[Question #5559] HSV 1 Transmission

21 months ago
I acquired HSV 1 genital infection at age 23. I'm now 41.  At time of initial outbreak, I had lesions in genital area and was swabbed but that came back negative. I then got married, had three children and never once had an outbreak.  My husband and I had unprotected sex our entire marriage and he never had an outbreak.  I don't know his official status, however. We are now divorcing and I took a test to determine my actual status, as I didn't know for certain. Test came back with HSV1 positive.  I have never had cold sores, so it is genital infection. My question is, I am now divorcing and I am wondering if after all these years, without an outbreak ever, does my body still shed the virus?  Also, with daily suppression therapy of Valtrex, what are the rates of transmission?  
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
21 months ago
Unfortunately, we don't have transmission data for genital HSV 1 but I can tell you that it is significantly lower than HSV 2 transmission and I personally have not seen it happen.  You are certainly shedding less than someone with HSV 2 AND probably less because you have well established infection AND because you don't have outbreaks.  And Valtrex would certainly also reduce the risk of transmission.  Your risk of giving this to someone through intercourse is really really really low.

Terri
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21 months ago
That is excellent news! Would you say it would be beneficial to stay on suppression therapy?  Also, what about oral sex?  From him to me, and me to him?  Is this more of a risk?  If he has hsv 1 I assume the  risk is zero?  

Probably an entirely different question, but he is very experienced sexually, so he may be a carrier already and we will be using protection until I am sure of his status.

Thank you for your expertise and candor!
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
21 months ago
I would say if you are having intimate contact with someone who is uninfected with HSV 1 (by antibody test) then yes, suppression therapy would be a benefit to reduce transmission to an uninfected partner, both for oral sex of him giving you oral sex (the reverse is not a risk if your infection is genital).  If he is infected also, the risk is incredibly low that either of you would get this in a new location on your bodies.  You may wish to find out if he has HSV 2 by antibody testing unless he has already had that done.

Terri
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21 months ago
As with most posts, I have formulated a bunch more questions!  I will try to keep this as concise as possible.  I have been doing lots of research on hsv1 since this official Dx and am kind of confused.  What I experienced as an initial outbreak seems different than most of what I read people experience.  I didn't have bumps or groupings of bumps that turned into lesions, my recollection is that they were just lesions on the labia.  It was incredibly painful to urinate. At the this time, a swab came back negative for herpes.  This was maybe a couple days after they broke out.  I do not remember them ever crusting over, just healing and being gone.  I used to get canker sores a lot (or what I thought were canker sores) in my mouth.  I still do occasionally.  Could this be oral hsv?  I have never had a crusted over one on my lip, but once a long time ago I got a very weird blister on the outline of my lip that raised and was tingly and then went away spontaneously.  It never crusted over and was only there a short time, of maybe a few hours.  My recollection of my outbreak was like canker sores, but down in the genitals?  Does this sound like herpes?  At the time of my outbreak this was pre-google and I was only told oh it looks like herpes. I just accepted it and went on with life. I don't recall getting oral sex right before the outbreak, so I wonder if it could have been something else? How prevalent is hsv 1 in the general population?  I've read many different statistics. Also, with someone who says they have slept with over 150 People (by his admission and yes I believe he's telling the truth) how likely is he to already have hsv1?  I know this seems silly, I should just ask him if he's been tested. I will, when the timing is right...
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
21 months ago
So lesions on the labia often just fill in instead of crusting.  That's normal and common.
Canker sores are not herpes.
And if you didn't receive oral sex shortly before the sores it could be that it was a recurrence or it came from intercourse (rare) or it wasn't herpes.  Those are the options there.
About half the population has HSV  1 - the older the population you look at, the higher the rate and vice versa.
I would say if someone has had 150 partners, he is likely to be infected with not only HSV 1 and possibly with HSV 2 as well.  I hope you are asking him to get tested before you have unprotected sex with him!

Terri
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