[Question #488] HSV oral genital transmission

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99 months ago

Hi, I m 45 years old got the first ever oral herpes outbreak a month ago by kissing a friend who have HSV1 and HSV2. I kissed him on his lips only ( no French kissing nor saliva exchange). The guy did not have any symptoms at the time we kissed and he basically never had any outbreak of herpes in his life although he knows he has it.

I m starting a new relationship now and although my sore has healed two weeks ago I m terrified to pass on the virus to my new boyfriend through kissing and oral sex . my question: is it possible to pass him the herpes by oral sex through asymptomatic shedding? I know this is what is mentioned on the site already but I really want to know what is the exact or average percentage of this happening in real life ? I do not want to stop my normal life but I also must be aware of the consequences. I have seen that chances are that a person could be shedding 5% of the time and the transmission risk is 1% which makes it 0.005 chance of me transferring him the virus through oral- is this correct or not? I m really interested to understand what is the risk ?

Thank you


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Terri Warren, RN, Nurse Practitioner
99 months ago
Good morning Dalia,

You are asking a question for which we don't have any answer.  We know the shedding rates of HSV 1 genitally pretty clearly - the virus is given off on about 5 days out of 100.  For oral herpes the virus is given off on between 9-18% of days, depending upon which study you read.  We know that people give off more virus when they are first infected than later on, when the immune system has a better handle on managing things.  I'm not clear where you got the 1% transmission risk statistic but here I believe you are referring to genital HSV 1 statistics anyway.  HSV 1 is more active when it is oral than when it is genital.  I'm rather surprised that you got infected orally from an asymptomatic person with no saliva exchange and no french kissing - not that it couldn't happen but that's a pretty low risk activity. Do you know for certain that you've never been infected in the past?  What is a long encounter? 

About 56% of the US population between 14 and 49 has HSV 1 infection so it is more likely than not that you current boyfriend has HSV 1 and doesn't know it or maybe does know it - has a history of ever in his life having a cold sore.  About 70% of those infected with HSV 1 don't report symptoms that they recognize so testing can identify infection.  However, the problem with THAT is that the traditional screening test misses one in four infections, compared to the gold standard of herpes western blot.

So in summary, HSV 1 infection (he likely has HSV 2 genitally) is common in the population and it more frequently given off orally than genitally.