[Question #4445] I am positive for genital herpes and would like to know risk of transmission

29 months ago
F, 22. Hi there, I had my primary outbreak two years ago now (genital), and have not had an outbreak since. I contracted herpes from my (ex)boyfriend who gets cold sores, and performed oral on me (this was before we knew herpes could be passed this way, and the oral was performed about a week before his cold sore developed, so he was virally shedding at the time). Now that he and I are not together anymore after three years, I have many questions as I enter the dating world. Back during that primary outbreak, I was tested with IGM and IGG, and my results are inconclusive, IGM supposedly showing Type 2 and IGG showing Type 1. Swabs from my sores came back negative (yeah, ok). I'm getting a new IGG today, actually, though I'm going to assume I have only Type 1 (got this from oral herpes patient, have no physical effects from my own condition).

1. I've read that some people have their primary outbreak, then never have one again. It's been two years! Is this possible for me? (I've also been through some of the most stressful times in my life, which I know often induces outbreaks. No such thing for me!)
2. Does this lack of outbreaks mean I am not virally shedding anymore, or possibly shedding at a lower amount?
3. Also, if I do not get any outbreaks, should I still go on valacyclovir daily? (depending on question #2 answer)
4. Can my new partner contract (oral) herpes if he performs oral on me?
5. Is there still a risk of transmission during anal?
6. What are my risks of transmission with vs. without a condom for vaginal sex, with vs. without suppressive therapy (4 situations total)?
7. Is there any risk associated with me performing oral on him?
8. If I do in fact only have HSV1 genitally, can I pass HSV1 on to some else, either orally or genitally?
9. If someone else has HSV1 orally already (like more than half the population does) does this mean they are immune, even genitally? Figuring you can't get the same virus twice in different places, but I really don't know...
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
29 months ago
1. I've read that some people have their primary outbreak, then never have one again. It's been two years! Is this possible for me? (I've also been through some of the most stressful times in my life, which I know often induces outbreaks. No such thing for me!)

It is absolutely possible for you.  Many people who have HSV 1 genitally do not recur or do not recur often

2. Does this lack of outbreaks mean I am not virally shedding anymore, or possibly shedding at a lower amount?

It means you are likely not shedding often, correct.  Likely on less than 5% of days.

3. Also, if I do not get any outbreaks, should I still go on valacyclovir daily? (depending on question #2 answer)

If you are having sex with someone who has HSV 1 anywhere on their body, suppression is not necessary but if you don't know their status or they test negative, you may wish to consider the use of daily suppression.

4. Can my new partner contract (oral) herpes if he performs oral on me?

That is unlikely because HSV 1 sheds from the genital area infrequently, as above.

5. Is there still a risk of transmission during anal?

A small risk, greatly reduced with antiviral therapy.

6. What are my risks of transmission with vs. without a condom for vaginal sex, with vs. without suppressive therapy (4 situations total)?

We don't have that data for HSV 1 - we know daily suppression reduces the risk of transmission of HSV 2 by almost half - it is likely that it is a similar numer for HSV 1.

7. Is there any risk associated with me performing oral on him?

Not if your infection is only genital, no

8. If I do in fact only have HSV1 genitally, can I pass HSV1 on to some else, either orally or genitally?

orally not, genitally very small risk - I have not personally seen transmission of HSV 1 through intercourse but it has been documented in the literature.

9. If someone else has HSV1 orally already (like more than half the population does) does this mean they are immune, even genitally? Figuring you can't get the same virus twice in different places, but I really don't know...

Highly highly unlikely to get it in a new location.

BTW if you were tested for antibody immediately after your first outbreak, and your HSV 1 was positive, it was unlikely a new infection.

Terri
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29 months ago
Thanks so much for your response Terri. I am apparently dealing with the least competent gynecology office on the planet, but at least they provided me with the numbers from my IGG test (but no analysis or explanation of what they mean).

1. I was only tested via IGG and my numbers were as follows: 2.10 for HSV1, and 0.20 for HSV2. Do these numbers make sense? What do they mean?
2. Depending on those results, what would you recommend I do to lower my chances of transmission to others?

Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
29 months ago
They do make sense.  The HSV 2 is soundly negative and the HSV 1 is positive at a low index value .  So you have never had a positive swab test from a lesion?  How do you know for certain you have herpes?  Sorry, I did reread your post but am still a bit unclear.

Terri
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