[Question #4369] Follow up to #5757 Dr Handsfield/ Dr Hook thread

29 months ago

Is hsv1 less often transmitted genital to genital because it does not shed often / outbreak. 


If I came in contact with a lesion and did not know it would i still have a chance it did not infect me bc it’s not the desired location? 


Just trying to make sense of my anxiety. 

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
29 months ago
Welcome back to the forum. As you know, herpes questions are normally answered by Terri Warren, but I see you already have her perspectives, both in your previous thread and apparently in discussions with her on her own forum website.

I can reconfirm Terri's advice that there is little chance you have genital HSV1 and, if you do, little chance you will ever transmit to a partner. As she said, genital HSV1 is rarely transmitted sexually, so the odds are you were not infected 13 years ago by your sexual exposure to the partner with HSV1. For HSV2, which is much more readily transmitted sexually, the average transmission risk for a single episode of unprotected vaginal sex is around once for every 1,000 exposures. That's why at least half of all regular partners never catch it themselves. We don't have this kind of data for HSV1, but clearly the transmission risk is far lower than for HSV2. From the other thread, I see you had an exposure soon before your partner had an outbreak, which does raise the risk. But still, the odds of transmission from a single event were low.

And you also have the negative HSV1 blood test results and your lack of outbreaks typical for genital herpes (understanding that you were examined during possible outbreaks but the providers did not think them typical for herpes).

So my assessment is that for you to have genital HSV1, you would have had to acquire the infection despite a low chance of transmission; have false negative HSV1 blood tests; and infection without typical outbreaks. The first of these appears to be rare. The other two are not uncommon, but still happen in a minority of cases. The science of probability and statistics dictates that the chance all three of these would break the "wrong" way are very, very low. I would put the chance you have genital HSV1 at less than one in many thousand. And even if you have it, the chance you will infect a future partner is very low. Beyond the inherently low chance of transmission, statistically half of all potential partners will already have HSV1, mostly oral (with or without known cold sores etc). Those persons are immune to new HSV1, anywhere on the body.

So my advice agrees with Terri's:  You can safely go forward with confidence you do not have HSV1. To answer the two specific questions you have asked:  

1) Yes it is true that genital HSV1 is rarely transmitted sexually to partners. In even the busiest STD clinics, virtually everyone with new genital HSV1 acquired it by oral sex, not vaginal or anal intercourse. In my 40+ years in the STD business, I have never knowingly seen a patient with genital HSV1 not acquired by oral sex.

2) I'm not sure what you mean by "desired" location. HSV1 can infect any body area, but it most easily infects the mouth and for some reason does not as easily infect the genital area. "Could" you still have genital HSV1? Yes. Is it likely? No, very unlikely for the reasons discussed above.

I hope these comments are helpful. If you find yourself continuing to obsess over the possibility of having genital herpes despite the strong evidence you do not, professional counseling may be in order. It really isn't normal to remain as concerned as you are after the reasoned, science-based reassurance you have had.

Best wishes--  HHH, MD
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29 months ago
Thank you so much for your reply. I do have ocd and when things get stuck in my head I can’t shake them. 

I have been over and over this event until it exhausted me.

I guess I read these horror stories of only cerical outbreaks and remember feeling a burning that something wasn’t right. 

Or someone just had a bug bite looking thing  and i did have that at some point afterwards... i just assumed it was a bug bite or ingrown hair on my the area of the back of my thigh close to my butt. Other than that, and the amount of times I was checked, I am going to let this go. 

Unless those two symptoms of course change your mind. 

Thank you so much, you are all A God send and I will be seeking professional therapy to learn to deal with my ocd. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
29 months ago
These do not change my mind in any way. Almost by definition, internet "horror stories" are about rare events. In any case, cervical infections with anything are painless -- there are no pain sensing nerves in the cervix. So it can't cause "burning". Almost all red bumps on the buttocks, thighs etc are folliculitis, pimples, etc. When longstanding herpes recurs, it's almost always at the same site every time -- so spots in various areas, as your description suggests, almost never are herpes.

Thanks for the thanks. I'm glad to have helped.
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29 months ago
That’s why the fear came back for me. Bc the cut(s) started again in the same area as it did years ago. 

I guess I can conclude that I have some dermalogical issue that isn’t caused by the hsv virus. And my gyno back then probably just said the cut “could be herpes bc it kept coming back in the same spot” and she was tired of seeing my face lol. (Those tests were negative as well, not sure if she tested for 1 / 2 or both. )

I will move forward confident that I do not have virus. Thank you.  
29 months ago
When it first started  years ago it was in one area, and kept returning there. When it started again a few years ago is when it would show up in that same area and then two other areas. was in different places. Just to clarify. 
29 months ago
Disregard the in was in different places.. hit submit before fixing the sentence. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
29 months ago
You asked about a "bug bite" on your thigh, not genital "cuts" and that is what I responded to. Just because HSV generally recurs in the same area doesn't mean that ll things that do this must be herpes. The weight of evidence remains strong you do not have it. It's time to stop overthinking all this and to move on without worry about it. And/or seek the counseling that you agree you need.

Repeated anxiety driven questions are not permitted and are generally deleted without reply (and without refund of the posting fee), so this will have to be your last question on these issues. I do hope the discussions have been helpful. Best wishes.
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