[Question #1253] Voluntarily contract HSV 1

47 months ago
My girlfriend and I are in a serious relationship. We are in our 50s. We are not sexually active, but are hoping to get married soon. We both were tested for STIs. She has HSV-1 (although she never remembers having a cold sore). All of my tests came back negative.

When married, we hope to engage in oral sex. However, I am concerned about getting HSV-1 on my genitals. I would prefer to voluntarily contract HSV-1 orally, since it’s much more manageable then to contract it on my genitals. We have been dating for a year and kiss often, but I obviously haven’t contracted HSV-1 from her. Is there a method to purposely contract the infection? I know it seems like a crazy question. I’ve searched the internet and can’t seem to find any similar questions or cases. But this is important to me, so I hope you will take my question seriously and provide some insights. Thank you.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
47 months ago
I will totally take your question seriously, of course!
I think you're a little confused about HSV 1. HSV 1 really prefers the oral area - it recurs more often there and sheds without symptoms more often there.  Genital HSV 1 is far less active.  After the first year of infection, it recurs an average of 0.7 times per year and many people with HSV 1 genitally never have recurrences - if you've not had a recurrence in the first year, there is an 88% chance you would not recur.  So HSV 1 genital infection is quite benign.  I'm not sure exactly what you mean by "more manageable" and you might want to elaborate on that for me. 
The other thing is that you don't know if you partner's HSV 1 is oral or genital if she has never had a cold sore on her lip or nose.  If she has received oral sex, she could have this genitally.  Though contracting HSV 1 genitally through intercourse can certainly  happen, in my experience, the vast majority of HSV 1 genital infection is transmitted via oral sex, with or without the person giving the oral having a cold sore. 
Testing for HSV 1 is not terrific - the traditional IgG test misses about 30% of infections, so it is also possible that you have HSV 1 and the test missed it.
In the US about 56% of people between 14 and 49 have HSV 1 infection, and that's calculated using a test that misses 30%!  So you can see that HSV 1 is very common indeed in the population. 
My thought here is that you need to think carefully about the tradeoffs of the possibility of acquiring HSV 1 genitally against the intimacy and sexual pleasure that you would achieve by taking a risk of getting HSV 1 genitally.  Clearly, this is worrisome for you and if you would like to talk more about your thoughts about this, I would be happy to discuss this further. 

Terri
---
47 months ago
Thank you for your thoughtful response. I have considered the trade-off carefully. I think I do understand about HSV 1, although please let me know if you think I am still confused. My girlfriend has HSV 1. If she has it in the oral area and performs oral sex on me, then I risk getting HSV 1 genitally. I'm a bit OCD and while I do appreciate your stats on HSV 1 , the thought of getting the sores genitally turns me off (I wish it didn't). I  have less of a strong reaction to getting it orally.  From what I read, if I get it orally first and she performs oral sex then I won't risks getting the sores genitally. So that is why I prefer to contract the infection orally. However, we kiss regularly and I still have not contracted it based on my IgG tests. BTW, she is having a Western Blot test next week to confirm the HSV 1. Again, thank you for your response.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
47 months ago
OK I do understand your preferences here. 
The problem is that we don't know if her infection is oral or genital, so I can't help you to know how to get it on purpose because we don't know where she has it.
If her index value (the number associated with her HSV 1 positive result) is greater than 3, there is no point in doing the western blot to confirm her infection.  In a recent study that we did, we found that ever person with an index over 3.0 on the IgG test for HSV 1 confirmed by western blot.  However, I think the western blot would be very useful for you.  As I mentioned, compared to western blot, the IgG test misses 30% of infection.  A negative western blot would confirm your negative status - a positive one would resolve any concerns that you have about contracting her HSV 1 infection. 

Terri
---
47 months ago
Thank you for your response and . Her IgG test number was 18.20.  So I will let her know that a Western Blot is unnecessary.  If you could address my original question, I would appreciate it: Is there a method to purposely contract the HSV 1 infection orally? She has not engaged in oral sex (received or given).
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
47 months ago
If she has neither given nor received oral sex in her lifetime then it is most likely that she has HSV 1 orally without symptoms - that helps to clarify things a big.  The only thing I can think of to contract this orally is to continue kissing her  - a lot!  I don't think there is anything else that you can do other than to contract this orally.  And that's not such a bad prescription now, is it?  Thanks for your question

Terri
---