initial outbreak who gave me oral zovirax and told me I had HSV1. I did not have any genital outbreaks then or anytime since and I did not observe any genital outbreak on the partner previously mentioned. I do not have any knowledge of transmitting either oral or genital hsv to any partners since then. After my initial outbreak I continued to have minor outbreaks in the same spot above the upper lip 1-2 times annually which responded immediately to topical Zovirax. By the time I was 30 the outbreaks became less frequent and now occur once ever two years at most. Any recent outbreaks are very small and completely gone within a week. I always used topical Zovirax at the first sign of itching. Last month I learned that HSV2 can present orally so I decided to get tested. The IgM test came back negative but the IgG came back positive for hsv2 and negative for hsv1. My questions are: 1) Is it possible that I also have gential hsv2 if I never had outbreaks? 2) If I only present orall hsv2, and avoid sex during any outbreaks, can I transmit it to a partner’s genitals or would it only establish as oral hsv2. 3) If oral to genital hsv2 tranmission is possible, are there any established transmisson rates with someone with a similar medical history? Thank you

[Terri Warren]

Did you have intercourse with the person that you gave oral sex to prior to developing your first lesion? What was the index value of your HSV 2 positive test? Do you know that the HSV 1 screening test misses 1 out of 4 infections? Did the doc who diagnosed you do a swab test to get that HSV 1 diagnosis or was it just looking? If you have HSV 2 orally, which you should attempt to clarify with a PCR swab test the next time a sore shows up, it is unlikely but no impossible to transmit that orally to someone else by giving them oral sex. I don’t understand your last question about transmission, can you clarify please?

Terri

[whatnow]

My test results are: HSV1 ab IgG res = .19 HSV2 ab IgG res = 7.12. Prior to that first legion on my lip I never had a cold sore.
Yes we had unprotected intercourse prior to the legion but because I had shaved so closely and my skin so sensitive I had assumed it was an easy conduit for infection from my having performed oral sex. To the best of my memory, the sore appeared within a few weeks after that. The doctor did not perform a swab test. It was 1985 and at that time the dermatologist assumed is was hsv1 without further testing. I will have to wait for another outbreak which could be a while for clarification on the hsv type. My question is twofold. If I do indeed present the hsv2 orally does that mean I can still transmit it genitally if there is no outbreak. I understand the virus can shed without an outbreak present. Regarding transmission rates, I know that oral presentation of hsv2 is rare, so I was wondering if there is any documented rates of transmission from a person with oral hsv2 to a non infected individual.

[Terri Warren]

If you do have HSV 2 orally only, you would not transmit from the genital tract. But the likelihood that you have only HSV 2 orally is really small, truthfully. It is more likely that you have HSV 2 genitally but don’t recognize symptoms. That’s just statistics. I am not aware of anyone who has transmitted HSV 2 from the mouth to another person, no. And yes, the virus can be shed without an outbreak – far more likely from the genitals than the mouth.

Terri

[whatnow]

When you mentioned that hsv1 screening misses 1 in 4 infections were you referring to IgG or IgM screening? My IgM was negative for all hsv. Finally would it be unusual to have been infected with both hsv1 and 2 simulatneously? That oral lesion that appeared after I performed oral sex coupled with unprotected intercourse is the first cold sore I ever had. If it was indeed hsv1 then I either was infected with hsv2 from the same partner or a later partner. Thanks for the information and the invaluable website

[Terri Warren]

I am referring to IgG testing. The IgM is a fatally flawed test. Yes, it would be unusual to be infected with both types at the same time. Your situation is complicated. And yes, you could have been infected from this partner (I’m thinking you probably also kissed) and acquired the HSV 2 from another partner in your lifetime.

Terri

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