[Question #1836] Dr. Hook

43 months ago
Hello, 

This question is for Dr. Hook.

I am dealing with a probable diagnosis of genital hsv-1 from receiving oral sex from my boyfriend of 1 year.  There doesn't seem to be much information on this particular infection, but what seems to be consistent is that it is a very benign infection and genital to genital transmission is extremely rare.

I have read several posts by Dr. Handsfield, Dr. Leone, and Ms. Warren  (who specializes specifically in herpes) and none of them have EVER seen a genital to genital transmission of genital hsv-1 in over 35 years of practice and being part of herpes studies. It seems very, very rare 

I am trying to explain this to my boyfriend as he is interpreting hsv2 and hsv1 as the same thing and it's making him (and me) really scared for the future.  The reason I wanted to ask you specifically is because I've already seen answers from Dr. Handsfield and Ms. Warrwn  and wanted to hear your persctive as I know theirs already.  They both have never seen genital tranmission, and agree it's very rare. Many doctors will even tell you you don't need to disclose ghsv1

1) in your decades of experience, have you ever seen a genital to genital transmission of hsv-1?

2) many doctors say that suppressive therapy isn't recommended for ghsv1 because shedding and transmission rates are already incredibly low. If I end up with a hsv1 negative partner in the future, is it safe to have unprotected sex seeing as tranmission seems to be very rare? of course I would disclose to him.

3) I have read a previous post you said you really don't think ghsv1 is a big deal, do you think most peoples anxiety is because they think ghsv1 is the same as hsv2?

I am so grateful for your help Dr. Hook, I appreciate what you do.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
43 months ago
I answer the herpes questions on this forum, and we really don't allow people to chose a provider to answer questions, but since I have already answered this for you, and you seem to want Dr. Hook to answer this particular question so I'm going to ask him to do so.  We don't want to do this as a regular habit, however.

Terri Warren
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Edward W. Hook M.D.
Edward W. Hook M.D.
43 months ago
Welcome to the Forum.  I'll be happy to try to address your questions although, as Terri has already said, she typically takes our question on herpes infections.  I'm sorry your BF seems to be reacting abnormally to the infection her has given you.  In general, genital HSV-1 infections tend to recur less often than genital HSV-1 infections and are less transmissible.  In your case, if your BF gave you genital HSV-1 through oral sex, he cannot get infected genitally with the infection he already has by having sex with you.  In answer to your specific questions:

1) in your decades of experience, have you ever seen a genital to genital transmission of hsv-1?
No I have not seen genital to genital HSV-1 infection.  I would not be surprised to hear that it might happen vary rarely but like my colleagues, I have not seen it.  That none of us has seen genital-genital HSV-1 transmission indicates that it is extraordinarily rare.

2) many doctors say that suppressive therapy isn't recommended for ghsv1 because shedding and transmission rates are already incredibly low. If I end up with a hsv1 negative partner in the future, is it safe to have unprotected sex seeing as tranmission seems to be very rare? of course I would disclose to him.
In the situation you describe, disclosure is the right first step.  In addition, I would offer to take suppressive therapy if my partner wished me to and did not already have HSV-1, if for no other reason than to reassure him.  While the blood test for HSV-1 in not as good as the one for HSV-2 and misses about 25% of HSV-1 infections, if his blood test were positive, this would indicate that he already had HSV-1 making suppressive therapy or concern about acquiring HSV-1 though sex unnecessary.  About 60% of American adults have HSV-1 and most of those do not know it. 

3) I have read a previous post you said you really don't think ghsv1 is a big deal, do you think most peoples anxiety is because they think ghsv1 is the same as hsv2?
You are correct, genital HSV-1 is not a big deal biologically. it recurs less and is not readily transmitted to others.  Sadly however, the idea of genital herpes of any sort seems to generate unwarranted anxiety and emotion, likely due in part misunderstanding of the biology of the infection , as well as buying in to the stigma which inappropriately is part of all genital herpes.

I hope my comments are helpful to you.  EWH


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43 months ago
Thank you so much for your response. I really appreciate the time you take to do this.

1) if I end up with a hsv1 negative partner in the future, assuming I do not take medication and we never use condoms, what are the odds I'll never transmit?

2) I've read that as time passes,  shedding rates decrease, and for ghsv1 after a few years shedding rates are almost non existant. is this true? and does that mean that after time tranmission rates also *approach* zero? ( I know it will never actually be zero)  http://www.medhelp.org/posts/STDs/More-Questions-on-HSV-1/show/246285

3) is it true that most people who don't have outbreaks rarely if ever, shed the virus?

4) do you believe people with oral hsv1 should disclose?
Edward W. Hook M.D.
Edward W. Hook M.D.
43 months ago
1. There are no precise estimates of transmission probabilities for genital HSV-1.  Neither of us have seen transmission of genital HSV-1 to an uninfected partner but I am confident that it occurs, just rarely.

2.  The recurrence rates for genital HSV-1 are lower than for genital HSV-2 and many persons with genital HSV-1 never experience a recurrence or, if they do, experience only 1.  We know from studies of genital HSV-2 however that, over time (years), the frequency of genital HSV recurrences tend to decline.

3.  No, I suspect that most people with HSV of any sort do occasionally asymptomatically shed the virus, probably in small amounts.

4.  Yes, I do think it is appropriate for persons with oral HSV-1 to acknowledge this, matter of factly, to partners. 

Hope these clarifications are helpful.  EWH
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