[Question #2707] Risk throgh oral sex

43 months ago
Hi, I have read through some old posts on medhelp saying that transmission of oral HSV1 via asymptomatic viral shedding does not happen often and that even when there is shedding it's usually not enough to transmit virus. Does this still hold true? I've had unprotected oral sex with my boyfriend about six or seven times and to his knowledge, he doesn't get cold sores and never has, but I do know that people can have asymptomatic oral HSV1. I just want to know my risks of getting this genitally as I have tested negative for HSV1 before our relationship. 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
43 months ago
It has not been my experience at all that most transmissions of HSV 1 to the genital area happens when symptoms are present - in my experience, asymptomatic transmission is far more common.  People with HSV 1 oral infection that present with cold sores shed virus on about 25% of days swabbed - that's quite a lot of shedding. 

The problem with the IgG antibody test for HSV 1 is that is misses about 30% of infections compared to the gold standard herpes western blot.  So you could be infected and not know it.  Are you saying that you boyfriend does test positive for HSV 1?

Terri
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43 months ago
He has never been tested for HSV1. He has never gotten cold sores and I have never gotten any symptoms orally or genitally while I've been with him. And I'm curious as to how shedding is meadured, is it measured by days per month or days per year? 

So if IF did have HSV1 it would be asymptomatic since he's never gotten any type of symptoms, would he still shed as much as people who do get symptoms orally? 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
43 months ago
Shedding is measured by asking, in this case, people who had symptomatic oral herpes were asked to swab their oral area for some specific number of days, every day.  Let's say they swabbed 100 days and the swab test picked up virus on 25 of those days.  They would then have had 25% shedding rates.  People who are infected but no symptomatic shed virus less often than people who do have symptoms correct.
So why hasn't he been tested since you are so concerned about this?

Terri
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43 months ago
It's not really that I'm terribly concerned about, I know that genital HSV1 is t that big of a deal and I am willing to take the risk. It's just that testing is so unreliable and the Western Blot is so expensive, but I'd rather not get genital HSV1 if that makes any sense. I'm just wanting to know my risks so if it were to happen I'd be able to deal with it accordingly. I know that once you are infected that you may never have symptoms, but isnt it. Ore likely that someone would present with symptoms if they were exposed? 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
42 months ago
You're correct, the HSV 1 IgG test is unreliable and the western blot is over $200.  I understand that you don't want HSV 1 genitally but you might start this exploration by having him get the IgG test.  Our study shows that if he tests positive at an index value greater than 3, he is infected and doesn't need confirmation.  If he is negative, then you and he are in the same situation - negative but don't know if it is accurate.  The IgG test is far less expensive and in your situation, it's at least a place to start.  People who are negative and get infected will often have symptoms but definitely not every time.  For example, 80% of people infected with HSV 2 don't know they are infected - now in this situation, previous HSV 1 infection may well keep things very much milder, but even people who are HSV 1 negative might not notice a new infection. The same is true for HSV 1 but we don't have as clear a number about the percentage who have symptoms with infection and who doesn't.  In my experience, I think about 70% of people with HSV 1 infection don't have recognizable herpes symptoms.  Try starting with the IgG for him maybe and see what you get back.

Terri
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