Want to be fully informed about oral HSV 1

[ljm01]

I’m a 40 year old female. Went to dermatologist in 4/08 because I was unsure about a pimple near my mouth (acne since 7th grade, thought this was a pimple and picked at it). I was diagnosed with Impetigo. Dermatologist said I likely infected a cold sore while picking at it. This was the first time I heard “cold sore” from my doctor.  No clue if I had one before or not. I don’t think I did, but I thought this was a pimple. I never thought it was a cold sore until my dermatologist suggested it (she wasn’t certain because it was infected). I got additional “sores” (same spot – right side of bottom lip):
6/08
8/09     
(didn’t write anything down between these dates so not sure if/how many cold sore outbreaks)
1/12
12/14    
                
Since these sores never caused me pain (and I don’t recall kissing anyone with a visible cold sore), I wasn’t 100% positive I really had the virus. In 3/15 I got a blood test and here are my results:
HSV 1 Glycoprotein G Ab, IgG = 11.18 (IV) H
HSV 2 Glycoprotein G Ab (“IgG” is in heading) = 0.21 (IV)    
HSV Type 1 IgM Antibodies = Negative (Negative)
HSV Type 2 IgM Antibodies = Negative (Negative)

Nurse said I’m negative for HSV 1 and HSV 2, but with the 11.18 I’m positive for HSV 1, right?

The sore is in the same spot and I sometimes feel tingling, but never painful. Sometimes a cold sore doesn’t end up forming, so I assume I must be shedding, right? 

With such a high number for HSV 1 does this mean I have had it since childhood, but didn’t have a cold sore outbreak until I was 33?

Or did I not notice other cold sore outbreaks and thought they were pimples?     

Assuming my next partner doesn’t have HSV 1:
Likelihood/% chance of me passing HSV 1 genitally with no cold sore present:
   with no condom and no suppressive  
   therapy?   
   with no condom, but with suppressive
   therapy?
   with condom, but no suppressive
   therapy?
   with condom and with suppressive
   therapy?

Likelihood/% chance of passing HSV 1 kissing on the lips with no cold sore present?

I’m not on daily suppressive therapy so:
How much does daily suppressive therapy reduce viral shedding?
Does “less shedding” mean I’m less likely to pass the HSV 1 virus?
Or do I not get enough cold sore
outbreaks to be on daily suppressive therapy?

How long do I need to be on daily suppressive therapy for it to work at 100%?

Is it ok to be on daily suppressive therapy while breastfeeding and on a birth control pill (Camila currently, but will change once I stop breastfeeding)?

How often am I shedding the virus?
Do I only shed when I feel a tingle, or am I shedding even when I don’t feel a tingle?

On the days I don’t have a cold sore present or I’m not shedding can I still pass HSV 1?

Without a cold sore present can I still kiss/lick/bite other areas of my partner’s body (eg cheek, neck, ear, chest, stomach, back, upper leg, inside thighs, shoulder, back) or is the risk of passing the virus the same as when I kiss on the lips or give oral without a cold sore present ?

Since I have HSV 1 orally, I’m protected from HSV 1 or HSV 2 genitally, or on any part of my body, right?

What is the % of people who carry HSV 1?

What is the % of people who actually get cold sore outbreaks?

What is the % of people who have one cold sore outbreak and never have another one?

What is the risk of me passing HSV 1 if I kiss my kids on the cheek, or give them  raspberries on their bellies, or they accidently touch my mouth when I don’t have a cold sore present?

However, if my next partner has HSV 1 orally, he’s protected from me passing HSV 1 to him through oral sex (or anywhere else on his body), right?

I just want to be fully informed and have all the facts

[Terri Warren]

It is not possible to know how long you have had HSV 1
We do not have any statistics on the questions that you ask about transmission of HSV 1 infection, sorry, we only have statistics about HSV 2.
Anyone can be on suppression to reduce viral shedding, regardless of frequency of outbreaks
It is as maximum efficiency after being on therapy for 5 days.
You should talk to your own provider about use with breastfeeding – in general it is considered safe.
Birth control pills do not interact with suppressive therapy.
Viral shedding with HSV 1 ranges from 9-18% of days, depending upon the study referenced.
Shedding can happen with tingling and with no symptoms whatsoever. So yes, you could pass it to someone that you are kissing or to whom you are giving oral sex.
You won’t pass virus to other thicker skin parts of someone’s body
You are not protected against getting HSV 2 but are likely protected against getting HSV 1 in a new location on your body
About 56% of the US population between 14 and 49 have HSV 1 infection and about 70% of those don’t know it. I can’t tell you a percentage of people who get one outbreak and never another.
HSV 1 is not a risk to your children by the methods that you describe.
Yes, if your partner also has HSV 1, it is extremely unlikely he will also get your strain of the virus.

Please try to keep your questions a bit shorter – somehow our space limiter missed your post.

Terri

[ljm01]

So it’s correct that I carry HSV 1 based on my Glycoprotein G Ab, IgG = 11.18 (IV) H result? If so, I can’t believe the nurse at my doctor’s office said I was negative.

How do I disclose to a new partner that I get cold sores without feeling like I will immediately be rejected? I know it’s just a skin condition that’s manageable, but society doesn’t seem to see it that way since it’s “herpes”. 

I feel like I can never kiss anyone on the lips again or give oral sex for fear of passing HSV 1 to them.  I would feel awful if I passed it.

I know you said 56% of people 14-49 have cold sores, but in all my 40 years, I’ve only seen a handful of friends/coworkers with cold sores.  But, I guess it’s because only 30% gets outbreaks, while 70% who have the virus don’t.

Is it true that people can go years before their first outbreak?

Is it also true that I cannot pass the virus via a towel, cup, or other inanimate object? What about kids at daycares who share toys and put everything in their mouths (since HSV 1 can be aquired in childhood)?

I can only pass HSV 1 when I have a cold sore or when I’m shedding, correct?

Does daily suppressive therapy significantly reduce viral shedding of HSV 1?

Does this mean that I shed less frequently, or the amount of HSV 1 I shed is reduced, therefore decreasing transmission?

Thank you for all your help. It’s greatly appreciated.

[Terri Warren]

Yes, you are infected with HSV 1. The nurse was completely mistaken
I think you don’t have to disclose this immediately, but when you do, describe your infection as cold sores – I don’t think you need to specifically mention herpes. but I do think partners need to aware that this is an infectious disease and they could get it from you.
Deciding not to kiss anyone ever again because of an infection that well over half the population has seems an overeaction to me
Yes, people can go a lifetime without ever having an outbreak but may still be infectious to others.
No, I have no concerns about transmission through inanimate objects at al
Yes, you can only transmit when you have a cold sore or are shedding the virus, correct
Yes, daily suppression reduces the risk of transmission. Though we only have studies looking at HSV 2, these viruses are similar enough that we can be confident in saying it would also reduce the risk of HSV 1 transmission, though we don’t know how much with HSV 1.
Yes, that is correct.

Terri

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