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!

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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