[Question #2619] HSV and kissing

43 months ago
Hi Terri:

Dr. Hook recommended I ask this question of you.  I have been seeing a new person, who says he is HSV1 positive.  We have only kissed, but it has been some extended open-mouth kissing, and we've probably done so about five different days over the course of 5 weeks.  He has never had any evidence of a cold sores, and I don't believe he knows whether his HSV1 is oral or genital.  He has a pretty extensive sexual past, so it's very possibly either or both.  

Since I am cautious about testing and sexual health risks, we have only kissed.  We've never had any genital contact at all, and not oral / genital contact either.  I have not seen his medical records, but theoretically he has copies he can show me.   He said all was clear on an STD panel, and he is negative for HSV2 but positive for HSV1.  

I am growing paranoid that I have exposed myself to HSV1 more than I had thought through kissing alone.  We first kissed about 4-5 weeks ago, and I have not had any symptoms.  The last time we open-mouth kissed was about 36 hours ago.  I feel some very slight tingling in my lips but nothing painful, and it's very possible that is paranoia on my part.   

I work with the public and live a very clean, healthy life.  Even the idea of presenting with cold sores is overwhelming to me now.  Have I most definitely acquired HSV1 through kissing?  Is it 50% likely?  20%?   

Given my lack of comfort, I suspect I should perhaps end this relationship.  Aside from not kissing someone who is HSV1 positive (hard to tell a lot of times), is there anything I can do to realistically help ward off HSV1 at this point?  Spironolactone?  L-lysine?  Vitamin D?  Anything? 






43 months ago
I should add that as of four weeks ago, I know I tested clear for all STD's and I was conclusively negative for HSV1 and HSV2.  I've never had a cold sore. 

Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
43 months ago
My response is going to relate not only to this partner but to future partners that you might have.  About 56% of the US population between the ages of 14 and 49 has HSV 1 infection - most of it likely to be asymptomatic.  That's the majority of the population studied.  Most of it is likely oral but more frequently these days, it is genital as there is more oral-genital sex happening now than say 50 years ago.  People who have oral HSV 1 are very unlikely to acquire it genitally as well so in a way, cold sores are a sort of vaccination against genital HSV 1 infection (but not HSV 2).  In addition, the traditional IgG test misses 30% of HSV 1 infections, compared to the gold standard herpes western blot.  This means that your test may be inaccurate as well as any future partner of yours who might test and tell you they are negative.  So if more than half that population is infected and testing misses 30% of those infection, what should you do?  It's a bit of a quandary, isn't it?  Not everyone is as worried about getting HSV 1 as you might be. Some might ask about cold sore histories in their partners if no history is reported, they proceed with the relationship.  Others might ask their partners to test  and still others might ask partners to get the gold standard western blot (expensive and not simple to get).  Others might not worry about HSV 1 at all but rather focus on avoiding the acquisition of HSV 2 only.  It's all over the board, believe me.  

The other factor at play here is how do you balance your concerns about acquiring this very common and manageable infection against affection that might feel for someone who is infected?  Would you leave a relationship with someone you really care about to avoid this common infection, only to be infected later by someone who doesn't know they have HSV 1?  It used to be that this discussion and decision came up only about HSV 2 but lately, it seems that more people, like you, are worrying about HSV 1 acquisition.

In the end, this decision will have to come down to you - your preferences, you fears, your emotional feelings about an infected partner.  The good news is that there are a few things to do about this aside from just leaving the relationship. You could ask your partner to take daily antiviral therapy to reduce (but not completely eliminate) the risk of transmission, use condoms with intercourse (should he have this genitally) and certainly avoid to oral to oral, genital to oral and genital to genital contact between any outbreaks (I know he doesn't recognize symptoms). It would also be great if he could identify the location of his infection.  He should observe the nostrils and the lips for breaks in the skin.  He should look anywhere from waist to mid-thigh for genital outbreaks - penis, buttocks, thighs, anus.  It should be noted that HSV 1 genitally recurs infrequently for most people who have infection in that location. 

And here is one final thing you can do about this:  you can work on your fears and recognize that if you are truly negative, you are in the minority.  You can dig deep into your feelings and think about the balance between how much you care about someone vs. acquiring this manageable infection.   I would also suggest that you try to think differently about this virus - you say you lead a "clean" life and I get what you mean, but people with HSV 1 aren't the opposite of clean - they are simply infected, very often by an adult with a cold sore kissing them when they are children. 

Please let me know what further questions you might have.

Terri
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43 months ago
Thank you for the counseling.  I agree this involves soul-searching.   I'm grappling with my conservative past while starting to date a person whose past (drugs, smoking, sex with men in threesomes, many partners with unprotected sex, etc.) is very different than mine.  While trying to take things slowly, I thought I was giving myself time to get acquainted while also protecting myself from irreversible health consequences.   I'm asking myself this:  "Ultimately, are we too different to really have a shot?"   I don't know yet.   

Rest assured that my clean life description was not a comment about people who have HSV, but rather an explanation that by nature I'm risk averse.   Many wonderful people in my life (a parent, my sister-in-law, several close friends) are HSV positive, and I love them sincerely.   I've been through a difficult year, and I just don't know if I'm ready for a change in my health -- not that people get that choice very often.  

Will you please answer the questions I asked in my first email?   

• If he has oral HSV1, have I probably already acquired it through open-mouth kissing?  Or is the chance more 50% or 20%?   (I get that if I'm part of 1%, it's still 100% for me.)  I want to be realistic about the position I'm in right now.  

• And is there anything that I could do to ward off an outbreak at this point?  Spironolactone?  L-Lysine? Lemon balm?  Vitamin D?  

•I look at images of cold sores online and they look quite painful and awful, and perhaps what's coming up are the worst of the worst -- quite red and crusty and weepy and often spreading to the chin or nose.   Maybe I'm seeing not seeing what is typical, and I need some perspective.  (In theory, if 56% of people have HSV1, I must be seeing a lot of people coping with cold sores, but I'm not noticing.)  Could you provide a link to an image of what is typical?





 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
43 months ago
If you have had no symptoms of oral infection (blisters, cold sores) and you've never been infected before, I think the chances of you having acquired HSV 1 is well below 10%.
There is nothing that you can do to "ward off infection" at this point if you are infected, no
Cold sores vary greatly in how they look - some are indeed extensive and others are very small red bumps.  People who take antiviral medicine at the very start of a cold sore sensation can completely block lesion development so it doesn't look like anything out of the ordinary.  I don't really have the ability to provide you a picture, but I would say if you have skin changes around the mouth that seem abnormal for you, you should have the changes evaluated.

Terri

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