[Question #2097] Liklihood of genital HSV1 infection

45 months ago
Hello,
I have gotten recurrent cold sores since I was 13. I had two sexual partners in the past both of whom I had unprotected sex with. The first did not have a known history of cold sores (orally or genital) and I am unsure about the second. 5 years ago, after approximately 11 weeks after a one-time unprotected sexual encounter with the second partner, I was tested for every STD and everything was negative except for a positive antibody test for HSV1 with an index of > 8.0. I even waited another year, had no new sexual partners, and got tested again in case anything was missed. Again, I tested positive for HSV1 IGG > 8.0 and negative for HSV2 <0.2 and everything else. My question is, how likely is it that my HSV1 is also genital? I was expecting a positive antibody test since I have always gotten cold sores, but I recently learned that the antibody test does not confirm WHERE you have the infection. My concern is if either (or both) of my two previous partners had HSV1 genitally/orally and didn't know it, that I may have gotten a genital infection, too. How likely is this? I have never had an outbreak in the genital region that I know of, except a bad BV infection in 2011. The area was swabbed and PCR cultured for HSV1&2 twice by two different facilities and both types came back positive for gardnerella BV and negative for HSV1/2 both times. I am concerned because I have a new bf and we are intimate. He says he gets cold sores rarely (once every couple years). I told him I have a history of cold sores, but do I need to worry that I also have a genital infection I could be unaware of? I do not want to put my new partner at risk: Please help, I am having a lot of anxiety. Thank you!
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
45 months ago
So that's a pretty easy one - the chances that you have genital HSV 1 after having cold sores since you were young is very low.  I have seen a clinical presentation of this situation only once in 33 years of practice - a person who reported a history of cold sores who had an HSV 1 positive genital lesion.  That's it.  Once.  I think you are likely just fine with an oral infection only.

Terri
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45 months ago
I cannot thank you enough for your prompt response. I have read many of your Q and A's as of recently and must say it is a privilege to speak with you directly like this, as I trust your expertise. Just a follow up, now that I feel more confident that I am not putting my boyfriend at risk genitally, I am wondering about the risk of oral to genital transmission of HSV 1 through oral sex. I have refrained from performing oral sex on my current bf for fear of infecting him even though he has admitted to having cold sores in the past ( I guess I worry that since he hasn't had a blood test, there's a chance his cold sores may actually be something else entirely) I have even gone so far as to be on suppressive therapy for my cold sores by taking 500mg Valacyclovir daily. In your opinion, is this necessary or would simply avoiding contact with active symptoms/sores be enough to keep him safe?

 In addition, if anyone has ever had cold sores, will they undoubtedly test positive for HSV1 antibodies assuming their infection is not recent? I ask because my sister has gotten cold sores before, but claims she was blood tested for everything (she believes this means herpes since she asked for everything) and she received no positive result. I am wondering if there's a chance someone could have cold sores but not have the HSV antibodies.  This caused me to worry about my own results, because I thought perhaps if people CAN have cold sores without HSV 1 then maybe my infection was genital. Thanks for your time!
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
45 months ago
Great questions.  If he has actually had cold sores before, the risk of you giving him genital HSV 1 is incredibly low.  I would make an attempt to clarify that what he experienced actually is cold sores and not canker sores, inside the mouth.  The IgG test misses 30% of HSV 1 infections, compared to the gold standard western blot,  so I am not surprised that your sister may have had cold sores but tests negative for HSV 1.  Also, herpes may not have been included in the testing as we know it often is not included, even though the CDC says "herpes testing should be considered in those having an STD screen".  So yes, people can have cold sores without testing positive for HSV 1, but the vast majority of recurrent cold sores are caused by HSV 1. 

Terri
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45 months ago
Thank you so much,

Last post. So if I understand you correctly, because I already have HSV1 orally, it would be extremely unlikely for me to be infected genitally through oral or vaginal intercourse even if I have oral/intercourse with another hsv1 positive partner? My boyfriend said he has had them before, only when it is very cold and he forgets to put Chapstick on. I imagine this means he experiences sores on the lips(still rarely- every couple years or so), but I will clarify in the near future. If it turns out he has not had cold sores, would the risk still be low if I avoided contact when prodome/sores were present and I was taking Valtrex? I'm not even sure taking Valtrex is needed in this situation.

Final question. I know having HSV 1 orally gives you some protection from acquiring HSV2. I am sure my partner has never had a genital outbreak to his knowledge because  if that were the case I know he would have disclosed especially before we had unprotected sex. Of course that does not necessarily mean he hasn't been exposed because there's always the question of asymptomatic carriers. My question is, when I go for my annual Pap smear in November, should I request a herpes antibody test be included in my STD screening to check for exposure to HSV2, or would you recommend I only request a herpes test if I experience symptoms? If I did experience symptoms and did test positive for HSV2, would it be safe to assume I acquired the infection from my current bf since I tested negative 5 years ago and he has been my only partner since? 

I want to thank you so much for your efficiency, as it has proved immeasurable in ways you can't imagine in easing my concerns. If I have any further questions, I will purchase another submission.  
45 months ago
Oops, sorry I just remembers something else. My cold sores has only ever presented in my nose, under my nose, and on my lips. It is common for lip/facial cold sores to appear INSIDE the mouth such as on the tongue, roof of the mouth etc. I sometimes get ulcers and have recently wondered if it is probable for cold sores to suddenly manifest inside the mouth area. Sorry for the last minute comment! 
45 months ago
I meant to ask "Is it common for lip/orofacial sores to manifest inside the mouth" not state it as a fact lol!
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
45 months ago
HSV 1 does not offer you protection against HSV 2 - that is a common misconception, as far as our research show so far.  However, if you have HSV 1 infection, you are more likely to have a mild or subclinical infection should you acquire HSV 2.  It is common for cold sores to present in the nostril and lips - usually herpes does not present with symptoms IN the mouth though it can be shed from inside the mouth.  And I also think you should take the word "exposed" out of your herpes library.  Either a person is infected or they aren't.  No such thing as a positive test just because someone has been "exposed" to the virus.  That's like saying your pregnancy test is positive because you've been "exposed" to semen - either you are pregnant or you are not.

Terri
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