[Question #2354] Oral transmission HSV1

46 months ago
Hello Doctors, 
My question is regarding the risk of oral transmission from an HSV1 positive to a negative person. My partner recently developed a cold sore for the first time, however since it was pretty mild I believe it was not a primary outbreak, and he probably contracted it a long time ago. We abstained from kissing and sexual contact while it was healing. It has now been over one month since the cold sore. For the sake of argument, let's assume I don't have HSV1 (I have never had a cold sore but I have also never been tested to be absolutely sure). Would it be safe for us to resume sexual contact (oral sex) and kissing without the presence of lesions? How much risk does this carry? Is there a greater risk for kissing than for oral sex? If we kiss for an extended period of time and then engage in oral sex, would the virus be more likely to take hold in the oral area? 
Thank you in advance. 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
46 months ago
Unfortunately, we don't have statistics on HSV 1 transmision - either mouth to mouth or mouth to genitals or genitals to genitals.  What we do know is that most genital HSV 1 is transmitted from receiving oral sex from someone who has HSV 1 orally.  We also don't know if there is more chance of mouth to mouth transmission or mouth to genital transmission but I will take a wild guess and say mouth to mouth is a greater risk. In this situation, I think it would be wise for you to be tested via IgG for HSV 1 and 2.  If you are also positive for HSV 1, then we don't worry about you in this situation.  We also know that people who have both HSV 1 and HSV 2 give off virus at times when they have no symptoms.  So if you test negative either you are uninfected or the test missed it (it misses 30% of HSV 1 infections).  In that case, if you are concerned about transmission, he could take daily antiviral therapy to reduce the risk of infecting you, either orally or genitally

Terri
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46 months ago
Thank you for your reply. Without antiviral therapy, would you be able to give a guess as to the risk of transmission for discordant couples? Is this something I should be concerned anout? I feel a bit silly asking him to go on antiviral therapy after only one minor outbreak in his life. 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
46 months ago
Unfortunately, I don't have even a clue about the transmission rates.  I do have a clue about the genital to genital transmission rate of HSV 1 - very very low - but with the oral infection, we know people who have visible outbreaks, shed virus from their mouth on about 25% of total days swabbed, so the rate is decently high.  But here's a question that I have - if he's never had a cold sore before this, could you have given it to him?  You don't have to have ever had a cold sore to be infected with HSV 1. I think the next most reasonable step here is for you to get an antibody test and try to see what your status is.  You don't need to see a clinician to do this, you can order your own IgG test through several internet source - all sources send people to reputable labs for this process. 

Fifty six percent of people in the US between 14 and 49 have HSV 1 infection, with those percentages growing as the age gets older.  There is an excellent chance you are already infected if you are in that age group.

How long have you been together and has has he been the giver of oral sex to you normally?

Terri
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46 months ago
I suppose I could have given it to him. The reason I doubt this is because his outbreak did not resemble a primary outbreak from what I understood. It was quite mild and went away after 2 days with topical antiviral cream. It was a bump that spread a little and then decreased to a tiny spot before going away. He also had surgery a week before that, and wasn't able to work out regularly for a few days, which he is used to. We have been together for a year and have both received oral sex equally. 
As far as shedding, is there always enough of the virus for it to transmit to another person? For the 25% of days, is someone equally contagious all of those days? 
In your experience, how often have patients come in with genital herpes infection through oral sex from a partner without symptoms?
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
46 months ago
So we really don't know that this was a herpes lesion, do we? Did anyone do a swab test of the lesion?  Two days is incredibly short for an oral herpes outbreak. 
Now I think that both of you need IgG testing. 
There is not always enough virus to infect another person, no.  They are not equally infectious on all of those days, no. 
I often see people who test positive for HSV 1 antibody but have had no genital or oral lesions, so I guess that's the best way I can answer your last question.

If you two want to know what's going on here, you will need testing

Terri
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