[Question #3628] Genital HSV-1 transmission concerns

34 months ago
Hello, 
     I have started dating this girl (I am a male), who disclosed to me that she was hsv1 positive per the igg test and hsv2 negative. I myself have tested negative for all STI. She has moved forward to tell me that it's  genital since the initial outbreak was vaginal and has not had any oral lesions or soars. She does not take antiviral medication. My main concern is transmission. We have had sex, with use of condom, but there has been times where the condom has broken, in which a new one is placed on immediately after noticing. What are my risks there with the exposure from the condom breaking? How effective is use of condoms? How often does the virus shed, Both assymptomatc and symptomatic? She has had the virus for more than two years. And how long does each viral shed last? Am I only at risk during viral shed? Could I possibly receive the virus from kissing?

Thank you!
- Gentleman with questions
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
34 months ago
Your risks are really low.  Genital HSV 1 is infrequently shed from the genital tract and the condoms are quite effective in reducing transmission.  The episodes of viral shedding can be hours or days, with and without symptoms, but again, with HSV 1, infrequent.  You are at risk from viral shedding but the risk is quite small.  If her infection is only genital you will not get it through kissing.  But anyone infected orally will shed far more often (25% of days) and is far more likely to infect you by giving you oral sex than this person is through intercourse. 

You say you are not infected - does that mean you are certain that you had a herpes antibody test with previous STD screening?  It is also important to note that the traditional IgG test misses 30% of HSV infections compared to the gold standard herpes western blot.  I take it you have never had a cold sore on your lip or in your nose?

Terri
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34 months ago
Thank you for your reply! Correct I have never had any sores or concerns of sores either oral or genital. The test I took was routine for STI so only the ig herpes antibody test was performed. Should I follow up and do western blot if I am not having and sores?
 Referring to your previous answer are you referring to the far more likely to get infected with oral sex if she had oral herpes? 
In addition, how often has it shown for GHSV-1 to shed? I have read that as years go by the shedding is less frequent, is this the case? She has had the infection for more than 2 years?
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
34 months ago
Yes, HSV 1oral herpes is more active than HSV 1 genital herpes and thus is more transmissible.
Shedding usually does decrease over time - an older study showed viral shedding of HSV 1 genitally to be about 5% of days.
Whether you do the blot or not is surely up to you and depends upon how much you want to be certain that you do not have HSV 1.  70% of those infected with HSV 1 do not display symptoms do it's just hard to know for sure.

Terri
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