[Question #1331] Herpes questions

46 months ago
The previous Monday night/Tuesday morning - 13 days ago - my girlfriend (of 4 months) noticed an area of her lip was painful. On the Monday night, it was just a sore area of her lip. By the Tuesday morning, it was looking like this sore was turning into a cold sore. After discovering this on the Tuesday morning, we refrained from kissing or sexual activity while it heals. 

On that Monday night, we had condom protected sex and kissed extensively. There was no oral sex. This seems like a relatively high risk encounter for passing on the virus orally (mouth to mouth). However, thirteen days have now passed and I have noticed no symptoms or changes around my mouth.

So my questions:

1) Do you think I have managed to ‘dodge the bullet’ and avoid contracting the virus on this occasion given it has now been 13 days without symptoms since the exposure event on the Monday night? I think you usually say after two weeks without symptoms is usually sufficient to be reasonably confidence after a possible exposure and no herpes like symptoms. This is typically in discussions about genital herpes, is it the same with oral herpes?

2) How long before we can resume kissing and sexual activity? I have read varying recommendations - some say to wait until the skin is completely healed, others saying to wait a further week or two after the skin completely heals.

3) If we are able to avoid kissing or sexual activity in the future during outbreaks or when the ‘tingling’ starts, what are the chances or passing the virus on to me in the future? I am mainly interested here in the chances of passing on the virus orally (mouth to mouth, by kissing) because oral sex is not particularly common in our relationship. However, we do kiss (mouth to mouth) frequently.

Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
46 months ago
Here are a few questions for you:  have you actually had an IgG test for HSV 1 and 2 to know that you aren't infected and just don't know it?  The HSV 1 antibody test isn't the best - it misses 30% of HSV 1 infections, but if positive, can usually be relied upon.  If you already happen to be infected, this discussion is moot.

Now to your questions: Most people who develop symptoms with first infection do so within 2-10 from exposure, whether oral or genital, correct.
You can begin kissing and having sex again (intercourse isn't a risk here if she only has HSV 1 orally), but there is always a small possibility that you could become infected even when she has no symptoms, so it is not a perfect science.  I would wait until new skin has replaced the lesion for the most reasonable approach.
We don't have any data on transmission of HSV 1, either mouth to mouth or mouth to genitals 
It might be that if you do end up testing negative and want greater protection, she could consider daily antiviral therapy to increase your protection.

Terri
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46 months ago

Thanks for your reply.


I’ve never been test for HSV, its not commonly done in the UK unfortunately on the NHS. But I suspect I am negative because I do not recall having a cold sore previously (although I know many people are invected without knowing). I think its reasonable to proceed trying to minimise the risk of transmission. 


So a few follow ups:


1) I understand there is no hard facts on this, but is it possible to give any more clarity on the ‘small risk’ of transmission due to asymptomatic shedding (still talking HSV1 mouth to mouth transmission)? There seems to be some date about asymptomatic transmission for genital HSV2 discordant couples - I have read that couples who simply avoid sex during out breaks tend to pass the virus on about 5% a year which does sound low. Do you think as a rough ‘benchmark’ a similar transmission rate would apply to HSV1 being transmitted orally (mouth to mouth)?


2) If the transmission rate is roughly 5% (and I realise this is rough, but it gives a ball park idea of risk), I just wonder how this stacks up against the fact that HSV1 seems to shed asympomatically about 10-20% of the time in the mouth (I seem to recall reading this in a few studies). To me, this sounds like if you kiss every day you could be exposed every ten days, certainly a few times within a month, which certainly makes the risk sound a lot higher and more risky. Or is my logic not correct here?


3) How much suppression of asymptomatic shedding would antiviral protection offer? Do you think it would significantly reduce the chances of transmission?


Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
46 months ago
I think it would probably be a mistake to try to extrapolate from HSV 2 genital to genital transmission to HSV 1 oral to oral transmission. 
I doubt that the risk of HSV 1 mouth to mouth transmission without any cold sore present is the same amount of risk as genital to genital transmission - I think it is probably lower  but again, I just don't know and I don't believe it is known.
Yes, suppressive therapy would reduce the risk of transmission.  HSV 1 is slightly less susceptible to the impact of antiviral than HSV 2, but it is still a very good tool in reducing transmission, yes.  And given your worries, I would think this would be an easy, inexpensive thing to do. 
The perception that you don't have HSV 1 because you've never had a cold sore may not be fully correct -probably 70% of people with HSV 1 don't recall a cold sore in their history.  In your situation, I think it would be worth trying to get tested rather than operating on the premise that you are not infected.  This may be a worry you don't need to have.

Terri
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