[Question #13724] hsv1

1 months ago

I am a 29yo who was a victim of unconsented sexual encounter while on travel. I came back about a month ago and tested immediately for STIs. All came back negative. I thought I was ok, until I had vaginal pain and painful urination. I self examined and saw redness and some elongated lesions. I went to a clinic and to see an obgyn. The OB said that it didn't look like herpes. At the clinic, the PA seemed unsure but did a swab. About 5 days later, it came back indicating HSV1. Would it be worth it to do IGG testing or is the culture a true test and because it is HSV1, what is the transmission to a partner and what do I need to disclose in this case? With Valtrex my symptoms disappeared in 2 days, but I am unsure about the above. Thanks!

Terri Warren, RN, Nurse Practitioner

1 months ago

Did someone give you oral sex while on your travels?

An IgG test would have told you if this was truly a new infection or a recurrence but now that it is month out, that test will be far less reliable in making that distinction but you may wish to do it anyway . I don't think you need a blood test to confirm that this is HSV 1. Transmission to a partner can happen with a new infection but that risk will decrease after you've been infected for 6 months and dramatically reduce after you've been infected for two years (again, IF this is truly a new infection). It would be helpful for you to read the Herpes Handbook at westoverheights.com. But lesions that resolve in just a few days with antivirals could be a recurrence, rather than a new infection.

Terri

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1 months ago

I just got my IgG results back and the value for HSV1 was 24. It has now been 4-5 weeks post possible exposure. I completed the treatment protocol at diagnosis from the swab and then just started on suppressive therapy this past Friday. Does this sound like a new infection or something I may have had but dormant? I would like to add that I was on PEP due to SA and sick prior due to illness before the SA so unclear if I had new fevers. Pain was not excruciating just discomfort with urinating. The excoriated/linear appearance of the two lines in the vulvar folds went away within 2-3 days (with meds). There was also 4 spots the size of a pen point but at no point were they vesicles, no blistering or scabbing. Those were all gone in 4 days. Any advice?

Terri Warren, RN, Nurse Practitioner

1 months ago

Its an educated guess, really, but this sounds more like a long standing infection - both based on the high index value of HSV 1 and the very quick healing time of the lesions. HSV 1 genitally is almost always acquired from someone with HSV 1 orally giving oral sex to someone who is HSV 1 negative, which is why I asked about the oral sex on your trip.

Terri

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1 months ago

If this is a longstanding HSV1 infection, does the absence of classic vesicles/blisters rule out that this being a primary infection? What are the current recommendations around what exactly I need to disclose to future partners since I have never had symptoms before and what is the realistic transmission risk to partners (any stats?) for GHSV1 and if suppressive therapy reduces recurrences and/or transmission risks. Thank you!

Terri Warren, RN, Nurse Practitioner

1 months ago

Nothing rules out a primary infection or makes it one except a negative IgG test at the same time you had a positive swab test and even that, since the IgG test misses 15% of HSV 1 infection, isn't a certainty. But you are beyond that now so you just can't know for sure if this is new or not. Because HSV 1 is almost always (not 100% of the time) transmitted by receiving oral sex, that's why I asked you if you had received oral sex at this encounter. If you did NOT, then this is more likely a recurrence. If you did, then we can't know if it is a primary infection or not. Generally speaking, someone with no antibody to HSV 1 or HSV 2 would be more likely to have multiple lesions with a true primary.

There is no solid recommendation from health care providers about disclosure of HSV 1 infection. And we don't have any data on transmission of genital HSV 1 but we do have shedding data - how often the virus is given off after a primary infection. For the first 6 months or so, it is given off about 13% of days. After that, for the next few months, about 7% of days. After having the virus for 2 years, the average number of days of shedding in a year is 4 days.

We also don't have data on the benefit of suppression on shedding of HSV 1, but given that the medications work for both viruses, and we know it is effective for treating cold sores (HSV 1), I wouldn't hesitate to extrapolate to suggesting that suppressive therapy would also work for genital HSV. However, given the low rates of shedding after a while, the benefit maybe limited. But might be useful with a new infection for sure.

Remember also that about half the adults in the US already have HSV 1, the likelihood that you will transmit is also low because you aren't going to give this to someone who already has it.

Terri

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