[Question #6894] Oral + genital HSV1

9 months ago
I have had cold sores since I was young and have relatively frequent outbreaks (every few months)- I also have a pre-existing skin condition which I think is why I have them so frequently. I was also diagnosed with ghsv1 a few years ago and only had the one initial outbreak in that location. I would like to know :
1) how does virus shedding work- if I have an oral outbreak on my lips, does that mean that I am also asymptomatically shedding the virus from the genital area at the same time?? Or most likely it only sheds from the location with the outbreak?
2) I understand the virus sheds asymptomatically 1.3% after 2 years in the genital area but does this apply to me if I get cold sores frequently? As I said, I only had the one primary outbreak there. 
3) Are there any studies/sources for cases with infections at both sites? Anything that could help?
4) If my partner already gets cold sores and has antibodies for it, if I have an active outbreak, can we have unprotected sex without the partner then getting it 'down there'? Have you heard of such cases? 
5) How much do condoms protect in case of asymptomatic shedding ?
Please help, I am extremely anxious about this.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
9 months ago
First, it is quite unusual to acquire HSV 1 genitally after having it orally for so many years.  How exactly were you diagnosed with genital HSV 1?
Studies have shown that when people have an outbreak in one location, shedding is also possible and more likely at a second location.  If immune suppression of some kind is allowing the herpes virus out, it can come in more than one place at a time
If you have oral herpes, you didn't have a primary outbreak on the penis.  The terminology doesn't' work quite that way.  If you do indeed have HSV 1 in both locations, then you are going to shed far less in the genital area as the virus has a pretty strong site preference for the oral area and will shed there far more often than a genital site.
Once you have HSV 1 in one location, it is highly unlikely that one would get it in a new location.  It seems to have happened to you, but I have seen it happen only once in my practice and heard about here on one other location, so it is rare indeed.
Yes, condoms protect against asymptomatic shedding transmission.