[Question #12532] Genital HSV1 transmission
7 months ago
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OCD sufferer here, if possible to address each point below 1-by-1 it will mean less annoying follow-up on my end :)
Context: Based on regular IgG blood tests, I'm negative for both HSV1 and HSV2 (I realize HSV1 test can be less reliable). Recently began casually dating a woman, not yet intimate. (I'm a man.) This woman recently had genital irritation that clinic swabbed, confirmed was genital HSV1 (negative for HSV2). Assuming this is her first outbreak due to severity & no prior similar experience.
1. Am I at any real risk of contracting GENITAL hsv1 from this person via protected, penetrative sex? From what I've previously read, this doesn't happen often, or hardly at all...
2. How does this risk compare to, say, receiving Unprotected oral sex from someone who has ORAL hsv1, with or without an outbreak?
3. If someone told me they were positive for oral HSV1--which is a lot of people!--I would not refrain from receiving unprotected oral sex from them, provided they didn't actively have a cold sore. Given that, would refraining from having penetrative sex with this woman who has GENITAL hsv1 just be...nonsensical?
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Terri Warren, RN, Nurse Practitioner
7 months ago
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1. Why would you assume that this is her first outbreak? had she very recently received oral sex from someone else? That's the only way really that this would be a first outbreak If it is her first outbreak/new infection, she will be shedding virus on about 13% of days for a few months and there is a real risk of acquiring this from her during intercourse. Condoms reduce transmission from women to men for HSV 2 by about 65% and I would think if this is truly a brand new infection for her, the percentage of protection for you would be similar
2. We have no data on that and would not because the experience of people with oral HSV 1 is so different. Some people shed a lot and some people rarely.
3. I think my answer to this question is included in the other two answers. Receiving oral sex from someone who gets cold sores but doesn't have one at the moment of giving oral sex is certainly not risk free, BTW
Terri
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7 months ago
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Huh, just a little confused. Previous posts on this forum seemed to suggest genital to genital HSV1 transmission is very rare, like VERY rare? Whereas yes I know that passing oral HSV1 to someone's genitals is quite common with or without active cold sores.
Can you clarify--in other posts on this site genital to genital hsv1 transmission discussed as a rarity...but here you seem to be saying the chances of transmission with a condom would be akin to the same scenario with genital hsv2?
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Terri Warren, RN, Nurse Practitioner
7 months ago
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Yes, genital to genital transmission is rare, but people with a brand new infection shed virus a lot more than people who have been infected for a while. I formulated my answer to your question based on you saying you think she has brand new infection. People with established HSV 2 infection shed virus anywhere from 10-20% of days on average, depending upon whether they have symptoms or not. People with brand new HSV 1 genital infection shed virus somewhere in that same frequency.
Keep in mind that just because this is her first RECOGNIZED outbreak, it may not be her first infection - very different situations.
Terri
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7 months ago
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Got it! I think she assumed this was a new infection since she had never experienced something similar before, and I thought with genital hsv1 often the pattern is a bad first outbreak and then maybe milder or no outbreaks in the future.
I guess in terms of what risk I'm comfortable with it comes down to the likelihood of contracting genital HSV1 from protected penetrative sex VS the odds of getting it genitally via receiving oral sex. I'd thought the latter scenario was MUCHHHH more likely than then the former, but maybe the wrinkle here is the timing and whether this is indeed a first outbreak.
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Terri Warren, RN, Nurse Practitioner
7 months ago
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Exactly. If we knew this was a recurrence, I would say the risk of acquiring this from her would be very very low indeed!
Terri
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