[Question #276] Herpes type 1 positive blood test

94 months ago
Hi I've known for a while that I am positive for herpes type 1 by antibody (blood test).  I've NEVER had a lesion anywhere either mouth or genital. 

Found out five years ago, I'm a 31 year old white male.  

I understand that more than 1/2 of the population has herpes type 1 and most people got it as a kid orally.  I assume that I got it orally as a kid.  I understand that most people are asymptomatic for life like me.


The reason I ask is that Dr. HHH basically said in another blog "no obligation whatsoever to mention it, I'm not putting sex partners at risk".

I have seen a mental health psychiatric nurse practioner (because I obsess over it) and she told me she didn't think it was necessary to tell.  She went on to explain that people are full of asymptomatic viruses.... that I'm normal and this is just the human body.

But Dr. Hook said he recommends to tell about herpes type 1 positive blood test.  Why would he say that?  Did I misunderstand him? 

If everyone has it, and I've never had a lesion anywhere (that I know of..... I'm borderline hypochondriac, so I would know if I did) and I've never given anyone herpes..... why would he say that?

I don't feel I n
94 months ago
Also, several years ago I had a girlfriend who had occasional mouth sores.  But I also remember being a kid and some of my friends getting mouth sores.  I guess that doesn't really matter since I never had a lesion anywhere and it's impossible to figure out when I got it and my immune system shut it down.

Thank you in advance for your response for calming me down about something that is so common and insignificant.
Terri Warren, RN, Nurse Practitioner
94 months ago
Your last comment implies strongly the way you want me to answer this question!
You ask a question about which experts often disagree and I will say right now there is no perfect answer to your question.  I'm going to run your question by Dr. Hook to be certain you understood him correctly, by the way.
You are correct - more than 56% of the population between 14 and 49 has HSV 1.  and it is very likely higher than that as we know now that the screening test misses about1 out of 4 infections.  The test used to determine the prevalence is not the same test that misses 1 out of 4 but very similar and in small studies, appears to miss a lot of HSV 1 as well.
So we are talking about something that lots of people have but we are also talking about something that is declining in prevalence over the years.  It used to be that people acquired HSV 1 as children from parents or other adults kissing them when they had cold sores present.  Now that more people know that cold sores are caused by the herpes virus, they are being more careful about oral to oral transmission to children.  The down side of that is that now we have a whole bunch of people entering into their sexual maturity, absent antibody to HSV 1.  And now we have more oral sex as a population accepted practice.  That leaves people vulnerable to HSV 1 genital infection, through oral sex.  Does that make sense?
There is no 100% correct answer about should you disclose this or not to sex partners.  If someone did acquire HSV 1 from you from receiving oral sex from you, they would have an infrequently recurring minor skin problem, however, one that stigmatizes people anyway, irrationally. 

If I were single and dating, would I disclose to someone that I have a history of cold sores?  Probably I would this discussion prior to giving them oral sex, yes.  There are a few factors that would drive that decision.  First, I would not want to infect someone genitally without them knowing there was that possibility.  Second, in some states, this could be considered something for which you could be sued.  I am handling a case right now of someone who acquired HSV 1 genitally from receiving oral sex from someone who had a known history of cold sores and did not disclose.  Whether this is winnable, I have no idea.  In this case, HSV 1 would have to be defined as a sexually transmitted infection and therein lies the rub.  Is it?  If it is oral?  Or in an unknown location, such as you?  The third reason I would probably disclose this is that many sexual relationships these days, actually most, don't end up in long term relationships but at some point, one might.  If you don't disclose, or don't disclose until after having sex, then trust could become an issue in this relationship even if herpes does not ensue. 

On the other side of this coin is that if someone agrees to have sex with you without undergoing STI testing to see what each of you has then they are consenting to taking a risk of getting whatever you have and the reverse is also true.  As you might imagine, given my job as a nurse practitioner running an STI clinic for 33 years, I don't think sex without testing is a good idea.  But I'm not so naive as to think that doesn't happen - I'm well aware that it does, probably more often than it happens WITH testing. 

In summary, I think this decisions rests with you and not everyone will handle this in the same way.  There is room here for many opinions.

93 months ago
Ok.  I think you ignored my statement....."never had lesion in my life"  I'm 31, it would've happened by now, I can safely assume that it won't happen to me.

Also, Dr. HHH REALLY disagrees with your logic.  See link.


So someone with just as much experience and credentials, completely disagrees with you.  You say "it's my decision" but then you go off on this guilt trip and all these dangers....about stuff that doesn't apply to me.  You quoted a case where someone had a known history of cold sores.....I DON'T.

YOU NEED TO THINK A LITTLE HARDER WHEN YOU TALK TO PEOPLE ABOUT THIS.  I UNDERSTAND YOU ARE TRYING TO WARN PEOPLE BUT FOR PEOPLE LIKE ME WHO HAVE OCD ABOUT STD'S your words can cause a lot of damage.  Good thing I've been in counseling and they've helped me understand I shouldn't reach out to internet doctors.

I hope this website leaves my response up so that other people with the same fears can realize that they can control this irrational fear and basically forget about hsv1.
Terri Warren, RN, Nurse Practitioner
93 months ago
As I said, Joseph, this is a question about which experts disagree.  I know herpes experts who feel completely opposite about this issue, and strongly in both directions; I'm actually rather moderate in this debate.
We know that people who have HSV 1 infection, whether they have cold sores or genital lesions or none, still shed virus from whatever site is infected, thus the caution.  If not having a lesion ever equated to lack of infectiousness, this would be a slam dunk - easy decision, but asymptomatic shedding complicates this picture. 
You don't technically have an STD at this point - we have no idea where your HSV 1 infection is on your body.  It could be oral or it could be genital.  If oral, it is common to acquire in childhood orally and many people never in their lifetime have symptoms.  On the other hand, there are many people who are infected who do have symptoms but don't recognize them as herpes symptoms but my guess is that you personally, having known for five years, would likely have recognized symptoms by now if you were having them.
When I presented to the arguments on both side of this issue, I was not at all trying to "guilt trip" you - I was simply pointing out the factors that people consider when making this decision. 
So when you tell me that "I need to think a little hard when I talk to people about this", my response is that I have thought long and hard about this, and try to present all the factors that go into making a decision about whether to disclose HSV 1 status to future partners or not.  What I do hope is that going through the reasoning on the pros and cons of disclosure, helps epople to make decisions they can feel comfortable with in the long run.  Many people, will decide not to disclose and some will decide to disclose and patients, like health care providers, are all over the place on what they decide and how strongly they feel about it. 
I"m sorry that you have OCD about STD's - I see that quite a bit and I know that can be quite a struggle, and I'm glad you are in counseling for that. 
We will of course leave this post up - I think it is useful for others to consider the pros and cons of HSV 1 discloser as HSV 1 genital infection, in particular, becomes more and more common, now accounting for about 40% of our new genital HSV cases. 
One thing to think about Joseph:  I would be certain that your test was an IgG, not an IgM and that the index value obtained on the test was >3.5 so there is no confusion about whether you are actually infected or not.  Since you've had this for five years, I'm guessing you've already confirmed all that but just throwing it out there to be sure.