[Question #5603] HSV-1 Genital Herpes

73 months ago

I recently had a culture test done for genital herpes and it tested positive for HSV-1. My new partner had oral HSV-1 and didn't have symptoms when we were together but she did have a cold sore about 2 weeks later after I had my first symptoms. I read that only about 14% of people diagnosed with genital HSV-1 have any symptoms after theirinitial outbreak, is this true or is it likely that I will have reoccurring outbreaks? What percent of the US population has HSV-1 and what percent has genital HSV-1? Is HSV-1 genital herpes more contagious than HSV-1 oral herpes? If I take daily Valtrex medication is that a very effective method for preventing transmission of the virus to any future partners and is there any estimated percentage of risk of still transmitting the virus? I recently was diagnosed with HSV-1 genital herpes. Can someone who has HSV-1 oral herpes get genital HSV-1 from me from unprotected sex?

Terri Warren, RN, Nurse Practitioner

73 months ago

i don't know where that statistic comes from - can you quote me the source of that information? That would certainly surprise me.

Close to 50% of the population between 14 and 49 have HSV 1 and in the age group older than that, certainly higher.

There is no way to know what percentage has HSV 1 as an antibody test cannot tell you where you are infected, only that you are or are not infected.

HSV 1 genital infection is shed on about 5% of days and HSV 1 oral infection, in people with recurrent cold sores, is shed on about 25% of days.

Daily Valtrex will definitely reduce the risk of infecting someone else - we have data on HSV 2 genital infection but not HSV 1 genital infection but we know it works well for oral HSV 1.

It is extremely unlikely that if you have this genitally that you will ever get it orally, if you don't have it already.

Transmission through intercourse of HSV 1 genital infection is quite unlikely - it has been documented in the literature but it is rare.

Terri

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73 months ago

Thank you Terri. Here is the link to the 14% statistic. http://ottenheimerhealth.com/blog/the-heartbreak-of-herpes/

You mentioned that it is very unlikely that I could transmit my genital HSV-1 virus to someone via intercourse even if they have never been exposed to HSV-1? My new recent partner had oral HSV-1 and has tested positive in the past. I got genital herpes symptoms about 10 days after our first encounter. I have not been tested for HSV-1 since 2015 but at that point it was negative and I have not had any symptoms until now. She is in somewhat denial and said it is possible I already had it and just now had symptoms. How likely is it that I was recently infected? The test was a culture sample and was positive for HSV-1 and negative for HSV-2. Is it at all possible to have a false positive? Also is it possible to have been exposed to the virus and not carry the virus if I get tested in a few months and it comes back negative? Lastly, can you share the HSV-2 data regarding the success Valtrex has in spreading the virus.

Thank you!

James

73 months ago

From your knowledge, how frequent are HSV-1 outbreaks on an annual basis? You mentioned the HSV1 genital infection is 5% of days, how is that compared to HSV2 shed rate?

Terri Warren, RN, Nurse Practitioner

73 months ago

After the first year, the average number of outbreaks per year is 0.7, so about once every other year. Maybe that's where they got the 14%? I honestly don't know and I've not heard of that blogger. perhaps your partner is unaware that she can transmit the oral form of the virus when she has no symptoms. It might be a little confusing to sort this out because the IgG test misses 30% of HSV 1 infections so your previous negative COULD have been a false negative. I would say that if you re-draw and are positive for HSV 1, then that indicates that you were likely newly infected and were able to seroconvert and the antibody be picked up on the IgG test. This is not a perfect answer, but I think it's pretty darn sure. I would say the likelihood of a false positive swab test is very low indeed, particularly if you had herpes symptoms. If you retest in a few months and are negative, I would blame that on the poor test performance rather than the fact that you are not infected.

Valtrex reduces transmission by about 48% compared to placebo for HSV 2.

Terri

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73 months ago

Thank you Terri. You mentioned "Transmission through intercourse of HSV 1 genital infection is quite unlikely - it has been documented in the literature but it is rare." So genital HSV1 is much less contagious or not contagious via sexual intercourse compared to HSV 2? And to confirm as I have read mixed opinions, if someone already has HSV1 orally, is it possible for them to get genital HSV1 from me and vice versa? Thank you!

Terri Warren, RN, Nurse Practitioner

73 months ago

I believe I answered this on a separate post this morning.

Terri

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