Some worries about HSV-1

[Anonymouse]

Hi,

Background: I am a male who had a sexual encounter about 2 months ago with a female. We kissed, she performed oral sex on me without a condom, and we had sex twice, using condoms. Prior to sex, I asked she said she didn’t have any STIs/STDs. I did not return her texts for about 48 hours after the encounter (because I didn’t have a good experience and wanted space before I responded) and at some point in that window she said that she had an STI that she didn’t tell me about. I suspected she was just trying to get me to respond to her texts. Eventually I did and I asked her if she was serious and she insisted she was for a while. I asked what she had and she said HSV-1 and that she forgot to tell me because it was so common. After talking for some time she said that she actually didn’t have any STI and just wanted to make me feel bad because her feelings had been hurt. I asked if she had cold sores and she said: “did you see any?”

I have been diagnosed with OCD and one theme is worrying about harming others. So, I have spent a lot of time and energy and hand-sanitizer since then with the idea to not infect anyone.

I went to a free STI clinic near me and got all the routine tests a month after the encounter which all came back negative, but they did not test for herpes, which they only do if there are apparent symptoms. A visual examination of my mouth and genitals revealed nothing.

I got conflicting information from the nurse there and the doctor there. Also, the research I have done on the internet has given inconsistent information. So, I have some questions:

1. What would you say are the actual chances of me having gotten HSV-1? Based on the information that the nurse told me in my first appointment about asymptomatic shedding, I calculated the odds to be around 1 in 360. But then when I asked the doctor at a later appointment, she shrugged and said 5%, although her demeanor suggested that she was pulling the figure out of thin air.

2. I have specific worries about certain sorts of activities, these have to do with whether I can transmit the virus (if I have it) through the various activities, and if so, what the odds of doing so are:

a. Touching my mouth (or genitals) then touching some other object (e.g., a piece of paper, a faucet, a doorknob, etc.) which someone else later touches. Or, e.g., shaking hands after touching my mouth. I am also curious about tertiary touching, so, e.g., I touch my mouth, I touch my leg, someone touches my leg.
b. One activity that I have been avoiding but would like to take up again is Brazilian Jiu-Jitsu—a grappling art that involves wrestling. I am worried about my mouth touching the mat and then someone else’s mouth or eye or whatever touching the mat. I am also worried about my mouth accidentally touching the other person’s mouth, eye, or even just their hand and then that hand touching their mouth etc.
c. Activities that involve sweating in which the sweat runs across my lips and then falls on the floor or something.
d. Showering, I told my roommate the story and told him not to use my razors, towels, silverware, or drinking glasses. But, e.g., he leaves his toothbrush and razor and other items in the shower and I am worried about passing the virus from water splashing off my face or if I wash my mouth, somehow having those cells touch his things.
e. Preparing food for other people.
f. Kissing my dog.
g. Using a jacuzzi.

3. How long does the virus survive outside of the body? The doctor at the clinic said about an hour (again, in an attitude which did not give me confidence). I saw on the internet that (perhaps in a lab with effort) it has survived for four hours.

4. What’s your opinion on disclosure. Should I disclose the possible risk to a new partner before kissing? Before sexual activity?

5. Should I worry about having HSV-1 genitally?

6. How can I differentiate between good advice/facts and bad? E.g., I have heard conflicting numbers about what percentage of the population carries HSV-1.

Thank you for your time and attention.

Best.

[Terri Warren]

1. What would you say are the actual chances of me having gotten HSV-1? Based on the information that the nurse told me in my first appointment about asymptomatic shedding, I calculated the odds to be around 1 in 360. But then when I asked the doctor at a later appointment, she shrugged and said 5%, although her demeanor suggested that she was pulling the figure out of thin air.
I depends upon whether she has HSV 1 orally or genitally, which I am assuming you don’t know. Also, we don’t have statistical odds about HSV 1 transmission. You may well already be infected with HSV 1 and don’t know it.

2. I have specific worries about certain sorts of activities, these have to do with whether I can transmit the virus (if I have it) through the various activities, and if so, what the odds of doing so are:

a. Touching my mouth (or genitals) then touching some other object (e.g., a piece of paper, a faucet, a doorknob, etc.) which someone else later touches.

no risk
Or, e.g., shaking hands after touching my mouth. I am also curious about tertiary touching, so, e.g., I touch my mouth, I touch my leg, someone touches my leg.
no risk
b. One activity that I have been avoiding but would like to take up again is Brazilian Jiu-Jitsu—a grappling art that involves wrestling. I am worried about my mouth touching the mat and then someone else’s mouth or eye or whatever touching the mat. I am also worried about my mouth accidentally touching the other person’s mouth, eye, or even just their hand and then that hand touching their mouth etc.

If you were to have an active cold sore, I would avoid wrestling activities. Without one, no real risk

c. Activities that involve sweating in which the sweat runs across my lips and then falls on the floor or something.
no risk
d. Showering, I told my roommate the story and told him not to use my razors, towels, silverware, or drinking glasses. But, e.g., he leaves his toothbrush and razor and other items in the shower and I am worried about passing the virus from water splashing off my face or if I wash my mouth, somehow having those cells touch his things.
no risk
e. Preparing food for other people.
no risk
f. Kissing my dog.
no risk
g. Using a jacuzzi.
no risk

3. How long does the virus survive outside of the body? The doctor at the clinic said about an hour (again, in an attitude which did not give me confidence). I saw on the internet that (perhaps in a lab with effort) it has survived for four hours.
How long the virus can live off the human body and how long it can be infectious to others are different questions. I would say an hour for infectiousness is a real stretch.

4. What’s your opinion on disclosure. Should I disclose the possible risk to a new partner before kissing? Before sexual activity?

NO, you don’t even know if you have it or not.

5. Should I worry about having HSV-1 genitally?

It depends upon if she has HSV 1 and whether she has it orally or genitally. If she has it genitally, then you don’t have risk. If she has it orally, there is some risk that you could have acquired this via receiving oral sex from her.

6. How can I differentiate between good advice/facts and bad? E.g., I have heard conflicting numbers about what percentage of the population carries HSV-1.

Fifty six percent of the US population between the ages of 14 and 49 has HSV 1 infection, 70% of those are asymptomatic.

In terms of sorting out good information from bad, I would inquire of your source “how many publications on the topic of herpes do you have in the professional literature?” I can tell you that I have 28 publications in the professional literature including New England Journal of Medicine and Journal of the American Medical Association. You can trust my advice, I believe.

Your OCD is going to be a tough one when it comes to herpes. I hope you can stick to believing reasonable risks though I would guess that this is a them you’ve encountered before.

Terri

[Anonymouse]

Terri,

Thank you very much for your apply. I have a few follow up questions:

Again, I am curious about the risk for a number of things:

1. I have heard that mucus is another way that the virus can spread; is there any risk for touching my nose then touching things or sneezing into the air, on people, or on objects?
2. Contact of others with my blood, pus, saliva, etc.
3. Accidentally getting saliva on people while talking.
4. I have heard that sometimes the virus can get into one’s fingers; what are the chances of this, and does this pose a possible risk for masturbating a girl during a sexual encounter?
5. What is the risk, of transmitting HSV-1 through kissing?
a. What about kissing someone’s eyes?
b. What about performing oral sex on a female?
6. For most of the activities I asked about, you said there was ‘no risk,’ however, for Jiu Jitsu you said “no real risk”. Assuming I do not have an active cold sore (I have never had one as far as I know), what is the risk here, how small is it, and what are the factors that make this activity have some very small risk whereas the other activities did not have any risk?
7. You said: “I hope you can stick to believing reasonable risks though I would guess that this is a theme you’ve encountered before.”

If I understood you correctly, you meant that I should simply continue with activities that have reasonably small risks without avoidance or succumbing to compulsions, e.g., washing my hands or confessing/disclosing. Is that what you meant? I have encountered this theme before; one of my themes is acting ethically (which is of course not itself a problem, but the degree of perfectionism that I would like to achieve does seem to make this a problem; i.e., I would like to have zero risk), and so the question of disclosure, and the possibility of taking even tiny risks with other people’s health are particularly problematic for me and are potential opportunities for compulsion.

Thank you again for your time and attention. It is much appreciated.

Best.

[Terri Warren]

1. I have heard that mucus is another way that the virus can spread; is there any risk for touching my nose then touching things or sneezing into the air, on people, or on objects?
No, this is a skin to skin (or mucous membrane to mucous membrane)

2. Contact of others with my blood, pus, saliva, etc.
This is a trickier one because saliva could carry virus from oral HSV 1 so if you kiss someone and have oral infection, saliva might be a possible method of transmission

3. Accidentally getting saliva on people while talking.

no – not enough volume

4. I have heard that sometimes the virus can get into one’s fingers; what are the chances of this, and does this pose a possible risk for masturbating a girl during a sexual encounter?

If you have herpetic whittled, which are lesions on the hands, you could transmit it to a partner while masturbating her if there is a lesion present.

5. What is the risk, of transmitting HSV-1 through kissing?

We don’t have statistics on HSV 1 transmission with kissing, sorry
.
a. What about kissing someone’s eyes?
I think that is unlikely but again, we have no statistics on this.

b. What about performing oral sex on a female?

If you have oral infection with HSV 1 you can transmit that virus from your mouth to the genitals of another person.

6. For most of the activities I asked about, you said there was ‘no risk,’ however, for Jiu Jitsu you said “no real risk”. Assuming I do not have an active cold sore (I have never had one as far as I know), what is the risk here, how small is it, and what are the factors that make this activity have some very small risk whereas the other activities did not have any risk?

If you do not have a cold sore, I am not worried about transmission in this way.

7. You said: “I hope you can stick to believing reasonable risks though I would guess that this is a theme you’ve encountered before.”
Yes, that is exactly what I mean.

Terri

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