[Question #4941] HSV1 / Genital / Anal region

26 months ago
I recently had oral sex with a woman and she initiated oral to anal activity with me.  A week later I had painful blisters on and around my anus and tested for HSV1 &2 at 15 days after exposure, both tests were negative but knowing it was too soon after exposure I tested again after 5 weeks, this time, I tested positive for HSV1 , IgG 3.07  and neg for HSV2, IgG <0.1.   I have not been with anyone since that experience and since at 15 days I was negative and at 5 weeks I was positive, I know it was that exposure (oral to anus) that did it.    So, I am a heterosexual man with HSV1 in my anal region.   Ok, so no one is ever going there ever again - fine with me.    Since the exposure was limited to the anal region (there was no intercourse).  Is it possible now for me to spread HSV1 through normal penis/vagina intercourse if the infection was anal?   Can and would the virus migrate to my penis from the anus?    please tell me I am safe to have intercourse again.   And....since it was HSV1 that affected the anus, do I need to worry about passing HSV1 orally through kissing and can I perform oral sex safely on a woman without fear of infecting her?
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
26 months ago
The nerve group that innervates the anus also innervates the genital area.  HSV  1 genital infection recurs infrequently after the first year (0.7 times per year on average) and is shed on about 5% of days from the genital area.  So that means out of a year, you would give off virus on about 18 days.  Remember that almost half the US population between 14 and 49 are infected with HSV 1, most of it oral but increasingly genital.  So the likelihood that you would be having sex with someone else who is infected with HSV 1 is high and they are not at risk of your infection.  You do not need to be concerned about passing this from your mouth to someone else - you are far less infectious to someone else that a person who has recurrent cold sores - they give off virus on about 26% of days measured. 

Please let me know what other questions you may have.

Terri
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26 months ago
Thank you.  It's all very embarrassing.   Would it be beneficial to start on an oral anti-viral med for HSV1?  If so, which one responds the best?   Also, I would assume someone is at risk if they perform oral sex on me?
26 months ago
Also....oral to anal is the only thing that could have caused this HSV1 on my anus.  There was no other contact there.    Was I just super unlucky?    I was married for 15 years to a woman that got fever blisters and I was negative for HSV1 when I tested the first time recently.   Then, just one encounter with this woman and I tested positive after 5 weeks of exposure.  

*encounter was on Dec 30
*symptoms developed approx. 1/6
*First test HSV1 and HSV2 both neg on 1/14
*Second test 2/4 - HSV2 neg,  HSV1 positive  
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
26 months ago
You could start antiviral medicine for your genital HSV 1 infection, yes, that would reduce transmission risk even further.  None of the three of the experts on this panel have seen a case of genital to genital transmission of HSV 1.  At least, when I diagnosed someone with genital HSV 1 I always asked if they were the receiver of oral sex.  No one said no.  Both valacyclovir and acyclovir are equally effective when taken as directed.

Yes, I think you were simply unlucky at this encounter.  The testing results and the timing of the encounter all point to a first infection. 

Terri
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26 months ago
It's unfortunate for me, but it sounds like since I have HSV1 in the genital area , then the virus can not migrate through the body to the mouth.  And since I have antibodies built up, i should not be able to get HSV1 orally.    It should stay in the nerve group down below.    It also sounds like there are rarely cases of the HSV1  being sexually from genital to genital.  Is all that true?  If so, my condition could surely be worse. 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
26 months ago
All of those statements are true, yes.  And yes, your situation could certainly be more difficult than it is now.

Terri
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