[Question #335] Transmission of HPV-1

35 months ago


I was recently diagnosed with genital HSV-1 based on the results of a culture from a lesion.  My symptoms and presentation were so mild  (two tiny broken blisters) that the Nurse Practitioner was unable to visually diagnose the condition.  As a result she took a culture from the area (near my anus) just to be certain.   She initially said she really couldn't see any thing and that it was probably just a skin rash from stress. I was completely shocked when the results came back positive.  I have been in a monogamous relationship for 4 years and prior to that I was in a monogamous relationship for 2 years.  Prior to this I never had any symptoms and I see my GYN several times a year.  I also had major surgery on my ovaries in 2010, at which time I assumed that the hospital would have tested me for everything including HSV.  My partner has not had any symptoms of HSV (cold sores blisters etc).  Furthermore, my parter had a blood test which showed he was negative for HSV-1 and 2 four years ago.  We are both very concerned about treatment as well transmission as I do not want to pass the virus to my partner.  Most of the information about transmission that I have read has been focused on transmission of genital HSV-2 but very little or conflicting information on genital HSV-1.  I would like to know: 
1.  Is it possible to spread genital HSV-1 through regular sex or genital to genital contact .
        a.  when not having an outbreak (via shedding or otherwise)   If so what is the likelihood or prevalence of this type of transmission, and   what precautions can we take to prevent transmission.                  
        b. when having an outbreak     
2.  Is it possible for my partner to be infected by performing oral sex on me when I am not having a outbreak.
3.  How should I go about treating the virus?  would suppressive therapy be an option?

Thank you 


Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
35 months ago
Good morning, Shannon.  I think you mean HSV 1 for your title, just to clarify for others reading this.
While it is possible (and I have seen it) to transmit HSV 1 through intercourse, it does not happen often at all.  It is possible to transmit both with and without an outbreak.  This is called asymptomatic shedding.  And it is possible for him to get this orally by giving you oral sex, yes.
But the thing is, this all is not common.  And more than half the population between 14 and 49 already has HSV 1.  And the screening test misses 1 out of 4 infections when compared to the gold standard test, the herpes western blot.  Since your partner was tested four years ago, I think it would be good to have him retested.  But remember, if he still tests negative, the test could be missing his infection.  The herpes western blot is much more sensitive for HSV 1 but it is not available routinely from your local labs.  Our clinic can order the test for you (Westoverheights.com) or you can contact the University of Washington lab directly to send you a kit that you can give to his clinician to draw the blood, spin it down and return it to them.  It sounds like you are both pretty worried about this so confirming that he is indeed NOT infected would be a good idea.
If he turns out to be truly negative, then you being on suppression would reduce the risk of infecting him, yes.
but having said all of that, I would encourage you to step back a moment, rid your head of the stigma associated with the word HERPES and try to see this virus more clearly.  As I mentioned, most people in the US have this infection and as you can see for yourself, for most people, it is a very minor, infrequently recurring infection in the genital area.  It is most often acquired through receiving oral sex.  The average recurrence rate is about once every other year, and the virus is shed on about 5 out of 100 days, so not often at all. 
I think you are likely reacting to the fact that it is in the genital area, right, vs. orally?  Please try thinking about this with a little less  emotion.  Try to take steps to sort out his actual HSV 1 status and then if negative and it really worries him, take antiviral therapy to reduce the risk of infection 

Terri
---
35 months ago
I also wanted to know if it is possible for me to transmit the virus to him via oral sex.  Or am I only able to transmit from the site of my infection. (near the anus)
35 months ago
Thank you so much for your response.
To clarify I want to know if
1.  I can transmit the virus by performing oral sex on him?  Given that my symptoms were near my anus and I have never had a cold sore, I want to be clear on the possible transmission sights on my body. 
2.  If I am having an outbreak how long after the outbreak ends can we resume intimacy?Does this diagnosis mean we should use condoms and dental dams from now on? 
 I want to protect him as I know how devastating this diagnosis can be.  With that said I am trying to put it in perspective.  
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
35 months ago
If you only have HSV 1 genitally, you cannot transmit this to him by giving him oral sex, no.
The problem is that you can give off virus even when you don't have an outbreak (though not often with HSV 1) so I can't say that it is "safe" to resume having sex after an outbreak.  But I would wait until new skin has replaced the lesion before resuming sex.  Using condoms and dental dams is the safest thing to do, yes, but trying to keep perspective here, right, I would find out if he really has this or not before greatly altering you sex life.

Terri
---