[Question #5574] HSV-1 to a partber

21 months ago
I am a 39 yo heterosexual female.

I had a bad genital outbreak three years ago. The doctor in Lebanon (where I was living at the time) told me it was herpes. A swab test was taken but I was not told which strain it was. Last week, I got a blood test (in NYC) and the results came back positive for hsv-1 (index 17.40) and negative for hsv-2. I have been on 500mg of Valtrex for a year now because I thought it was Hsv-2 and only use condoms when having sex. I may have had an outbreak once or twice in my first year of diagnosis but nothing in the past year or so (or at least I don't know if I have had one because I do not feel anything). My current nurse practioner told me I should always dislose to a partner and get my partner tested for hsv-1 . She said if my partner is negative for hsv-1, I run the risk of transmitting hsv-1 to him genitally. If he is positive for hsv-1 then I don't have anything to worry about. What I have read in the literature (and from your website here) is that transmitting genital hsv-1 is very rare and unlikely.

What should I believe? Do I risk transmitting hsv-1 through genital-genital sex to my partner if he tests negative for hsv-1 (he is going to get tested next week)?
Is there any reliable literature I can direct my partner to get more knowledgeable on the topic to assuage his fears (if he tests negative for hsv-1), because he seems to have an irrational fear of herpes.

Thank you

Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
21 months ago
It sounds like your new infection was indeed HSV 1 and it can look exactly the same as HSV 2 in the genital area.  Genital to genital transmission of HSV 1 is rare - I personally have not seen it nor has Dr. Hook nor Dr. Handsfield (that is, new infection, no oral sex, only intercourse).  However, it has been reported in the literature so we cannot say the risk is zero.  I think it is more common to transmit via intercourse when you have brand new infection and are shedding often (not you).  The other issue here is that the IgG test he will likely take misses 30% of people infected with HSV 1 so the test isn't great, if negative.  There is a free handbook at westoverheights.com that he can read or he can read this forum or ask his own questions of us, if he would like.

Terri
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21 months ago
Thank so much Terri. 

One follow up question: if I am not having an outbreak in my genitals, what is the likelihood of transmitting oral HSV-1 to my partner via oral sex (him giving me oral sex)?

Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
21 months ago
We don't have any research about that but remember that HSV 1 genital infection is not often shed from the genital tract and thus is not often infectious.  It is shed on about 5% of days so maybe 18 days out of the year, on average?  And if your partner already has HSV 1 infection, it's a moot point, right?

Terri
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21 months ago
Thanks so much Terri. One last question: 

Why is there so much hype out there about disclosing genital HSV-1 to a partner if the science says there is almost no possible transmission genitally to am HSV-1 negative partner? Ella Dawson, an HSV-1 positive woman in New York, has made a career out of trying to destigmatize herpes, but I feel that in making her ordeal so public she has stigmatized it further, especially since her rate of transmission is so low.  I understand why HSV-2 needs to be disclosed, but I am confused why we are making genital HSV-1 such a big deal when it's not really.

thanks
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
21 months ago
It's a complicated situation but I do understand your concern.
First, we know it happens albeit not often.  it has definitely been documented to happen, in the absence of receiving oral sex.  And it probably happens more than we actually  know.  When someone is diagnosed with new HSV 1 genitally, I always ask if they have recently received oral sex.  The answer in my case has always been yes.  So I'm making the assumption that this was transmitted via oral sex but I can't prove that it wasn't through intercourse.  So although we say we think that's what is going on, we can't be positive.
Second, if a relationship progresses and disclosure has not happened, then trust becomes an issue, if it is disclosed later in the process of things - what else haven't you told me?
Third, if you know that you have HSV 1 genitally and do transmit via intercourse, it could become a legal issue of disclosure. 
Those are some of the reasons why someone might chose to disclose.  Not everyone does.

Terri
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