[Question #2029] Risk of transmitting HSV-1 without an active cold sore

47 months ago
I get cold sores on my lips and I'm pretty sure it is the HSV-1 virus. I am from Canada and we don't have the kind of testing available in the US, so I can't be 100% sure that its HSV-1, but based on the symptoms I experience, I am about 99% sure it is. Anyway, I also know that the virus can be transmitted without an active sore being present. I was at a bar talking to a girl and we went back to her place and began kissing. I didn't have an active cold sore present at the time, but I didn't tell her that I get cold sores either. I've heard that the risk of transmission without an active cold sore present is 1%. Is this accurate? Should I tell this person that I get cold sores and that I may have transmitted the virus to them? I feel really bad that I didn't tell them beforehand, but it also seems kind of silly to have to tell each person you kiss that you get cold sores. I've heard that the majority of adults (50-85%) already have HSV-1. I guess I just don't know how to balance this out ethically. 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
47 months ago
If you have recurrent cold sores, then I also am 99% positive you have HSV 1 causing the cold sores.

I don't know where you got the 1% number - as far as I know, we don't have statistics on the frequency of transmission of HSV 1 - either mouth to mouth or mouth the genitals.  What we do know is that people with HSV 1 orally shed virus on about 25% of days sampled (25 out of 100 days).  The issue of should someone tell another person they have cold sores before kissing has been discussed extensively and frankly I doubt that many people ever do that.  And yes, the majority of the adult population in the US anyway tests positive for HSV 1 antibody.  One place I think it is helpful to perhaps draw the line is discussing a history of cold sores before giving someone oral sex.  What do you think about that?  I'm interested in other people's thought about this topic

I don't personally think you now need to contact this person at this time and discuss your cold sore history unless you are having trouble letting this worry go.  I have a feeling if this person didn't already have HSV 1 and they got a brand new cold sore outbreak, they would contact you do discuss it.

Terri
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