[Question #17] genital HSV-1

41 months ago
Hello - I was diagnosed with HSV-1 genital herpes about 5 years ago. All this time, I have been mistaken about tranmission from partner to partner; I thought that transmission only occurs with an active outbreak. 

Two years ago, I had unprotected, vaginal sex with a man. I had no symptoms at the time, and so I had thought that transmission would be nil. I have recently learned that asymptomatic shedding occurs with both HSV 1 and 2. 

I have had no indication from my partner that he has experienced any symptoms whatsoever. The question is this: how likely is it that I have given him genital HSV-1? Some pertinent details: I am female. I've had very few outbreaks, and if I do have a sore, it would occur on the inner labia, near my clitoris. 

Thank you in advance. I have had great anxiety over this, as I don't want to ever cause anyone any of the past guilt and shame that I've experienced. 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
41 months ago
Transmission from females to males is significantly lower than the reverse, and HSV 1 transmission is less than HSV 2 transmission.  I understand that you have anxiety over this - you just didn't know about asymptomatic transmission.  However, if that person has ever had a cold sore then he likely has HSV 1 already and is very unlikely to acquire HSV 1 at a new location on his body.  Do you know if he has ever had a cold sore?

Terri
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41 months ago
No, I don't think he's ever had a cold sore. 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
41 months ago
OK, well, he could still be infected with HSV 1 even if he has never had a cold sore.   The majority of the US population over the age of 14 has HSV 1 infection. 
This was two years ago? 
Statistically, the risk that you infected him is low, given your HSV 1 is genital and that most people already have this.  Did you have multiple contacts with this person over a longer period of time or was the sexual interaction more limited?  Of course the less the contact, the less likelihood that he became infected.   Has he contacted you about this or what brings this up so much past the time of the interaction?

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41 months ago
We've had contact, but it has been with condoms ever since that one moment of indiscretion. No, he hasn't contacted me about this; I was just shocked to know that asymptomatic shedding exists and that none of my health providers have ever mentioned it before. Supposedly, he tested negative even after years of having unprotected sex with women (which I found out about later, of course). Fortunately we've both tested negative for HIV well after the "window" of our past partners. I've read on this site that genital HSV-1 often causes symptoms (albeit mild; is that true? 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
41 months ago
The thing about herpes testing is that often it is not included in STD screens and even when herpes is included, often it is just HSV 2, not HSV 1.  And the other thing is that the HSV 1 screening test misses a whole lot of people who actually have HSV 1, as compared to western blot.  I guess my point is here that the testing that he has had done should be evaluated carefully in terms of whether it was actually done and then keeping in mind the inaccuracy of the screening test for HSV 1. 

The literature about asymptomatic shedding has been available since 1982.  That's more than 30 years and I am amazed at how many clinicians don't share this with their patients so you are not alone in not knowing.  Now you do, now you can act accordingly with the information that you have.  And I'm sure you will.  If this relationship becomes more serious or this becomes an issue between you, the herpes western blot is far better at picking up HSV 1 infection and he could always get that if he really wants to pursue this more.

Best to you.  This was your last post on this set of purchased questions.  If you find you have more, you can certainly re-do your question subscription.

Terri
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