[Question #1186] HSV-1 Positive

48 months ago
Hi Doctors:

I was diagnosed with gHSV-1 in early May via culture. I had about two weeks of painful symptoms (burning urination, visible sores).  I am fairly certain I transmitted this from receiving unprotected oral sex from a female partner two weeks prior.  Although she doesn't think she claimed to have been tested for STDs and the results came back negative.

I haven't had any symptoms since the initial symptoms.

It was an emotional roller coaster at first.  I started to come to terms with it until recently when I started dating someone.  My doctor told me that due to low transmission risk and since hsv1 is so prevalent, disclosing my status is not necessary.

My questions for you:

1. What are your thoughts on disclosing ghsv1?  Are they different than disclosing ghsv2?
2. What are the actual transmission risks for my situation? With and without condoms?
3. If my parter is positive for hsv1 (let's say it's oral), then what are the chances they could transmit ghsv1?
4. I read someplace that Dr Handsfield said If he had to get herpes then he would prefer ghsv1 compared to all other types of herpes.  Can you elaborate?
5. Lastly,  I've seen all types of numbers around as far as the prevalence of hsv1 in America.  I live in Chicago. What would be a good guess for the percentage of 20-30 somethings in a large metropolitan area with hsv1?

Thanks for your help.  Your words provide lots comfort.

R

Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
48 months ago
Your previous partner may have had an STD screen, but it may not have included herpes.  In my opinion, any STD screen should include herpes testing or patients should be told, at least, that herpes is not included in testing.  Here is what the CDC says about this issue:  HSV serologic testing should be considered for persons presenting for an STD evaluation (especially for those persons with multiple sex partners), persons with HIV infection, and MSM at increased risk for HIV acquisition.  And even if HSV 2 testing was done, HSV 1 testing may not have been included.  So she may actually think she's been tested when she has not.  Anyway, back to you.  I'll go ahead and answer your questions.

1.  In my opinion, genital HSV 1 should be disclosed.  Many people do not agree with me about this, but my thought is that if it is not disclosed and transmission occurs, or discloser happens later, then trust becomes a significant issue, perhaps more than the herpes itself.
2.  We don't have transmission data for HSV 1, but we do know that people who have HSV 1 shed virus about 1/3 as often as HSV 2. And we know the transmission risk from males to females, no condoms, no medicine, no sex with outbreaks, discloser has happened, is about 10% per year, having sex about twice per week.  you add daily medicine and it cuts the risk almost by half, condoms, even more, lots more.   So you can do the math here.
3.  The chances that someone would acquire the same type (HSV 1) in a new location once they have well established infection is very low indeed.
4.  This is because HSV 1 recurs far less often and sheds less often and is likely not transmissible to someone who already has HSV 1, say, with cold sores.
5.  The prevalence off HSV 1 in the US Population, ages 14-49, is 56%.  So in the 20-30 age range, probably somewhat less than that.

Terri
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48 months ago
Hi Terri:

Thank you for your response!

A few additional questions for you if you don't mind.

1.  During my first outbreak I had very painful urination and only a few visible sores on the top of the shaft.  Is it safe to say that if I do have a reoccurrence that I will experience similar painful urination?  Also, how long can I expect subsequent outbreaks to be?  My initial outbreak lasted about 3-4  weeks (I took Valtrex for the last two weeks or so.) 

2.  I have read some conflicting things on reoccurrence rates for ghsv1.  Can you shed some light on what I might expect down the road? 

3.  As far as disclosure goes, I have read contradicting things from Dr. Handsfield.  I know that I can't request an answer from a particular expert because typically all three of you have similar opinions.  However, this topic seems to be an exception to the rule.  Can I request for some clarification on his position?

Thanks for your help!

Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
47 months ago
This is very odd - I wrote quite a long response but now I don't see it here.  I will try again.
Your recurrences, should you have them, will likely be much shorter and you may not have lesions in the urethra, that cause painful urination.
The average recurrence rate for HSV 1 is 0.7 times per year, with many people never having recurrences at all.
I do think HSV 1 genital herpes should be disclosed, for reasons mentioned above.  However, in situations where the person you might have sex with already has HSV 1 in the form of cold sores, it may not bev necessary, though I would personally still do it for trust issues, as I indicated.  Also, I am currently involved as a consultant on a law suit involving someone who transmitted HSV 1 and did not disclose prior to having sex.  I have no idea how that will turn out but we shall see.  In some states (this was someone from Washington) it is a crime to engage in sex if you have an STD and don't disclose it, so you might want to check your own state laws.  Though HSV 1 could be oral or genital, in your case you know you have HSV 1 genitally, so this might apply - I think it is uncovered ground, up until now.  These are just my opinions and the basis for my opinions.  Dr. Handsfield might not agree - I'll ask him about this.

Again, not sure where my response went and I'm sorry you had to wait.

Terri

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47 months ago
Thank you.  I look forward to hearing Dr. Handsfield's remarks.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
47 months ago
Here is Dr. Handsfield's reply re: telling partner

"I don’t disagree with any of your replies, and disagree that anything he has seen from me does not “contradict” any of your comments.

I have the feeling his main concern is the implications of disclosure. I do believe a case can be made that genital HSV1 recurs so infrequently (in most but not all patients) and subclinical shedding is sufficiently uncommon that a case can be made that disclosure could be optional. But only after a year or two of observation to at least see the recurrence frequency. Also, I strongly believe that almost all partners would hope and expect to be informed about genital herpes, regardless of type:  even if professionals (and some infected patients) understand the risk of sexual transmission is low, there is still the fear factor. Simple human kindness dictates informing partners!"

Terri

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