[Question #2776] Question for Dr. Handsfield or Hook regarding HSV1 transmission risk.

43 months ago
Hi there, 

I had an encounter two days ago that has made me quite anxious. Basically, I received unprotected oral sex for 2 minutes from a female who I realized afterwards had a small reddish mark (possibly lesion)  on her chin area about an inch and a half away from her lips. As a concerned biology student, I have done quite a bit of research on HSV1 transmission since this incident and don't remember ever having a cold sore as a child, nor does my mother. Although she says that she and all of my other siblings have had cold sores I was an exception (from what she remembers). For a guy who worries quite a bit about avoiding STD's and selecting my partners carefully, I feel like this is a perfect example of just plain bad luck.  I know many guys who will have intercourse with girls they don't even know from bars every weekend, and don't have herpes. Yet myself, the choosy guy who knows too much about STD prevention may have been infected. The irrational side of me is beginning to feel like the odds of transmission are probably quite high based off of what I've read on medhelp posts by Dr. Hook and Handsfield, and am sort of just waiting for lesions to show up in the next 3-7 days. The thing is, the red mark or potential sore could have just been acne, and this is what the person I was with says she believes it is. But, I'm having a bit of a left brain/right brain disconnect, where I'm assuming a worst case scenario regardless. This is because if it was a lesion, I probably am not being all too irrational, correct? The odds of transmission in this scenario would be quite high and I probably could expect to have been infected? 

Any thoughts would be appreciated. 
43 months ago
Is there an issue with my question? I ask because multiple others have had their questions answered that have come after mine and I appear to be the only open question currently on the list. Since this is my only reply, I should also add that the woman I had relations with is 100% sure it was not a cold sore, but for the purpose of the question it's probably best we assume a worst case scenario. If it was a cold sore, but located in an area (cheek/left chin area) that was not involved in the oral sex, is my risk the same as if there was not a cold sore? Or could it still have been shedding near the lips? I would greatly appreciate a reply, it seems others have had their questions answered quite quickly.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
43 months ago
I don't think that the risk of you acquiring HSV 1 in this situation is high at all.  Your encounter was a single one, it was very short, the chin is quite an unusual place for an outbreak of HSV 1 and the woman denies a history of cold sores.  All that is working against this being herpes and/or you getting it from this encounter. 
If this was by some fluke a cold sore, it is possible that she was shedding from the mouth as well.  But still, with such a very short encounter, I think transmission if really unlikely.
BTW, have you ever tested to know if you already have HSV 1 infection?  Since 56% of the population between 14 and 49 is infected, the chances that you have kissed someone who has been infected with HSV 1 are very high indeed!

Terri

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43 months ago
No,  I haven't been tested. Unfortunately, the province I live in makes it difficult to get a herpes test without lesions being present. My mother, grandmother, brother, sister, and other family members have had cold sores, but I don't recall ever having any and neither does my mother. So, assuming a worst case scenario - where she had a cold sore,  was shedding from her lips, and I was HSV-1 negative - could you provide some level of a numerical risk of infection? I read a response where Dr. Hook that the risk in a similar scenario was still around 1% but have also read responses from each of you where the risk in a similar scenario was "more likely than not" - that is a huge disparity assuming I interpreted it correctly.  Additionally, assuming I am HSV1 free but cannot get tested without lesions, is there any way I can avoid getting genital HSV-1 without totally abstaining from oral sex? What if someone has cold sores I don't notice or is asymptomatically shedding? I mean, I am willing to go to pretty great lengths to avoid STD's and am pretty selective in choosing partners - but so many people have oral HSV1 that it seems risky assuming I do not have it. Or is the transmission risk low enough per encounter - even without oral HSV1- that worrying isn't warranted? I appreciate your responses.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
43 months ago
We have no numeric value to pass on to you regarding the risk of receiving oral sex for 2 minutes with a person who has HSV 1 (assuming for the moment that she does).  I would not agree that it is "more likely than not" but I have no number.  Let's assume that a person who has HSV 1 orally and has symptoms of recurrent disease sheds virus about 1 our of every four days.  And that is correct.  But we don't know for how many hours in that day a person might be shedding.  Let's take a wild guess at 4 hours.  You can do that math yourself. 

You've made a lot of assumptions here, all in the negative direction - you aren't infected, she is, she is shedding virus, the lesion was a cold sore, etc.  But I'm working here with your negative assumptions. 

I have many many patients in Canada who very successfully have gotten type specific antibody testing so it certainly can be done in Canada. 

You can receive oral sex with a condom on - that would greatly reduce the risk of acquiring HSV 1 genitally.

It should be noted that being "pretty selective" about choosing partners has nothing to do with whether someone might be infected with HSV 1 or not - most people infected with HSV 1 don't have recognized symptoms, just like with HSV 2. 

Terri
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