[Question #3198] Positive for HSV-1 but asymptomatic

38 months ago
A couple months ago I had a sexual encounter (performed and received oral sex) in which I contracted gonorrhea and/or chlamydia (had obvious symptoms a few days after incident). I received the standard treatment for both. 6 weeks after my treatment (7 weeks after the encounter) I got a full panel STD test, which showed negative for everything (including gonorrhea, chlamydia, and HSV-2) but positive for HSV-1. I have never had any cold sores and have seen no genital symptoms. My questions:

1. Does the fact that I did not experience an initial outbreak, or the fact that I tested positive after only 7 weeks, indicate in any sense that this is more likely oral and long-standing than genital and recently acquired?

2. I have a regular partner with whom I have remained abstinent since this incident. She has no history of oral cold sores and has not been tested for HSV-1. What is the likelihood that, if this is genital, that I asymptomatically transmit the virus to her, given that I've never had an initial outbreak?

3. I understand that if my partner is positive for HSV-1, I need not worry about transmission. If she is negative, what sexual precautions would you recommend we take in order to prevent transmission? I am particularly worried about genital to genital transmission.

Thanks!
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
38 months ago
If you had tested for HSV 1 right after the encounter and it was positive, then you would know if you had established infection prior to the encounter or if you acquired HSV 1 at the encounter.  Unfortunately, now there is no way to know.  Seventy percent of those infected with HSV 1 show no symptoms so it could be old or new. 
1.  Since you did not demonstrate symptoms of new infection, and assuming you were negative for both prior to the encounter, I think it is unlikely that this is new infection.  A person who is double negative (no HSV 1 or 2) who acquires new HSV infection and is looking for symptoms, may well find them.
2.  I think the likelihood of transmission is unlikely given what you've said.
3.  You are assuming that you infection is genital which we don't know to be true.  Have you been having sex with her for quite a while?  If she is negative, and the IgG misses 30% of HSV 1 infections so don't count on that, then you taking daily antiviral therapy would be recommended to reduce the risk of transmission to her as well as condoms if it might be genital.  you could also have this orally and could give it to her genitally through giving oral sex.  So as you can see, you could do all sorts of things to reduce the risk of transmission and some could be quite disruptive. 

without an outbreak either orally, nasally or genitally, you cannot know where this infection is so you cannot really know which area to protect, right?  And you don't know if this is new or old since you didn't test for HSV right away.  I'm sorry I cannot help you more here.  The best place to start is for her to get tested. Then you will know whether to be concerned or not. The best test is the herpes western blot.

Terri
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38 months ago
Thank you for your quick and thorough response! A quick follow-up:

Given that, as you said, it is unlikely this is a new infection and therefore unlikely that I transmit it, even if my partner tests negative for HSV-1, would you recommend taking the precautions listed? If so, which ones should I take? As you said, most would be quite disruptive. I am trying to balance being safe and responsible with being realistic and reasonable.


Thanks again!

Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
38 months ago
So often people ask me this kind of question.  I can't provide you with any certainty about this - it's all a guess - a reasonable guess but still a guess and I can't be responsible for the decision that you make about this.  I think the least invasive thing you can do here is to take daily antiviral medicine to try to reduce the risk of transmission IF this happens to be new infection.  Genital to genital transmission of HSV 1 is uncommon but it has been documented.  One thing you could do is to tell your regular partner that you thought you might have some odd sensations (and I'm sure you did with your symptoms) and you decided to test for herpes and you were positive for the cold sore virus.  You think she should be tested too, that this was a surprise for you, that you've had no oral or genital sores, but that you read people could have the cold sore virus without any symptoms and you were concerned about her.  Something like that.  It's all true and it might be a way to sort out who has what?  Just a couple of ideas. 

Terri
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