[Question #3319] HSV - Oral Transmission
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91 months ago
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I recently had a full panel STD retest conducted. I tested negative for HIV, and all other STDs, but tested positive for both HSV 1 &2. I understand over half the US population has HVS1 and are unaware and show no symptoms. I've been asymptomatic - I've never experienced oral cold sores or blisters, or genital sores, blisters etc. I've opted for suppressive therapy with daily Valtrex 500 mg. Can I transmit the virus to another by giving oral sex even though I have no active symptoms e.g. oral sores or blisters?
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Terri Warren, RN, Nurse Practitioner
91 months ago
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I would be very interested in the index values associated with your positive test. Also, I would like to be certain that you got the correct test which is an IgG test, not an I GM test. If your index values fall below 3.5 confirmation is recommended by the CDC. Assuming for a moment that your positives are correct, it would be possible, if you are infected orally, to infect another person by giving them oral sex. Well we cannot be certain that you are infected both orally and genitally come I think that is the most likely interpretation of your lab results. It is correct that most people infected with both HSV one and HSV-2 have unrecognized infection.
Terri
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Terri
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91 months ago
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Hi Teri,
Thank you. Re: test - please see results below.
Regarding transmission and oral infection - I've never experienced any clinical symptoms e.g. cold sores, blisters on lips or inside the mouth, and even before I started suppressive therapy. I was informed by another STI healthcare counselor (not this forum) that transmission is highly unlikely if I have no open sores, blisters, etc., but wanted to get another opinion.
Conversely, if another performs oral sex on me even though I'm asymptomatic may I transit to them orally? I understand suppressive therapy may reduce transmission by 50%-70%.
Test Name In Range Out Of Range Reference Range Lab
HSV 1/2 IGG,TYPE SPECIFIC EN
AB
HSV 1 IGG, TYPE SPECIFIC
AB 12.10 H index
HSV 2 IGG, TYPE SPECIFIC
AB 16.20 H index
Index Interpretation
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<0.90 Negative
0.90-1.09 Equivocal
>1.09 Positive
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90 months ago
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Hi Teri,
Just checking back on feedback on my test results and follow up questions. I know you all are inundated with many questions! Looking forward to your follow up.
Thank you.
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Terri Warren, RN, Nurse Practitioner
90 months ago
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Hi,
So your results are solidly positive for both HSV 1 and HSV 2.
The reality of transmission is that most herpes is transmitted when no symptoms are present. This has been found in several studies. People with HSV 2 genital infection shed virus on about 15 out of 100 days on average - those with symptoms shed more , perhaps 20% of days and those without symptoms, about 10% of days tested (10 out of 100). If you are taking daily antiviral therapy, the transmission rate is less. So transmission rates and and shedding rates are not the same. You don't mention the gender of the people with whom you have sex so I am going to assume for a moment that your sex partners are female. With condoms and daily antiviral therapy and no sex with outbreaks and with disclosure to partners, the risk of transmission is about 2-3% per year, having sex twice per week.
Terri
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So your results are solidly positive for both HSV 1 and HSV 2.
The reality of transmission is that most herpes is transmitted when no symptoms are present. This has been found in several studies. People with HSV 2 genital infection shed virus on about 15 out of 100 days on average - those with symptoms shed more , perhaps 20% of days and those without symptoms, about 10% of days tested (10 out of 100). If you are taking daily antiviral therapy, the transmission rate is less. So transmission rates and and shedding rates are not the same. You don't mention the gender of the people with whom you have sex so I am going to assume for a moment that your sex partners are female. With condoms and daily antiviral therapy and no sex with outbreaks and with disclosure to partners, the risk of transmission is about 2-3% per year, having sex twice per week.
Terri
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90 months ago
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Hi Teri,
Thank you. Yes, I was quite surprised when I received the HSV results as part of a broader STI test panel especially without ever having symptoms orally or genitally. I’ve only had a slight “sensation” in the genitals that resolved in a few days (no outbreaks ever e. g. blisters, sores, burining etc). I never thought or was informed by my doctor that the sensation could be HSV. If it wasn’t for the broad STI test panel which included HSV 1 & 2 along with HIV, syphillis etc., (all negative) I would have never known. Also mentioned I now take Valtrex 500 mgs daily as suppressive therapy.
Re: my sexual orientations, I’m gay.
My final unanswered question which I’m getting mixed answers is oral sex specifically me giving oral sex to another and transmission of HSV. I have some healthcare counselors stating low possibility if I have no open sores or blisters on my mouth or on gums (I’ve never had either in my life) and also being on suppressive therapy.
Conversely I understand higher probability of transmission if oral sex is performed on me if I’m in a shedding period.
Thank You.
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Terri Warren, RN, Nurse Practitioner
90 months ago
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HSV 1 can be transmitted via giving oral sex. Even if you've never had a cold sore. But remember,for you, we don't know if your HSV 1 is oral or genital for sure, right? I am assuming you have received oral sex in your lifetime which means you could be infected genitally with both. I think the risk of transmission is higher if you are infected orally with HSV 1 than if someone gives you oral sex and you transmitting HSV 2 to their mouth. HSV 2 doesn't like the mouth and HSV 1 orally even without symptoms sheds not infrequently. Suppressive therapy will reduce the risk of transmission of both viruses.
Terri
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Terri
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