[Question #2104] Further HSV 1 clarification

45 months ago
Hello again,

Thank you for answering my recent precious questions. I am finding I need further clarification to put my mind at ease, so I hope you do not mind  my inquisition. I want to be as safe as possible!

1)  Just to be clear, since I have gotten cold sores since the age of 13 and did not engage in oral/vaginal sex until the age of 16/17, I can rest assured that my positive HSV1 blood test is strictly oral, correct? Is 3-4 years with antibodies sufficient protection against a subsequent genital infection?  I apologize for the redundancy as I know this forum does not permit repeats, but I am so fearful it could also be genital (despite having never had a genital OB-I fear my anxiety is getting the best of me) 

2)  I told my partner I have cold sores. Am I obligated to disclose that I am HSV1 positive or is that a given with my admission of cold sores? As far as I know,  he said he gets them too, but my fear is the chance he is mistaken. I just don't want to NOT tell him if there's a risk I have it genitally. If there is no risk I have it genitally, then I don't want TO tell him it could be genital and scare him. 

3) If my boyfriend does NOT in fact have cold sores,  and I perform oral sex on him with no active symptoms or sores, in your professional opinion , what is the risk of him becoming infected genitally with HSV1? I read in your other posts that HSV1 sheds orally 25% of days, does that mean per month, so on average 8 days out of 30, I could be contagious? I have been taking valtrex for suppression, but I am wondering if this is necessary and if in fact it will reduce shedding to the point where I shouldn't be concerned about transmission. 

I love my partner very much and the overwhelming thought that I could put him at risk is the sole cause of my elevated anxiety. Should I be worrying this much about this? 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
45 months ago
Once you have HSV in one location it is very unusual that you would get the same virus in a new location on your body, correct. 
I do not think you are under any obligation to discuss the possibility of genital infection with HSV 1, given the above statement I just made, no.
Yes, the most recent study on HSV 1 viral shedding from the mouth suggests it happens on about of 25% of days - so you math is about right.  Antiviral medicine reduces viral shedding of HSV 2 by about 70%, we don't have data as clear as that for HSV 1 and it is somewhat less effective for HSV 1 so I would say a wild guess would be a 60% reduction.  Suppressive therapy is not perfect but is very useful. 
But if he is already infected, the risk is very low that you would infect him from giving him oral sex.
I think you need to get clearer about his cold sore status - ask, do you get them on your lip or in your nose?  Sometimes people confused cold sores with canker sores, so you want to get clearer about that.
Please keep in mind that more than half the US population between 14-49 have HSV 1 so it is very very common and normally is an annoying skin problem rather than anything serious medically, with the exception of pregnancy when the infection is genital. 

Terri
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45 months ago
I am feeling much more assured now, thank you. 

Now, as far as HSV2 goes, I was negative via blood test twice in the past. Once when I was tested 11 weeks after a sexual encounter and then again a year later. Both came back negative for HSV2. I have not had any sexual encounters for the past 4 years up until recently with my current boyfriend. Here are my questions: 
1. If I receive a positive HSV2 blood test in the future, is it safe to assume I acquired it from my current boyfriend?
2. There have been random times where I have experienced one of the following in the vaginal area (not all at once, rather sporadically at any given time): tenderness of pubic bone/glands, inner thighs itch/tingle briefly, fleeting sharp pain, burning sensation, cramping, or redness. Other times, like yesterday, I notice small flesh colored, pink bumps on the labia majora here and there that look like razor bumps or pimples, and they are not painful to touch and often go away the next day. I imagine these are normal experiences to have as a woman, but I've read that many people with HSV2 confuse signs of herpes as something else. Are the symptoms I've listed normal to experience every so often?
3. Would you mind telling me specific symptoms of HSV2 so I know what to look for in the future since I've been having unprotected sex in my relationship?  You said because I have HSV1, if I acquired HSV2, I may experience milder symptoms, so I just want to avoid running to the OBGYN for every harmless/normal experience.
4. Lastly, I had a question about the index level of herpes tests. I know anything >1.0 is positive, however do those numbers mean anything, such as whether an infection is recent or how many antibodies I have? My HSV1 was >8.0.
Thanks!

Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
45 months ago
1. If I receive a positive HSV2 blood test in the future, is it safe to assume I acquired it from my current boyfriend?

well, if you are negative at 11 weeks, then I think you are negative for this exposure.  If you turn up positive in the future it could like have been from anyone, not necessarily him.  If the test is missing an infection, it could be missing it from any time.  Has he been tested?

2. There have been random times where I have experienced one of the following in the vaginal area (not all at once, rather sporadically at any given time): tenderness of pubic bone/glands, inner thighs itch/tingle briefly, fleeting sharp pain, burning sensation, cramping, or redness. Other times, like yesterday, I notice small flesh colored, pink bumps on the labia majora here and there that look like razor bumps or pimples, and they are not painful to touch and often go away the next day. I imagine these are normal experiences to have as a woman, but I've read that many people with HSV2 confuse signs of herpes as something else. Are the symptoms I've listed normal to experience every so often?

yes, probably

3. Would you mind telling me specific symptoms of HSV2 so I know what to look for in the future since I've been having unprotected sex in my relationship?  You said because I have HSV1, if I acquired HSV2, I may experience milder symptoms, so I just want to avoid running to the OBGYN for every harmless/normal experience.

Sore, blisters, scabs, breaks in the skin that are new and last several days.

4. Lastly, I had a question about the index level of herpes tests. I know anything >1.0 is positive, however do those numbers mean anything, such as whether an infection is recent or how many antibodies I have? My HSV1 was >8.0.

The index values will be low or negative in the beginning of infection and rise as time goes on, for most people.

Thanks!

Terri
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45 months ago
Sorry, let me clarify. My blood test after 11 weeks was 4 years ago (2013) after the last time I had sex with a new partner. The HSV2 was negative. Then in 2014 I had not had any new partners and I got another test just in case the first missed anything. It was also negative. I have not had another sexual parent since this encounter until my current boyfriend.  So if I were to test positive for HSV2 after having been with my current boyfriend, I was asking if it was safe to assume I got it from him since he has been my only sexual partner since my last negative test in 2014. I am unsure if he has ever been tested.


As for the HSV1 index, you say a low index or negative one is the beginning of an infection. Is >8.0 considered low? Could this have indicated a new infection for me? I received the same index a year after the first test- so it stayed the same. Since you said it's unlikely to be reinfected in the genitals,  I imagine this should not be of concern to me, correct?

Lastly, I just left my GP's office. I was having some irritation (shaving bumps) and just wanted to be on the safe side. I've also been bleeding during intercourse everytime I have it, so I went for a check up. The doctor said my irritation looked like shaving bumps, and that my vagina in general looked clean. No signs of problems, discharge, but no odor. She swabbed me for HSV saying that my symptoms do not worry her, nor does what I'm experiencing appear to be HSV, however, she wanted to make sure there was nothing going on that could be causing bleeding during sex or irritation outside. Of course, I am not very worried as the results will take until next week to receive. Is it possible to leave this discussion open so I can share my results with you? 

Thanks!
45 months ago
Sorry, I meant of course I AM very worried. I don't know why she would I sit on swabbing for HSV when she said "everything looks very clean. " and "the irritation outside isn't herpes, it looks like razor bumps." So I am on edge right now knowing there are results pending. 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
45 months ago
If you test positive now, it is likely from this partner, yes.  Has this partner been tested? I guess I"m confused about why you are particularly concerned at this point in time. 
Bleeding with sex is not normally a sign of herpes - perhaps she did a swab test to reassure you?

Terri
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45 months ago
I guess I am concerned any time I notice irritation in the area.  She did not even swab the irritation, since she said it was common razor bumps. She took a vaginal swab from inside. A new thought has since popped in my mind as I told my partner about my doctor visit. I told him I know I am herpes free because of my negative blood test all those years ago.

I just remembered an encounter I had with a man I dated a year ago. We never had sex. No genital sex. No oral sex. However, we did kiss and rub against each other's genitals while wearing clothing. I wore thin leggings and I believe he was wearing jeans. He may have changed into shorts, I don't remember. We grinded/rubbed this way for awhile, some point I could feel his erect penis tip pushing close to the opening of my vagina through his shorts and my leggings. There was a point where I gave him a hand job briefly, then stopped. I may have gotten on top of him (still wearing leggings) while he was in his boxers and we grinded for a while. It was rigorous. I am wondering if herpes can be passed in this way. We both had underwear and pants of some kind on.  I can't recall if any semen was pesent, but I believe I was wet in the area a little. I didnt masterbate afterwards, but I don't know if I touched my vagina after touching his bare penis during the hand job like in the bathroom or adjusting my clothes. Should I be worried about HSV2 from that encounter? Should I get another blood test? 

Also, are we able to keep this open until my results come back?
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
45 months ago
No, the encounter that you describe is not a risk for acquiring herpes. You do not need another blood test to clarify your status based on this experience.
No Jennifer, I cannot leave this open any longer because you have already posted five times and the limit is three times. If you obtain a lab test result about which you have questions, you may feel free to open a new post. It just isn't fair to others if I allow this discussion to continue.

Terri
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