[Question #5370] HSV-1 Transmission

75 months ago

I am 43 years old and never had a cold sore until this January. I've been married for 10 years and have never cheated and my husband says the same. The onset occurred two days after I had dinner with a former colleague and we shared a dessert (brownie/ice cream). I did not see a cold sore on her lips at dinner but it was not a well-lit restaurant and after getting the cold sore recalled seeing her with a cold sore at work years before and assumed that was how I got the cold sore. It was multiple blisters and lasted for ~3wks, so I am assuming it was an initial infection. Since then I have had two more cold sores, each smaller and shorter. I have been careful about not touching it, not sharing cups and not kissing or being intimate with my husband when I have it and for a few days after for good measure. This last cold sore I now have had for 7 days it is gone. Two days ago (day 5) it was small and scabbed and on the bottom of my lip on the left crease. My girlfriend took a sip of my beer before I had time to tell her not to drink out of my glass. I was careful when drinking to not touch the cold sore to the glass and she drank on the other side but I have been worried sick that I may have given it to her. There is SO much conflicting information about whether HSV1 can be transmitted by sharing drinks/food on the Internet. My questions are:

1. How likely can HSV-1 be transmitted by drinking out of the same glass directly after someone with a cold sore. Is it less likely if the actual sore did not touch the glass and the person drank from the other side of glass?

2. Is HSV-1 virus in saliva or just the sore? When there is no sore is there virus in saliva or just shedding where sore presents itself?

3. Based on what I've read on this site, I am now questioning whether I got my initial cold sore from sharing food with my friend but maybe that is more possible because it was a gooey brownie/ice cream?

Terri Warren, RN, Nurse Practitioner

75 months ago

I don't believe that you acquired HSV from sharing a dessert with a friend. The environment that you describe would not present a risk for HSV infection.

There is virtually zero risk of getting HSV 1 from sharing a drink with someone. The virus is present in the sore and because the virus is normally on the outside of the lip, the saliva does not come into contact with the lesions. However, it is possible that the virus can be shed from the oral area tissues when there is no cold sore present so when that infected and shedding tissue comes into contact with a person who is not infected,transmission can occur.

Terri

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75 months ago

Thank you so much for your reply, I appreciate you explaining as I said there is SO much conflicting information on the internet from what appear to be reputable sources. Do you know the basis for why so many sources warn that you can transmit HSV-1 by sharing drinks and the like? I ask because my concern over passing it to others (or to other parts of my body) when I have an active cold sore is making me anxious and I don't want to start acting OCD when I have one. Prior to cold sores, I was already a pretty solid hand washer :)

In follow up re my exposure, seeing I have been with the same partner for 10 years and neither of us have had cold sores prior to my first one this January, is it most likely that I was exposed in the distant past and just happened to start having cold sores? I have now had 3 in 4 months. The only other exposure I can think of is that I gave my partner (male) oral sex 3 days prior (and I am sure we kissed too) but he has never had oral or genital sores and we have been engaging in that activity for over 10 years without any prior cold sores.

Finally, seeing I have had 3 cold sores in 4 months, would you recommend suppression therapy and if so what do you think is the most effective? How long do recommend being on it? What are the side effects you have seen with your recommended suppression therapy? How much will suppression therapy decrease the likelihood that I will pass HSV-1 to my partner oral or genitally when I do not have a sore? I have warned him that it can be passed when I don't have a cold sore but he is not interested in using condoms for oral sex.

Thank you in advance and for this service!

Terri Warren, RN, Nurse Practitioner

75 months ago

It's difficult to know for certain what is going on here but a more likely scenario is that your partner of 10 years is infected without symptoms. it is also possible that there has been some change in the way your immune system is functioning. I think suppressive therapy would be a a reasonable route here. we don't have statistics on how much suppressive therapy reduces shedding or transmission with with HSV 2 is reduces transmission by 48%. But I think it is an error to assume is negative and vulnerable when you don't know. And the problem is that the traditional test misses 30% of HSV 1 infections compared to the gold standard western blot. I would assume rather that he is, given everything that you said.

I don't really know why anyone says what they do on the internet. Certainly, you would not want to share lipstick with someone who has an active cold sore. And not give oral sex to or kiss someone whose status you don't know when having an active cold sore.

Terri

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