[Question #1238] HSV1 Genital-Transmission and Disclosure

47 months ago
I contracted HSV1 genital from a guy I was dating after two months.   We are not together anymore. Below is what I’ve gathered about communicating my condition to a new partner.  Are these correct?

If the other person already has HSV1 either orally or genitally, we basically have the same thing and there is no need for additional precaution.  If they are unsure, get tested.
If the other person does not have HSV1, I can give it to them through genital to genital sex, although this seems somewhat uncommon.  HSV1 genital causes infrequent outbreaks and only sheds an estimated 5% of days in a year.  Condoms and medication can bring that percentage closer to 1% chance of transiting the virus in a year.  The other person can get oral HSV1 from giving me oral sex but again with infrequent outbreaks and medication (and maybe dental dams, saran wrap?), the chance for this is pretty small, maybe 1% a year?
If I make it a year without another outbreak, there is an 80% chance I will never have an outbreak again.  I am most contiguous in the first year after the initial infection.

Couple gray area questions:  If I got genital herpes from a guy with oral herpes that I was also kissing during the same sexual exchange, what are the chances that I also have oral herpes?  Should I now disclose to a new person that I might have oral HSV1 before I kiss them or before oral sex?  

My doctor said that if I wear condoms I don’t need to disclosure my HSV1 genital status to a new partner because the risk of transmission is so low.  He did suggest disclosing my status in more serious relationships.  Not sure how I feel about how, what and when to disclose.  The guy I was dating and I both got tested before we had sex.  He failed to tell me he got cold sores and afterwards admitted he was unaware that cold sores could cause genital herpes.  I don’t want anyone else blindsided like I was but would like to attempt to find a partner and continue my life.  Dating was hard enough in my mid 30s without herpes but now it feels like this stigmatized, soul sucking, pride swallowing, rejection rich experience for which there is no cure.

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
47 months ago
Terri Warren usually answers herpes questions, but we like to make sure all questions are answered promptly, so I'm taking this one.

Your own research has been excellent. Your bulleted understandings are perfect; I couldn't have said it better. The only minor correction I would make is that genital to genital HSV1 transmission not only is "somewhat" uncommon. It appears to be very rare. In my 40+ years in the STD business, I have never seen a patient with newly acquired genital HSV1 who apparently acquired it by genital intercourse, only by receiving oral sex.

The "gray area" questions:  In the absence of oral herpes symptoms, it is unlikely you also acquired oral herpes. I can't say it didn't happen, but it's unlikely. Since you had genital symptoms, you probably would have had noticeable oral symptoms if you had been infected. In any case, half the adult population has oral HSV1, mostly without symptoms. Those with known oral herpes should inform their partners, but there is no ethical or practical obligation to do so when there has only been an exposure, but no known oral infection.

I don't entirely agree with your doctor. It is true that the risk you will transmit your genital HSV1 through vaginal intercourse is low, even without condoms. (Of course not implying you shouldn't use condoms for sexual encounters with new partners!) Still, some partners would be distressed to learn you have genital herpes and didn't inform them. While you know the transmission risk is low, many of them will not. If you put yourself in their position, wouldn't you expect and prefer to be informed?

That said, I understand the difficult position you are in. In a society and in historical times when sex usually precedes true intimacy, informing a partner about herpes not only can interfere with an enjoyable night, but can impede the path to romance and commitment. There is no clear, black and white answer. For some relationships, non-disclosure may be fine; for others, it would be a mistake; and still others, it's a matter of timing:  maybe not the first time, but before too many sexual encounters.

I guess my bottom line is to say you'll have to decide on a case by case basis. But don't go overboard or get too worked up. Your doctor certainly is correct that for any particular exposure, with no symptoms to suggest a herpes oubreak and with condom protection, the chance of transmission of genital HSV1 is very, very low.

I hope this has been helpful, but let me know if anything isn't clear.

Best wishes--  HHH, MD

---
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
47 months ago
Hi Amy,
I'm back in town and completely agree with Dr. Handsfield, and I think he said it quite beautifully!

Terri
---
47 months ago
Thank you so much for the thoughtful response.  This is exactly what I was looking for.  I wanted to make sure my "talking points" were on point.  As for disclosure, I would have rather known about my ex-partner's status prior to any risky activity.  Then I could have made an informed decision for myself about my health and body.  I would like to honor that approach for future partners.  I like your advice about considering the timing of disclosure on a case by case basis.  Now just to get past this awful sigma and try to remember that dating can be fun.

Again, thank you both for your time.  I have no further questions on this topic.


H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
47 months ago
Thanks for the thanks. Terri and I are glad to have helped. I'll leave this thread open a few more days, in case another question or clarification comes to mind.

---