[Question #353] HSV-1 Risk and precautions

35 months ago
Hello, 
 I have recently become involved with someone who informed me that she tests positive for HSV-1 and had oral cold sores as a child, but has not had any symptoms since. 

 We both got tested for the full range of STIs, and both test negative for all other infections.  She, as expected, tested positive for HSV-1. I tested negative for HSV-1. 

I've been looking online for information on just how much I should be worried about this, but haven't had much luck finding anything clear. Some sites seem to suggest it's not much of a worry, others seem to suggest quite the opposite. 

My question relates to the relative risk of various sexual activities. She's well aware of the situation and I have no doubt that should she ever have symptoms again, she would tell me and refrain from contact - the concern I have is more from asymptomatic transmission.  

1) How much risk do I have from (french) kissing her ? Should I worry about this at all? 
2) How much risk (of oral-genital transmission) would I have if I let her perform unprotected oral sex on me? Should I avoid this and/or use a condom? Or is the risk low enough that I shouldn't worry too much about it? 
3) My understanding is that given the test results and the oral nature of her HSV-1, it's safe for me to perform oral sex on her, and for us to have intercourse. Am I correct? 

Thank You!

Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
35 months ago
Hi Steven,
Thanks for coming to our forum for your question.
More than half the US population between a14 and 49 have HSV 1 infection, though about 70% don't know it and don't have symptoms that they recognize as herpes.  Some of that is oral and some likely genital.  Unfortunately, the screening test (likely the one you had done) misses 1 out of 4 infections, when compared to the gold standard, herpes western blot.  So it is still possible that you are infected.  If you've kissed other people, and I'm guessing you have, about half of them have had HSV 1.  Many don't know it so can't tell you and others opt not to disclose this information.  My guess is also that if you have received oral sex, that you've been given oral sex by people with HSV 1. 
As you already know, HSV 1 is the most common cause of recurrent cold sores.  Yes, you could acquire HSV 1 by kissing her and we don't have good statistics on how often that happens.  If you acquired it AND were symptomatic it would look like a cold sore and likely could recur.
She could transmit her oral herpes to you by giving you oral sex, yes.  If that happened, you would have HSV 1 genital infection - it recurs on average once every other year and many people never experience a recurrence.  Using a condom would alleviate that risk, assuming her mouth stayed on the condom.
Yes, you can safely give her oral sex.  If you do happen to be infected and the test didn't pick it up, it is not an issue because she is already infected and will not "re-get" what she already has. 
I'm sorry that we don't have exact statistics on these issues of transmission with HSV 1, but suffice to say, it is more common to have HSV 1 than not have it and you likely have been exposed if not infected before. 
Please let me know what other questions you might have

Terri

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35 months ago
HI Terri,
 Thanks for your response -- I guess I'm still not clear on a couple of things:

1) Is she less likely to be contagious given that she hasn't had symptoms/sores in many years. Or is that irrelevant? 
2) Given the assumption that I'm negative (which I understand is not guaranteed even with the test) - I still need to make an informed decision on whether I should allow her to perform oral sex on me without a condom-- obviously I'd like to, but if that's considered an overly risky activity, then I'd prefer not to take the risk.  

I understand that you don't have any good transmission statistics - but are there any guidelines that say (given someone asymptomatic) that it's either low risk or high risk in the grand scheme of things? 


Thanks! 

Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
35 months ago
she is less contagious than someone who has symptoms, yes.
I would say that her giving you oral sex is lower risk, yes, but intercourse is risk free if she only has oral HSV 1
People who have HSV 1 shed virus from their mouth on about 9-18 days out of 100, depending upon the study that you read.   I guess some of this depends upon how much you are worried about this.  Remember that HSV 1 genitally is a very infrequently recurring disease, is fully treatable and is not infectious to someone else who already has cold sores.  Just some additional factors to consider.  I wish I could tell you more specifically what the risk is but we just don't know for sure.

Terri
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