[Question #5831] hsv 1 genital herpes questions

18 months ago

Thank you so much for offering your expert advice during such a disconcerting time for me. I am a 55 year old woman who approximately 4 months ago was diagnosed with HSV1 genital herpes via swab testing.  I experienced a classic primary outbreak and have had only had that one outbreak.  I am no longer with the man I was with at the time.  I have several questions that I hope you can help me with.

1.      How likely is it that I can infect a partner genitally with hsv 1?

2.      How likely is it that I can infect a partner orally with hsv 1 if he performs oral sex?

3.      Does my likelihood of infecting a partner decrease over time?

4.      Does my likelihood of infecting a partner depend on how often I have outbreaks?

5.      Is it more difficult to transmit hsv 1 genital herpes from female to male than from male to female? 

6.      Should I take daily suppressive therapy to decrease potential outbreaks as well as potential spreading hsv 1?

7.      Should I use condoms?

8.     How often will I experience asymptomatic shedding?

9.     Should I disclose my hsv 1 genital herpes status to future partners?

8.    If my partner has hsv 1 oral herpes what is the likelihood that he will get hsv 1 genitally?

9.    Are there any studies out there that I can participate in in regards to medications that may cure hsv 1 genital herpes or decrease the likelihood of asymptomatic shedding?

10.   Do you need my specific lab results to help answer the above questions?

Thank you for your help as I maneuver through this most unexpected and difficult situation!

Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
18 months ago

1.      How likely is it that I can infect a partner genitally with hsv 1?

If your infection is only genital, then you passing this to someone else through intercourse is highly unlikely.  Extremely unlikely!

2.      How likely is it that I can infect a partner orally with hsv 1 if he performs oral sex?

Also extremely unlikely.  Genital HSV 1 is shed infrequently in the vast majority of people.  In addition, the majority of people in your age group are already infected with HSV 1, most often oral, and would again be extremely unlikely to acquire HSV 1 at a new location on their body.

3.      Does my likelihood of infecting a partner decrease over time?

Yes, though it is already quite low indeed

4.      Does my likelihood of infecting a partner depend on how often I have outbreaks?

Yes, people who have more outbreaks also shed with no symptoms more often

5.      Is it more difficult to transmit hsv 1 genital herpes from female to male than from male to female? 

Yes

6.      Should I take daily suppressive therapy to decrease potential outbreaks as well as potential spreading hsv 1?

That depends upon the HSV 1 status of any partners that you may have in the future.  If they are already HSV 1 positive and your outbreaks are few, then I don't see an advantage to taking daily medicine.

7.      Should I use condoms?

If your partner is truly negative (the standard IgG test misses 30% of HSV 1 infections compared to the gold standard western blot), then they may wish to use condoms for greater protection but honestly, HSV 1 is rarely shed from the genital tract.

8.     How often will I experience asymptomatic shedding?

Probably on 2% of total days

9.     Should I disclose my hsv 1 genital herpes status to future partners?

That's tougher.  If you disclose, it's not about transmission, it's about trust.  If you enter a relationship thinking it will be only casual and it turns into something more serious and you have not disclosed, trust may be an issue when you finally do disclose.

8.    If my partner has hsv 1 oral herpes what is the likelihood that he will get hsv 1 genitally?

Very close to zero.

9.    Are there any studies out there that I can participate in in regards to medications that may cure hsv 1 genital herpes or decrease the likelihood of asymptomatic shedding?

No that I am aware of

10.   Do you need my specific lab results to help answer the above questions?

Nope, I've got it, but thanks


Terri

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18 months ago

Thank you – this information is somewhat relieving.  It has spurred a few follow up questions however.

1.       1. My concern about disclosing is that any future partners may walk away once they know my hsv status. I’m not sure if it is a generational thing, but I don’t think people my age understand the specifics of the types of herpes and the risk associated with hsv 1 (I know I didn’t).  But I hear what you are saying about trust issues.  I am struggling with what to do, however if I decide not to disclose and don’t know the hsv status of my partner what would you recommend for treatment, if any? Suppressive therapy and/or condom use?

2.       2. If I begin suppressive therapy, when should I start?  Now, even though I am not in a relationship?

3.       3.  How much time does it take for the suppressive therapy medication to reduce asymptomatic shedding?

4.     4.   If I take daily suppressive therapy would my shedding rate decrease from 2%?  And if so, what percentage rate would it decrease to?

5.      5.   How often have you and Dr. Hook and Dr. Handsfield seen hsv 1 transmitted genital to genital?

6.       6.  Is it easier to infect someone oral to genital (hsv 1) than genital to genital?

7.       7.  Do you have statistics on both hsv 1 genital to genital transmission rates and oral to genital transmission rates?

8.       8.  If you have oral hsv 1 is there an increase in the percentage of shedding days compared to genital hsv 1?

I guess these last three questions above come from a place of me being infected oral to genital, yet it seems the likelihood would be low – so wondering how it happened.

Again, thank you for your expert advice – it is invaluable! 

Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
18 months ago
1. My concern about disclosing is that any future partners may walk away once they know my hsv status. I’m not sure if it is a generational thing, but I don’t think people my age understand the specifics of the types of herpes and the risk associated with hsv 1 (I know I didn’t).  But I hear what you are saying about trust issues.  I am struggling with what to do, however if I decide not to disclose and don’t know the hsv status of my partner what would you recommend for treatment, if any? Suppressive therapy and/or condom use?

Suppression and condom use would drop this concern to very close to zero, should you decide not to disclose, yes

2.       2. If I begin suppressive therapy, when should I start?  Now, even though I am not in a relationship?   Medicine should be on board for at least five days prior to intercourse for best effect.

Th

3.       3.  How much time does it take for the suppressive therapy medication to reduce asymptomatic shedding?  five days

Gi

4.     4.   If I take daily suppressive therapy would my shedding rate decrease from 2%?  And if so, what percentage rate would it decrease to?  daily therapy reduces transmission risk to about 2%

5.      5.   How often have you and Dr. Hook and Dr. Handsfield seen hsv 1 transmitted genital to genital?  I have not seen it and neither have they BUT it has been documented in the literature - rare

6.       6.  Is it easier to infect someone oral to genital (hsv 1) than genital to genital?   WE don't know that, but if someone has oral infection, I think that is easier to transmit to someone's genitals through giving oral sex than intercourse transmitting the virus

7.       7.  Do you have statistics on both hsv 1 genital to genital transmission rates and oral to genital transmission rates?  I'm sorry, we do not

8.       8.  If you have oral hsv 1 is there an increase in the percentage of shedding days compared to genital hsv 1?

Oh yes, definitely.

Terri
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