I honestly don’t know, and I don’t think that anyone does, because I don’t think there is a study about this, what percent of people with new HSV 1 infection actually have symptoms within the initial period of new infection. I also don’t think we have a study (I could ask Hunter for a reference if he has one) about what the risk is of getting hSV 1 from oral sex is over time. I would think for a truly accurate answer to that, we would, again, need a study looking at discordant couples where one has HSV 1 and the other does not. The problem with such a study is that the diagnoses would need to have been made by western blot, given the lack of sensitivity of the ELISA for screening and then we would need to keep very close track of the oral sex encounters. This was what we did with the genital HSV 2 transmission trial. Then we would need to know where the HSV 1 infection is – that is, that they only have it orally (for example, someone who has had cold sores since they were a child and had no possibility of having HSV 1 genitally. Do you see how complicated this is? The genital transmission trial took several years and 70 million dollars to complete. I seriously doubt that there will be a similar trial for HSV 1 transmission.
So I guess what I’m saying is that I can’t comment on the 1 in 1,000 change of getting HSV 1 from oral sex because I give advice based on studies and generally gathered information from my practice of 32 years.
I think if you’ve been watching your genitals very carefully which I think you have, and you have no symptoms, that your antibody status is likely not different from the beginning of the relationship until now. Whether your first test was accurate, we do not yet know. But you will find out from your western blot. I think waiting 14+ weeks is enough. If your western blot is negative, then I would believe that you are uninfected. If your concern is infecting someone else right now, then I would recommend waiting for your western blot results before having sex with anyone else.
If I had to take a guess, I would say you are not infected, not before and not now. But I don’t think you are looking for guesses. Waiting for the test results will give you all you need to know, I believe, about your true situation.
Terri