[Question #6959] HSV-1 risk ?

10 months ago
Hello,

Few years ago I had oral sex (oral-penile) with condom from an escort girl. As I did not know about herpes at the time I didn't actively look if she had any sign on her mouth, so I am wondering what if she is HSV-1 positive and had an outbreak that day ?  As I have some doubts about the risk I took, I would like to ask you the following question please :

Assuming she had an outbreak that day, what would be the % risk of transmission of HSV-1 from oral sex with condom ?

For information please note I surely do not have oral HSV-1 myself as I never had any sores nor anyone in my relatives did and I was never at risk, and I am European living in Europe.

Thanks a lot.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
10 months ago
I read over Dr. Hook's response to your previous posts with this concern.  I simply couldn't agree more with everything that he said to you.
I think there is less than one in a million chance that you acquired HSV 1 by receiving oral sex while using a condom.
First of all, the condom was definitely your friend in this situation.  It is likely that even IF she had oral herpes (which we don't know) and even IF she was having an outbreak at the time of the contact (which we don't know) or even IF she had a history of cold sores but was only shedding virus without symptoms at the time of the encounter, the condom would protect you from infection. 
But even without a condom, you don't know if she has oral herpes (and I don't know the statistics about HSV 1 infection where you are, so I can't help you with that question).  People with oral herpes don't give off virus every day, so even if somehow the condom broke or came off (which you don't report), the chance of you acquiring HSV 1 on a single encounter, is very very low. 
But there WAS a condom used and you've had no herpes outbreak, I am guessing, or you would have said so.  And this was years ago.
Clearly, this experience has made a huge impact on your life, that you are still thinking about it years later.  I'm so sorry that this continues to be a worry for you.  But I can tell you, as a herpes expert, I see no risk in this situation for acquiring HSV 1 genitally.  I just really don't.  In 35 years of practice, specializing in both oral and genital herpes, I have never once seen a case of acquiring genital HSV 1 by someone who received oral sex while using a condom
So great job with using a condom for oral sex - not everyone does - but I want you to tell totally relieved that this was not a risky event.

Terri

---
10 months ago
Thank you for your answer.

I am in France and here statistics are about 15% of people have oral herpes. But would that statistic apply for escort girls as well, because I am thinking since they meet many people they must be at higher risk?
Also I remember she did not want to kiss me in the mouth, this could be for a few reasons - I am thinking one reason is that she did not want to transmit herpes because she had it, that is why I made the hypothesis that she may have had an outbreak that day.
Also I did not pay attention while she was performing the act, it was brief for maybe 1 or 2 minutes and I have no idea if the condom broke or came off as I was not looking. Is this something that happens often with people (condom breaking or coming off) ?
And it is true I have not had symptoms but I read most people are asymptomatic. But I would like to ask you, because it is true I have been anxious about this subject, wouldn't have stress caused an outbreak or is there no relation? I developped nervous itching (I itch when anxious as doctors told me), aren't I likely to develop symptoms if I had herpes or are there other reasons why people are asymptomatic?
Also, do people who have genital HSV-1 transmit it by shedding the virus without symptoms? I mean if I was at risk and I had it without knowing, could I transmit it to my partner?

Thank you very much for your time and sorry for these detailed questions.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
10 months ago
So if 15% of people in France have HSV 1, then there is an 85% chance that this person did not, correct?  And actually, I would say that escorts are no more likely to have HSV 1 than are the normal population.  You said she didn't want to kiss you, correct?  In my experience with commercial sex workers, they often find that kissing is just too intimate.  Way more intimate, in some ways, then intercourse or giving oral sex.  Did you watch Pretty Woman?  If not, you should.  It's in there! 
If the condom had broken or come off, I feel certain that you would have noticed that when you went to take it off.
While it is true that many people with HSV 1 are asymptomatic, the proportion of people who have symptoms that they recognize is higher than with HSV 2, for example.  And we know from studies of HSV 2, that people who are asymptomatic with their infection, shed less virus than those who do have recognized symptoms, in fact, shedding is about half as frequent in asymptomatic people are those who experience symptoms.  It is possible that if you were infected and you had stress, that could be related to more outbreaks, yes.
People who have genital HSV 1 (which is what you are afraid of), after two years of being infected, shed virus on about 4 days a year, on average.  So a very low number of days that one could shed virus. 
So let's recap - only a 15% chance that she had oral herpes to start with (low) and then she had no symptoms that you noticed (so low again) and she only gave you oral sex for 1 or 2 minutes (very very brief indeed so low), you have had no symptoms (low) and you used a condom (so super low).  When you add all of these up, I think you must come to the conclusion that you were not infected with HSV 1 at this encounter.  It is definitely time to let this go.  You are reaching and reaching for the "what if......" but you've simply worried too long about things that didn't happen.  I hope you can let this go.

Terri

---