[Question #4200] HSV1

30 months ago
Hi Ms. Warren

I am male who had a PCR test for herpes thru semen and came back negative. This was done after 4 weeks of last unprotected oral sex exposure (fallatio) that I was suspicious about.  Little less than two weeks later (almost 6 weeks from exposure), I did an igg test because I have not had any lesions or sores. Igg was positive for hsv1 with 1.3 index. Hsv2 negative. 

1) which of these tests is more accurate? can igg  be false  positive?  What's the possible scenario here, the two tests showing different results? Should I do Western Blot to confirm?

2) is this a new infection as 1.3 number is low?  Should I test igg again later to see if that number is changing? 

3) what's the difference if it was genital hsv1 or oral hsv1? At this point, I'm only guessing it's genial hsv1 as the infection seems recent and it could be from the oral sex.    Would it make any difference or matter any way , genital or ora, in terms of risk of transmission? If so, what sexual activity I should avoid so I don't transmit it?

4) Can intercourse with no condom cause hsv1 to be transmitted to a female if there's no outbreak?  

5) I want to have kids and my understanding is that the risk for the baby to be infected is low as long as there's no sex during last 3 months of pregnancy. True?  What if my partner wasn't infected and the first sex we have, she gets pregnant? Could she and baby get it?

5) In case of no outbreak, are antiviral meds needed? I feel neck pain and tingling sometimes and my right eye sometimes itches and is watery a bit. 

6) any medical tests I should be doing to ensure I won't develop Meningitis or something serious? 

7) not sure I should tell my partner if there's very small risk she gets infected? I don't want cause anxiety.  Thoughts? 

Thanks so much in advance!! Truly appreciate you. 




Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
29 months ago

1) which of these tests is more accurate? can igg  be false  positive?  What's the possible scenario here, the two tests showing different results? Should I do Western Blot to confirm?

I have never heard of anyone testing semen for HSV. Semen is a very poor carrier of HSV. The antibody test is more accurate,for certain.  And yes, that is a low positive that could be confirmed by westeren blot

2) is this a new infection as 1.3 number is low?  Should I test igg again later to see if that number is changing?

You could wait and do the blot 12 weeks after the encounter or do another IgG later and see if it has gotten much higher.

3) what's the difference if it was genital hsv1 or oral hsv1? At this point, I'm only guessing it's genial hsv1 as the infection seems recent and it could be from the oral sex.    Would it make any difference or matter any way , genital or ora, in terms of risk of transmission? If so, what sexual activity I should avoid so I don't transmit it?

You cannot know the location of the infection, if  your test confirms that you are infected.  Did you have sores appear after the concerning encounter?  HSV 1 orally is far more active than genital HSV 1 -it sheds virus more often - on about 25% of days vs. 5% of day

4) Can intercourse with no condom cause hsv1 to be transmitted to a female if there's no outbreak? 

It is possible but quite uncommon

5) I want to have kids and my understanding is that the risk for the baby to be infected is low as long as there's no sex during last 3 months of pregnancy. True?  What if my partner wasn't infected and the first sex we have, she gets pregnant? Could she and baby get it?

In utero infection with HSV 1 is uncommon but the virus can be transmitted to a baby at delivery.  Not having sex in the third trimester would be an effective way to prevent infection in the third trimester, yes

5) In case of no outbreak, are antiviral meds needed? I feel neck pain and tingling sometimes and my right eye sometimes itches and is watery a bit.

These are very vague symptoms and may or may not be related to HSV.If you are having sex with someone who is truly negative, antiviral medicines will reduce the risk of transmission,yes, very likely.   We only have data on HSV 2 but HSV 1 should be similar

6) any medical tests I should be doing to ensure I won't develop Meningitis or something serious?

None

7) not sure I should tell my partner if there's very small risk she gets infected? I don't want cause anxiety.  Thoughts?
I would ask her if she has ever had a cold sore-if yes, then she is already infected.  You might want to wait until you have confirmation with the western blot

Terri



Thanks so much in advance!! Truly appreciate you.
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29 months ago
Thanks so much Ms. Warren! Much appreciated!

So although intercourse without condom and without antivirals is very uncommon to transmit, the antivirals can lower the risk even more? So more assurance?

Are there any other benefits to taking those meds for the overall health, or are they just mainly to reduce transmission risk to others? I keep hearing antivirals are not needed for those with genital hsv1 given that virus sheds the least (5%)? I wanted to see if they have other reasons to be used for ( e.g. will help preventing any health complications)?  I have some dark green stools from time to time, sometimes watery and gassey stomach. Any relation to hsv1?

If taking the meds, can they be taken as needed? Maybe take within during certain period of time before having sex? Or they must be taken daily? For example if planning to have sex after two weeks, start taking it now and it can be stopped after sex and so on? I hear these meds will likely have side effects if used for long time. 

For genital hsv1, what sexual acts can transmit to others? We said intercourse is rare when no sores are present, what if the infected kisses, gives or receives oral sex with unifected people without condom or using antivirals, is there a risk to transimit? In other words, the only organ that can transmit is the penis in genital hsv1? If sharing a drink from same glass, saliva won't transmit because the infection is in the penis? Any other particular shared acts that can transmit so I can avoid, using toilets...etc?

If the infection occurred two months ago, it is safer to hold off on sex until 6 months or more for the infection transmission chances to lower? I heard that first few months are most contagious and trying to see what timeframe is normally safest. 

To answer your question, I haven't had any sores since that oral sex fellatio I received (2 months ago).  I have hemmroids and hydrocortisone helps relieve the itch and transient burning near rectum.  Dermatologist said to do anus scope. Also, the person who gave oral sex didn't have any visibles sores on the lips during the act. 

Would taking antivirals soon will help to avoid any outbreaks from happening although none happened yet? Have you heard of cases where genital hsv1 has never caused any sores or outbreaks and the person remained asymptomatic?  I hear of people who never develop symptoms and knew they had hsv1 after they tested as they never knew their status before.  So asymptomatic hsv1 isn't really a big deal after all if it rarely transmits to others and most importantly has no negative medical impact. 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
29 months ago
Antivirals can certainly decrease the risk of transmission–Study indicates a 48% reduction in transmission when antivirals are taking daily.
It is unknown taking antiviral therapy has other benefits the recent research seems to indicate that in some people with the specific genetic makeup, HSV is related to certain kinds of dementia and it has been suggested the daily antiviral therapy may reduce the risk somewhat in those individuals but I think more research is needed to confirm that initial opinion
. There are number of different ways to take antiviral therapy– Episodic therapy is taking the medicine when it is necessary to deal with an outbreak. Episodic suppression is kind of what you are talking about– taking it for some kind of encounter that one expects to last for a while. For example, if you wanted to take a vacation and not have an outbreak during that time, you could start treatment five days before you leave and then continue back during the vacation. The third where the medicine can be taken is to take it daily to reduce viral shedding and the frequency of recurrences.

The risk of HSV one transmission is unclear at this time. The area that is infectious is only the penis if the infection is only genital, correct. People with genital herpes do not shed virus out of their mouth.

It is correct that a person is most infectious during the first six months after a new infection.

I don't think there is any benefit to you taking medicine at this time before any diagnosis has been made and before any symptoms appear. It is possible to be infected and not know it, that is correct.

Terri
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29 months ago
Thank you Ms Warren!

So the infection doesn't shed from the mouth if genital hsv1. But unprotected intercourse transmission is quite uncommon. I know you mentioned you haven't seen one case although it's been documented.  How many cases were documented? Trying to see how risky it is to have intercourse and not transmit to others without using condom.  

How about if the genital hsv1 infected person receives oral sex from an uninfected person? Can the former give the latter oral hsv1?  

If a male has genital hsv1, can he get an uninfected female pregnant without infecting that female partner?  Some posts from Dr HHH state that genital hsv1 rarely gets transmitted via intercourse and that no prevention strategies are needed when no outbreaks. That said, wanted to see if semen from intercourse from the infected male can get the female infected?

If it does, then can artificial insemination be an alternative without infecting the female partner since hsv is mainly a skin-to-skin transmission? Any other alternatives to get pregnant without infecting the female partner? I understand the best measures to avoid transmission are condoms, not having an outbreak present and using antivirals. But obviously in the case of getting pregnant, condoms cannot be used. 

I also viewed Dr HHH's video about genital hsv1 not even requiring suppression therapy (using antivirals).  However, I want to reduce transimition risk further, so could I start taking them 5 days before sex to avoid transimition to others?  For example, I'm planning on having sex next weekend, so I would take them everyday starting Monday thru end of Saturday which is when I'll have sex. Then, I can stop them for a while and repeat the same strategy the next time I will have sex.  I'm not very sexually active, so on average, it's once a month or every two months, so thought that's better than taking meds daily in this case. 

To sum it up, wait 6 months after infection to reduce transmittion risk, use antivirals 5 days before and on the day of having sex? And stop having sex during the last 3 months of pregnancy to ensure baby doesn't get it.  Correct?

Per your comments on dementia, would it make sense to get a DNA genetic test to assess the risk? In general, I'm not in favor of using any meds unless needed and the benefits outweigh the side effects risks they may cause.  So given that I don't have sex often, thought I'd follow the episodic therapy.  Thoughts? And if outbreaks occur, then meds can be taken then as genital hsv1 does not recur frequently, meaning no real need for daily therapy. Correct? Trying to assess dialy vs episodic.

Also, does one have to keep testing every year to see where their index stand? Does that make any difference or tell us anything? If the index value went up, is that worrisome? Does that the person is more infectious or need treatment because the virus has spread all the over the body? 

It's been two months since the last suspected oral sex exposure and it was only one single time with that person that I had it with...Half the time, that oral sex exposure was done with a condom on and then it was removed. No sores on her lips. I'm also reading posts that for transmission to occur, it's normally repeatitive exposure (spouses, regular sex partners..etc).  

So,  any possibility hsv1 can be transmitted non sexually? If so, how or thru what ways?  Could it be possible that it is due to another exposure I had years ago as some people are asymptomatic for years and/or may never have symptoms?

Thankfully, I still haven't had sores on or near my penis and I was hesitant to even test at first and didn't expect the see hsv1 infection thru igg test positive at 1.3.  I'm truly hoping this is a false positive after western blot can shed some light.  I'm even reading online about some doctors not recommending further testing when symptoms never occurred and if igg was low positive under 3.

Truly appreciate all your attention to my questions and cannot thank you enough for all your help and patience with my questions.   It's great to have your expertise available to all people thru this forum.  Thanks so much again!

29 months ago
Ms. Warren,

I just had a thought while I'm waiting for your answers on my last post...

In order to reduce transmission even further to the partner, how about using condoms along with the antivirals while no outbreaks, and then just seconds before ejaculation, remove the condom and cum inside? That way, the female partner can get pregnant with a mininal risk of getting infected as the intercourse was used with condom most of the time except when during ejaculation to get her pregnant.  Unless semen is a carrier of the virus, which in this case, not sure how to get someone pregnant without infecting her and the baby. 

Thank you once again for your support!
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
29 months ago
Thank you Ms Warren!

So the infection doesn't shed from the mouth if genital hsv1. But unprotected intercourse transmission is quite uncommon. I know you mentioned you haven't seen one case although it's been documented.  How many cases were documented? Trying to see how risky it is to have intercourse and not transmit to others without using condom. 

we don't keep track of that actually.   I have seen one documented.  

How about if the genital hsv1 infected person receives oral sex from an uninfected person? Can the former give the latter oral hsv1? 

That is possible but unlikely

If a male has genital hsv1, can he get an uninfected female pregnant without infecting that female partner?  Some posts from Dr HHH state that genital hsv1 rarely gets transmitted via intercourse and that no prevention strategies are needed when no outbreaks. That said, wanted to see if semen from intercourse from the infected male can get the female infected?

You could accomplish insemination through something like artificial insemination even at home with a turkey baster.  Semen is not a good carrier of virus.

If it does, then can artificial insemination be an alternative without infecting the female partner since hsv is mainly a skin-to-skin transmission? Any other alternatives to get pregnant without infecting the female partner? I understand the best measures to avoid transmission are condoms, not having an outbreak present and using antivirals. But obviously in the case of getting pregnant, condoms cannot be used.

See above

I also viewed Dr HHH's video about genital hsv1 not even requiring suppression therapy (using antivirals).  However, I want to reduce transimition risk further, so could I start taking them 5 days before sex to avoid transimition to others?  For example, I'm planning on having sex next weekend, so I would take them everyday starting Monday thru end of Saturday which is when I'll have sex. Then, I can stop them for a while and repeat the same strategy the next time I will have sex.  I'm not very sexually active, so on average, it's once a month or every two months, so thought that's better than taking meds daily in this case.

I think it is totally reasonable to go on suppression.  And what you are talking about is episodic suppression and it is an excellent plan.

To sum it up, wait 6 months after infection to reduce transmittion risk, use antivirals 5 days before and on the day of having sex? And stop having sex during the last 3 months of pregnancy to ensure baby doesn't get it.  Correct?

Correct

Per your comments on dementia, would it make sense to get a DNA genetic test to assess the risk? In general, I'm not in favor of using any meds unless needed and the benefits outweigh the side effects risks they may cause.  So given that I don't have sex often, thought I'd follow the episodic therapy.  Thoughts? And if outbreaks occur, then meds can be taken then as genital hsv1 does not recur frequently, meaning no real need for daily therapy. Correct? Trying to assess dialy vs episodic.

I don't know enough about this actually to give a good answer to your question

Also, does one have to keep testing every year to see where their index stand? Does that make any difference or tell us anything? If the index value went up, is that worrisome? Does that the person is more infectious or need treatment because the virus has spread all the over the body? 

For you, we don't know if you are even infected.   I would suggest that you obtain a western blot for clarity.  You index value is quite low.

It's been two months since the last suspected oral sex exposure and it was only one single time with that person that I had it with...Half the time, that oral sex exposure was done with a condom on and then it was removed. No sores on her lips. I'm also reading posts that for transmission to occur, it's normally repeatitive exposure (spouses, regular sex partners..etc).  

So,  any possibility hsv1 can be transmitted non sexually? If so, how or thru what ways?  Could it be possible that it is due to another exposure I had years ago as some people are asymptomatic for years and/or may never have symptoms?

Sure!  Most people who have HSV 1 have it orally from someone kissing them, often as a child

Thankfully, I still haven't had sores on or near my penis and I was hesitant to even test at first and didn't expect the see hsv1 infection thru igg test positive at 1.3.  I'm truly hoping this is a false positive after western blot can shed some light.  I'm even reading online about some doctors not recommending further testing when symptoms never occurred and if igg was low positive under 3.

I  disagree with that as does the CDC

Truly appreciate all your attention to my questions and cannot thank you enough for all your help and patience with my questions.   It's great to have your expertise available to all people thru this forum.  Thanks so much again!


Terri


Mike (Mike112)
1 days ago



Ms. Warren,

I just had a thought while I'm waiting for your answers on my last post...

In order to reduce transmission even further to the partner, how about using condoms along with the antivirals while no outbreaks, and then just seconds before ejaculation, remove the condom and cum inside? That way, the female partner can get pregnant with a mininal risk of getting infected as the intercourse was used with condom most of the time except when during ejaculation to get her pregnant.  Unless semen is a carrier of the virus, which in this case, not sure how to get someone pregnant without infecting her and the baby.

That would work too, but again, I think you are ahead of yourself here.  You don't know for certain that you have HSV 1 nor do you know if it is genital.

Terri

Thank you once again for your support!
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29 months ago
Hi Ms. Warren,

Thank you for your answers!

I just don't see the point of igg testing if they can produce false results unlike the blot which is accurate. I also noted CDC doesn't recommend to test in general when there are no symptoms. 

By the way, who would have access to the Blot's results if done directly with the university? Must have a doctor's order, Primary care or urgent care doc?  Can test be anonymous or confidential? 

Forgot to ask, is a bit of redness on the penis head a symptom? Sometimes I see that in the same spot. Comes and goes and doesnt burn or have any feeling or pain.  Dermatologist told me it might be skin dryness and to use Vaseline. Wanted to see if you have a different opinion.

What I meant to ask about non sexual transmission was: are there any ways a person can become infected with genitals hsv1 non sexually? Such as using towels or toilet seats of an infected person?    

Does coming to contact with the urine of a genital hsv1 infected person transmit it to uninfected ones? Since semen doesn't carry the virus, wanted to see which body fluids can. 

Lastly, from your experience and the other doctors, genital hsv1 is rarely transmitted to an uninfected female thru intercourse without using condoms when there's no outbreak or symptoms.  That's because it sheds the least at 5%.   Did I get that right?

And even if the infected ejaculated in the female, he can still get her to become pregnant without infecting her or the baby as semen doesn't carry the virus.  Correct? 

Are there circumstances where unprotected intercourse can be more risky to transmit the virus?  Is that actual contact between the penis and vagina that may cause the transmission? Just trying to ensure and understand that best safety measures.

Thank you so very much!  Greatly appreciated!!
29 months ago
Sorry, one last question to add please, promise. 

If outbreaks happen for the first time, go to urgent care doctor and take antivirals until the symptoms are gone and then they can be stopped? 

If the blot came back positive, but symptoms haven't occurred, do you still recommend episodic suppression only when planning to have sex, as discussed? It's great to know that they can be taken and stopped and not taken daily to be effective. 

On the other hand, no need for the antivirals if symptoms haven't occurred and not having sex? 

What I understood is they are mainly to reduce transmission and control recurrence, so seems like a daily therapy is best for those who get outbreaks often and are sexually active? In the case of infrequent outbreaks, episodic still works as great? 

Thanks again very much. 


Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
29 months ago
All of that is correct, yes

Terri
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