[Question #1932] Environmental risk

53 months ago
Heya doctors,

I get coldsores on my lips (I think HSV1 but maybe HSV2 for all I know). The research I did led me to believe that I know the answer to my question but I wanted to make sure I am getting this right. When I do get coldsores I get very wary of going to restaurants or coffee shops because I worry I may drink from a glass or eat from a plate//silver ware that has HIV contaminated blood on it. What I read is that HIV transmission in the environment does not happen. So what I believe that means is that even if my cold sore (HSV1 or HSV2) or a cut did come into contact with HIV blood via a drink or place or silver ware or any other kind of contact, this would not be a risk because HIV needs very special and protected environment to infect a person.  So can I go to restaurants and coffee shops without having to worry that blood got on my glass//silver ware and then into my cold sore or cut and put me at risk for HIV infection (or any blood borne infection).

Many thanks for your help. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
53 months ago
Welcome to the forum. Thanks for your question.

Your research so far has come up with the right answers. There are no reported cases, ever, of anyone catching HIV from environmental contamination or exposure, and certainly no data to suggest a different risk for people with or without oral herpes. (Which almost certainly is HSV1. Recurrent oral herpes from HSV2 is extremely rare and pretty much limited to people who also have known genital herpes.) But I would slightly modify your presumed conclusion of the biological reasons for apparent lack of risk. It is true that HIV transmission requires a "special and protected" environment. But it's probably more important that HIV just doesn't exist in the environment. Even in the most HIV-intense cities and countries, the large majority of people are not infected; the amounts of potentially infected blood or body fluids that they might leave in the environment are very small; and even with larger amounts (e.g. blood spills after an auto accident), HIV rapidly becomes inactive with drying, air exposure, etc. And the notion that HIV would contaminate drinking or eating utensils is particularly unlikely. Among other things, saliva inactivates HIV, and therefore oral exposure of any kind, including oral sex, carries little or no risk of transmission. And in any case, your oral herpes makes no difference one way or the other.

So you really need not be at all worried about HIV in restaurants, friends' homes, public toilets, and the like. It just doesn't happen. If you would like a personalized example, my wife and I have several friends and professional colleauges who we know have HIV or who are at high risk. When we're together at dinner, in our home or elsewhere, we pay absolutely no attention to their used glasses, utensils, etc. We don't overtly and knowing use them, but the reason is because we don't do that with anyone else either -- we are protecting ourselves through common sense hygiene not against HIV, but colds, influenza, etc.  (One of those friends with HIV once was at our home for dinner, and had a high fever and headache that started the same evening. He went home early. We were concerned not a bit about his HIV infection, even in the pre-HIV treatment era, but about catching flu from him -- and indeed that's what he had, influenza. And my wife and I both caught it. But not HIV.

I hope this has been helpful. Let me know if anything isn't clear.

HHH, MD

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53 months ago
Thank you a whole bunch for your reply doctor. It was very informative.

I want to make sure I have got what you're telling me straight and let me do so in the setting that is typical for me. I was at the gym this evening and while on a machine a man sat down on the machine next to me. I happened to see that he had quite a few scabs on his leg that was closest to me. These scabs didnt appear to be bleeding but I'm not sure. I worried, what if his scabs got blood onto my water bottle which then touched my cold sore [[or that blood from his scabs otherwise somehow got into my coldsore or somehow posed a risk for infection to me]]. I guess my concern is that I felt as if I read that HIV binds to immune cells that are typically found in abundance near something like a coldsore. So I think that is where my worry is from. Could you educate me on this? And could you also speak any more about the general effect of air contact and room temperature contact on HIV? And maybe could you give me a guideline I can follow when I worry about exposure in public? I mean, I suppose what I'm trying to ask is if I can feel safe from HIV regardless of cuts or coldsores or any other kind of environment contact with potentially HIV infected fluids just as long as I do not share needles or have unprotected sex. If you could tell me this would keep me safe Id feel quite good. Cheers and thanks for your expert advice.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
53 months ago
Essentially, you are enquiring about the biological reasons for low (or high) risk of HIV transmission. I really don't think that's what's important, as I have said many times on this forum (at least a few times every week). The fact is that there has never been a proved (or to my knowledge, even suspected) case of HIV infection acquired from the environment. In the busiest HIV/AIDS clinics around the world, there are essentially no patients who did not have the traditional risks:  unsafe sex, usually in a high risk setting; shared drug injection equipment; being born to an infected mom; or, in the early days, blood transfusion. No cases, for example, in household members of HIV infected persons even after years of sharing toilets, kitchens, towels, eating utensils, etc (assuming they weren't also sex partners). Whenever an infected person reports no high risk exposures, it always turns out they were either intentionally untruthful or had unknown exposures, such as being unaware their spouse had HIV. Even before HIV was discovered, the absence of such cases enabled health officials to accurately tell the public that infection is not transmitted by casual contact or from the environment. These facts remain true today, 30 years later.

Thus very briefly, the biological explanations have to do with the small amounts of virus in most wounds and many secretion;  rapid killing of HIV in the air and by drying; that large amounts of virus typically are required for transmission (even HIV infected semen in the vagina results in infection of the woman only once for every 1,000 exposures); and typically lack of exposure of susceptible cells to the small amounts of HIV that might survive in the environment.

The basic truths remain valid:  The way to avoid HIV is to have only safe sex and to not share drug injection equipment; and add common sense hygiene in event of large exposure to blood, e.g. aiding an auto accident victim. Otherwise just forget it and move on.

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53 months ago
Hi Doctor.

I just wrote a whole reply which was deleted! Anyways, I have one more question related to my coldsore. This past wekeend (Thursday through Sunday) I was reunited with my romantic partner (we live long distance). We had sex many times. On Friday or Saturday (I cant remember which) I noticed a coldsore on my lips. Once I noticed my cold sore, I no longer performed oral sex on my partner. However, I had performed oral sex once or twice on her BEFORE I noticed my cold sore. It is also likely that some of my spit was on my penis and/or her vagina even after I noticed the cold sore.  

My questions are this: 1. It is my understanding that if my partner had cold sores before (HSV1) on her lips than she cannot be infected with HSV1 genitally. (I was tested and came up positive for HSV1 and negative for HSV2 -- I have only had coldsores on my lips, never no my genitals). Is this correct? 2. If she had not been infected with HSV1 before, what is the transmission likelihood from my lips//coldsore to her vagina given the description of events I gave above? 3. IF I did transmit HSV1 (which I hope hope hope I did not) to her, how serious is this condition, what will her symptoms likely be in the future, and what complications can she expect? 4. Is there anything else you think I should be considering?

I will talk to her tonight about this and hopefully I will have more information for her regarding the questions above. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
53 months ago
This was a high risk situation for your partner to acquire HSV1, either orally or genitally. Viral shedding and potential for transmission are quite high just before and in the early stages of cold sore outbreaks.

1) True:  people are highly resistant (probably entirely immune) to new HSV infections with the virus type they already have. If your partner has had HSV1, she is not at risk of catching your infection, anywhere on her body.

2) There are no data on which to estimate her risk numerically. But there is at least a fair chance she was infected, either orally or genitally. She should be on the lookout for symptoms, both oral and genital. In either case, she could expect multiple painful sores, a sore throat if oral, tender lymph nodes in the groin or neck, and maybe fever, headache, etc. Symptoms usually begin 3-5 days after exposure, sometimes up to 2 weeks. However, some infections are mild or entirely asymptomatic.

3) "Serious" is in the eye of the beholder. But most people with genital HSV1 don't have much trouble with it. While nobody wants genital herpes, if it happens, HSV1 is "preferred" over HSV2. Genital HSV1 recurs infrequently (many people have no recurrent outbreaks at all) and asymptomatic viral shedding is uncommon, so sexual transmission to future partners is infrequent -- all different than HSV2.

4) She should be alert for symptoms. The early symptoms probably would be mild, but at the very first sign she should see a doctor within 1-2 days to confirm the diagnosis and treatment with acyclovir or valacyclovir. If she develops no symptoms, I would still suggest she have a blood test for HSV, which will tell whether or not she already is infected. If positve for HSV1, she will know she is immune and the two of you would not need to take any precautions against future transmission. If negative, such precautions would be advised, i.e. avoiding both kissing and oral sex when you have outbreaks.

That completes the two follow-up comments and replies included with each forum question and so concludes this thread. If you have continuing questions about your oral herpes or your partner's risk, you are free to post a new question, which would be answered by Terri Warren, our herpes expert. However, at this point, she won't have much to add to my advice. It probably would be test to wait a couple of weeks and see if your partner develops symptoms.

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