[Question #2937] Primary HSV Outbreak

42 months ago
Hello,
I'm a provider who recently saw a pt and diagnosed her with genital HSV-1.  She has been in a monogamous relationship for 10 years and this was a primary outbreak (severe pain, fever, flu-like symptoms, etc.)  Her partner was tested once she was diagnosed and also has HSV-1 but has never displayed symptoms (oral or genital).  She was wondering if having intercourse during an outbreak would trigger him to have an outbreak.  I was not sure since he already has HSV.  I also have never seen a primary outbreak after 10 years of monogamy.  So I guess my question is two-fold:  1. Should they refrain from intercourse while she has an outbreak even though her partner also has HSV?  2. How often do you see a primary outbreak 10 years after exposure?
Thank you for sharing your expertise!
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
42 months ago
I'm so glad you found us.
I have seen many primary outbreaks after long periods of monogomy.  Was he the giver of oral sex to her?  Did you do an antibody test to determine that this was a primary?  The main cause of genital herpes caused by HSV 1 is receiving oral sex, and in my experience, it is most frequently happening with no cold sore present at the time.  We know that people who have a history of oral herpes shed virus on about 25% of days. 
It is very unlikely that a person with oral infection would subsequently acquire HSV 1 genitally.  And if he doesn't know the location of his infection, but is only positive by antibody test, it really doesn't matter - I would not discourage them from having intercourse whenever they like and they are comfortable.

Terri
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