[Question #6106] Genital HSV-1 Transmission Likelihood

19 months ago
My college-aged daughter was diagnosed with Genital HSV-1. She is trying to figure out what her approach should be about disclosing this in different situations. She doesn't want to risk infecting anyone and at the same time wants to try to live as normal a life as possible. It sounds from Dr Handsfield's video like if she doesnt have a current outbreak (she's only had one) and she uses a condom and if she is with someone who has had cold sores at some point, that the odds of transmission genitially are extremely low, is that accurate? I realize nobody can calculate precise odds, but would this combination of factors nearly eliminate the risk of transmission (condoms+someone who has had cold sores+no outbreak) or is that over-stating it? Any advice since of course having a herpes conversation early in a relationship is clearly not ideal but at the same time she would never want to risk passing the virus on.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
19 months ago
That is accurate.  If she is with someone who already has HSV 1, either genitally or orally, there is very little chance that someone would acquire this in a new location.  And if she has sex with someone who is truly uninfected with HSV 1 at any location, and they use condoms, the risks of transmission are very low indeed, probably less than 2% having sex twice a week.  Also, once she has had HSV 1 genitally for 2 years, she will only shed virus on about 4 days out of the year, so very very little opportunity for transmission.  With new infection, she is shedding about 13 days out of 100, when she is about 6 months into the infection, that rate is cut in half.  Then way further down at 2 years.  She may wish to ask future partners if they have ever had a cold sore on their lip as a way to start the conversation.  And not everyone suggests that people need to disclose their HSV 1 genital infection.  With new infection, like she has, I still fall on the side of disclosure.

Terri
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19 months ago
Thanks. These numbers are very helpful. can I ask, when you say "probably less than 2% having sex twice a week" do you mean 2% each time she has sex or 2% chance over time...meaning for example in an ongoing relationship the chances after a year would be 2%.. or does it mutliply times the # of times they have sex?  thx!
19 months ago
also in her situation would taking valtrex reduce her transmission likelihood more or is that not appropriate for HSV-1?
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
19 months ago
Valtrex is certainly appropriate to reduce the risk of transmission, with either HSV 1 or HSV 2.  It is probably less necessary with HSV 1 since is it not anywhere near as active genitally as HSV 2. 
The 2% is if there were 100 people in her situation with genital HSV 1, having sex with a person who is uninfected, 1 or 2 out of 100 would become infected, having intercourse twice a week.  That number  will be much lower, once she has had HSV 1 for a while.  I hope you can reassure her that this infection is quite benign so she should try hard not to get caught up in the stigma.

Terri
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