[Question #222] Partner tested positive for HSV-2 and I tested positive for HSV-1

36 months ago
Hello,

My new partner (female) just tested positive for HSV-2. According to her she has never had any symptoms.  She received an IgG test and her rating was 3.56. 

I (male) have HSV-1.  My test came back as ~8.5.  I have never had any cold sores or genital lesions so I assume I received the infection from my parents as a child since they both have it.

We are looking for information on risk of transmission from her to me.  Any information you have on transmission with and without medication and condoms would be appreciated.  We are looking for transmissions rates for kissing, cuddling, all types of sex, and anything else that is relevant or possible.  We have been attempting to do our own research but both of our doctors were fairly clueless and the internet has all kinds of conflicting sources.

At this point in our relationship, she has performed oral sex on me, I have manually stimulated her, we have showered together, and kissed.  What are both of our risks at this time?  Our potential exposure was two weeks ago and neither of us has had any symptoms in the ensuing timeframe.

Also, is it worth her getting a western blot test to confirm her rating with it being so close to the inconclusive range?

When would future test results be conclusive for both her and me?  We have read anywhere from two weeks to 3 to 6 months.

Thank you.

36 months ago
To clarify she tested positive for HSV-2 and is negative for HSV-1. 

I tested positive for HSV-1 and negative for HSV-2
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
36 months ago
So I'm going to assume John that you tested negative for HSV 2 though you don't list it here, correct?
There is an excellent study that was published in 2004, first author Larry Corey, you can find it on PubMed, relating to the reduction of transmission with daily antiviral therapy.  There are other studies on there looking at transmission rates and they will be useful for you to read.  A little summary of the averages of the studies is this:  the rate of female to male transmission per year is about 4% - that is, if there were 100 HSV 2 infected women having sex with 100 uninfected males, the couple knows they are discordant, about twice per week, no sex with outbreaks, no antiviral therapy, no regular condom use.  If she takes daily antiviral therapy, the risk drops to about 2% and if you use condoms it drops even lower.  So you can see that the risk is not high.
There are no risks for you given what you have done so far.  There is no risk for kissing and cuddling.  Minimal risk of you giving her oral sex and minimal risk of she is on daily antiviral therapy  for intercourse. 
I would be tempted to have her get a western blot if she was a patient of mine, yes, even though she is right on that border, particularly if she has no symptoms.
The accuracy of the results depends upon when either of you last had sex with anyone else.  Best to wait 16 weeks before obtaining the western blot.

Terri
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36 months ago

Hi Terri, first of all thank you for your detailed response.  I think a lot of my confusion stems from the lack of differentiation on many websites between HSV-1 and HSV-2.  I’m going to ask for clarification on a couple of points. Also, to answer your initial statement, I (male) tested negative for HSV-2 and positive for HSV-1.  My partner (female) tested positive for HSV-2 and negative for HSV-1.


I also reviewed the study.  Thank you for that information.  If there are any other scientific studies that we should be aware of, especially in relation to the questions below, please let us know.


  • If my partner performs oral sex on me is there a risk that I will become infected with HSV-2? 
  • If I perform oral sex on my partner is there a risk that I will become infected with HSV-2?
  • Some of the websites we have visited to obtain information have mentioned that asymptomatic shedding is possible from both the mouth and genital areas and anywhere with a mucous membrane.  Can you explain in detail the risk of transmission from any of those areas and which version of HSV can be shed from which locations and how often?
  • You said earlier that there is no risk of contracting HSV-2 from kissing.  Is that true even with asymptomatic shedding of the virus?
  • Is there a way to identify where the virus is present without symptoms?  Sites have listed that it is possible to have HSV-1 outbreaks in the genital area and HSV-2 outbreaks in the mouth.
  • Is it possible to transmit either virus by showering with each other?
  • Is it possible to transmit either virus by stimulating my partners genitals with my hands?
  • If the Western Blot test comes back negative is that considered conclusive or is there more follow up testing that is needed at that point?
  • My partner just informed me that her mother may have HSV-2.  Could that possibly be how she has it at such low levels and has never had any symptoms?


In material obtained from the CDC they state, “It’s easier to get HSV-2 in the genital area than in the oral area because different types of HSV prefer different tissue types. People who have 1 type of herpes and get another type may have no noticeable symptoms, or they may have symptoms that are less severe, similar to the symptoms of a recurrent infection.


HSV-1 and HSV-2 can be found in and released from sores that the viruses cause. But, between outbreaks, the virus can also be released from the genital tract or skin that doesn't appear to be broken or to have a sore.


The virus can be spread from an infected partner who doesn't have a visible sore and may not know that he or she is infected. Herpes is best spread by direct contact. Infection can occur when scraped or cut skin or mucous membrane tissue comes into contact with skin or mucous membrane tissue where the virus is present.


Skin outside the genitals that doesn't have open cuts or sores is unlikely to be infected. Transmission can occur during genital-to-genital touching, rubbing, or penetration.


A person can also get genital herpes by receiving oral sex from someone who has oral herpes.


Regardless of symptoms, infection can occur when scraped or cut skin or mucous membrane tissue comes into contact with skin, mucous membrane tissue, or oral or genital secretions where the virus is present.”


This seems to be directly contradictory to what you said earlier about kissing, physical contact, and showering not being able to spread the virus.  Can you explain why there is the difference in your answer and the CDC’s? Aren't there mucous membranes in the mouth/nose?


Any and all scientific studies that back up your answers to the questions above would be appreciated greatly.  Also, any resources that have clear concise information or where to get more information would be appreciated.  Finally, if you have any other stats on transmission from reputable websites it would be wonderful to get that information.  It is very hard to find information broken down by the type of HSV.


Thank you.


Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
36 months ago
  • If my partner performs oral sex on me is there a risk that I will become infected with HSV-2?
  • NO
  • If I perform oral sex on my partner is there a risk that I will become infected with HSV-2?
  • There is a small chance, but HSV 2 does not like the mouth and transmission in this way would result in a cold sore looking thing and essentially vaccinate you against genital HSV 2

  • Some of the websites we have visited to obtain information have mentioned that asymptomatic shedding is possible from both the mouth and genital areas and anywhere with a mucous membrane.  Can you explain in detail the risk of transmission from any of those areas and which version of HSV can be shed from which locations and how often?
  • If a person has HSV 2 genitally, the virus can be shed from the labia, perineum, anus, vagina, cervix.  If a person has oral HSV it can be shed from the mouth and likely inside the nares and in tears, minimally
  • You said earlier that there is no risk of contracting HSV-2 from kissing.  Is that true even with asymptomatic shedding of the virus?
  • If she has HSV 2 genitally, it does not come up and out her mouth, it stays in the boxer shorts area
  • Is there a way to identify where the virus is present without symptoms?  Sites have listed that it is possible to have HSV-1 outbreaks in the genital area and HSV-2 outbreaks in the mouth.
  • While that is true, particularly of HSV 1 in the genital area, HSV 2 oral infection is rare and when it happens, rarely sheds (about 3 days out of the year). We know that about 95% of people who have HSV 2 shed genitally.
  • Is it possible to transmit either virus by showering with each other?
  • No
  • Is it possible to transmit either virus by stimulating my partners genitals with my hands?
  • No.  Rarely people will get a herpes lesion on the hand if there are breaks in the skin while masturbating a partner with HSV 2.
  • If the Western Blot test comes back negative is that considered conclusive or is there more follow up testing that is needed at that point?
  • A negative western blot, performed 16 weeks after any possible exposure, should be considered definitive
  • My partner just informed me that her mother may have HSV-2.  Could that possibly be how she has it at such low levels and has never had any symptoms?
  • No, this is no way relates to her mother's condition.


  • This (the CDC info) seems to be directly contradictory to what you said earlier about kissing, physical contact, and showering not being able to spread the virus.  Can you explain why there is the difference in your answer and the CDC’s? Aren't there mucous membranes in the mouth/nose?

I don't know what you mean by this.  Again, her HSV 2 stays genital, it does not come out of her mouth.  And once a person has HSV 2, they do not subsequently acquire HSV 1.  Can you be more specific about what you see as discrepancies with our information?  I agree with everything you posted here from the CDC


Terri



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36 months ago

Hi Terri,


I guess my confusion stems from two points, one being the quote below from the CDC, and the other being your statement that HSV 2 oral infection is rare and when it happens it rarely sheds (about 3 days out of the year).


“Regardless of symptoms, infection can occur when scraped or cut skin or mucous membrane tissue comes into contact with skin, mucous membrane tissue, or oral or genital secretions where the virus is present.”


These two point seem to indicate that it is possible to spread HSV 2 from the mouth to the genitals even though it is rare, but your earlier statement says that if my partner performs oral sex on me I have no risk of obtaining HSV 2.  


So my questions to be clarified:


  • Is it rare to be infected, or impossible to be infected if my partner with HSV 2 performs oral sex on me?  

  • I have the same question about kissing and acquiring HSV 2.  Is it rare or impossible? 

  • If it is possible for either case, no matter how small a chance, is there a test to determine if the HSV 1/2 infection is genital or oral?

  • You already mentioned how there is a small chance that if I perform oral sex on my HSV 2 positive partner I could contract HSV 2 orally.  How big or small is that chance?

  • You said that it is impossible to get HSV 2 from manually stimulating my partners genitals but then say that it is rare to get an infection through broken skin.  Which is it?

  • Will taking acyclovir 500mg daily completely prevent any symptoms from coming up in the future or is there still the possibility of her having some symptoms?

  • I’m also confused how showering with each other will not transmit the virus as it is a wet and warm environment and the water will obviously be on both of us.


I really appreciate you taking time out in order to answer these questions fully.  This is the first time I've been able to get directed answers from a qualified professional and it's really clearing up a lot of our anxiety.

Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
36 months ago
  • Is it rare to be infected, or impossible to be infected if my partner with HSV 2 performs oral sex on me? 
  • Perhaps it is I that is confused.  I was thinking that she had genital HSV 2 not oral HSV 2.  Yes, if she has oral HSV 2 then there is some minimal risk of you acquiring genital HSV 2 from her performing oral sex on you - very small but present

  • I have the same question about kissing and acquiring HSV 2.  Is it rare or impossible?

See above - same response


  • If it is possible for either case, no matter how small a chance, is there a test to determine if the HSV 1/2 infection is genital or oral?

No, not unless she has a lesion in either location.  We AND the CDC (see 2105 STD treatment Guidelines) assume if a person is HSV 2 positive that they are genitally infected.


  • You already mentioned how there is a small chance that if I perform oral sex on my HSV 2 positive partner I could contract HSV 2 orally.  How big or small is that chance?
  • We don't have any statistics on that question.

  • You said that it is impossible to get HSV 2 from manually stimulating my partners genitals but then say that it is rare to get an infection through broken skin.  Which is it?

If there is broken skin on the hand, there is a tiny chance you could acquire HSV 2 on the hand but it would not result in genital infection.


  • Will taking acyclovir 500mg daily completely prevent any symptoms from coming up in the future or is there still the possibility of her having some symptoms?

There is still a possibility that she could have symptoms and/or transmit virus through a sexual contact


  • I’m also confused how showering with each other will not transmit the virus as it is a wet and warm environment and the water will obviously be on both of us.
  • Well, if you are having sex in the shower, then yes there is a possibility but just water washing over you both does not result in transmission.  You just asked about being in the shower together.


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