Oral transmission of HSV 2

[Mr. Anonymous440]

A potential partner disclosed to me that she has esophageal HSV 2. I would like to better understand the risks I’m taking if I proceed to date her. She is taking daily antivirals. She has told me that she has had multiple extremely painful out breaks, however she has not had an outbreak in about a year. To her knowledge, she is not immunocompromised. How likely is it that this would transmit through kissing? Would this easily transmit through saliva? Does OHSV 2 shed less often? She has told me she only has Esophageal hsv 2. She has never had a genital out break. Is it possible that she has symptomatic esophageal hsv 2 and asymptomatic genital HSV 2? Is there greater risk of transmission if she performs fellatio on me? Besides taking a daily antiviral and wearing condoms, is there anything she or I can do to lessen the risk of transmission? How concerned should I be in regards to oral transmission through kissing? It is not likely that I have hsv 2. I have taken an IGG blood test 12 weeks from my last partner and the results were negative.

[Terri Warren]

OHSV 2 sheds infrequently and I’m surprised that she has had multiple painful outbreaks.
It is possible it could be transmitted via kissing but not likely. I am assuming that she had a positive swab test for HSV 2, is that correct? If she only has this orally, which is also rare, then the only risk is her giving you oral sex. If you use a condom when she is giving you oral sex, then the risk is virtually eliminated for you.

Terri

[Mr. Anonymous440]

She was not swab tested, however she tested negative for strep throat. When she was symptomatic it was determined that the lesions in her esophagus resembled HSV. She took a series of STD tests and was positive for hsv 2 and nothing else. Given her symptoms and reoccurring out breaks it does seem likely that it was hsv 2. To your knowledge, are there any other diseases that would cause reoccurring out breaks with multiple lesions filled with fluid within someone’s esophagus? At this point, Is it safe to assume that she does not have gHSV 2 as she has only had out breaks in her esophagus? It is surprising to me that it is thought that gHSV 2 is not likely to be transmitted through kissing. Is this because hsv 2 has difficulty infecting mucosa tissue that is not genital? Thank you so much for your time!

[Terri Warren]

The reason transmission via kissing in unlikely is because HSV 2 in the oral area is not active very often.
Her presentation is so inconsistent with the way HSV 2 reactivates orally, it just made me wonder.
The possibilities here are the following:
1. She simply has an unusual presentation of HSV 2 orally
2. The antibody test that was positive for HSV 2 was a false positive
3. The antibody test is accurate that she has HSV 2 but the oral lesions are not HSV 2.
If she were my patient, I would definitely have the lesions swab tested and if positive, typed, the next time it happens.

Terri

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