[Question #72] Transmission of HSV-1

39 months ago
I am a female infected with HSV-1 in the genital region.  I am asymptomatic and have never experienced a real outbreak.  Shortly after I was infected, I experienced the very slight beginnings of sores but I immediately began taking Valtrex and they disappeared quickly without ever developing fully.  Since that time (8 months ago) I have experienced no other symptoms.  I also have not had any sexual partners.  My question is what is the likelihood that I will transmit the virus to a partner give the following factors:

- I am asymptomatic.
- My partner would be male.
- I am infected with HSV-1, not HSV-2.
- Condoms would be used.
- I have Valtrex refills that I could take during and around the time when intercourse takes place.

Thank you in advance for your response.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
39 months ago
HSV 1 is less infectious genitally than HSV 2.  But as with HSV 2, HSV 1 can be transmitted when no symptoms are present, bummer, I know. 
If your partner already has any history of cold sores, they are extremely unlikely to acquire HSV 1 genitally, through sex with you.  Or even they test positive on an antibody test for HSV 1 the same.  With condoms AND daily antiviral therapy AND no sex with symptoms, I think the chances of transmitting this through sex is really low - likely less than 1% per year, with sex about twice a week.  You should either take medicine daily OR for five days prior to sex. 

Please let me know if you have other questions, OK?

Terri
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39 months ago
Hi Terri,

Thank you for your speedy response and for the useful information!  I do have a follow up question-- are there any other measures I could be taking to prevent transmission outside of the ones already mentioned?
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
39 months ago
The other important factor here is discloser to your partner.  That turns out to be important in reduction of transmission.  And in your situation, you can safely have sex with people who are also infected with HSV 1, regardless of where their HSV 1 infection is.  If you are asking about supplements or diet, we just don't have any data supporting any of those interventions.  HSV 1 genital infection is difficult because it is so much less infectious through intercourse than HSV 2 but people tend to feel stigmatized just as though they have HSV 2 since the infection is genital. 

May I ask if you are asymptomatic, how do you know that you have HSV 1 genitally?

Terri
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39 months ago
I know that I am infected because not long after I was exposed I developed the very slight beginnings of sores.  They were barely detectable (tiny little red bumps that were not filled with fluid and didn't cause much pain).  I went to the doctor a few hours after they appeared.  That same day I began taking Valtrex and within a few days all symptoms were gone and have never reappeared.  When my lab results came back they confirmed that it was HSV-1.

I would also never dream of failing to disclose this to a potential partner.  I find that highly unethical, and the fact that disclosure correlates with lower transmission is just another good reason to disclose.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
39 months ago
I know we are at the limit of our questions but I think this is important enough to continue this discussion.  When you said your lab test came back positive - was that a swab test from the concerning area or an antibody blood test?  A swab test would be reliable in terms of identifying where you infection is but the antibody test is not definitive as to location and the fact that the symptoms went away with Valtrex is also not definitive as to this being herpes.  Can you clarify for me please?
Terri
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39 months ago
Yes, it was a swab test.  It was recommended that I not get the blood antibody test because it was too early on in the infection.  I take that to mean that my diagnosis is definitive?
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
39 months ago
Yes, a swab test from a lesions should be considered a definitive diagnosis.  Sure wish I had better news for you, but HSV 1 genitally usually is not a significant medical problem, at least.
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