[Question #7287] Genital Herpes

4 months ago

Hello,

I got genital herpes over 27 years ago when I was 21 or 22 years old I'm now 50. My boyfriend at the time had a cold sore and we had oral sex. Therefore, I'm assuming I have HSV 1 on my genital rather than HSV2, correct? If so, since I've had it for so long what are my chances of asymptomatic shedding and viral shedding? I read that over time transmission decreases and HSV 1 is less likely to shed than HSV2.


Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
4 months ago
Did you and your boyfriend at the time also have intercourse?  If the answer is yes, you cannot know if you have genital HSV 1 or HSV 2.  In your situation, I would strongly advise that you obtain a herpes antibody test for HSV 1 and 2 to determine the type of infection that you have.  You are correct that HSV 2 sheds far more often than HSV 1 when it is in the genital area.  I am assuming you had a swab test that was positive but no typed, is that correct?  What has your recurrence pattern been like?

Terri
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4 months ago
No, we didn't have intercourse. So, does that mean I have HSV 1 on the genital area? I don't remember being told which type. My recurrence has been very little maybe once or twice a year if that. Since it's been over 27 years and if it's HSV 1 what do you think my chances of asymptomatic and viral shedding? I always keep Acyclovir 400 MG on hand just in case I need it. Do you think I should take it daily? If so, is it safe to take one tablet once a day without any side effects like for example can it affect your kidneys?
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
4 months ago
If you have HSV 1 infection, you are likely shedding quite infrequently.  Generally, people who have been infected for 2 years or more, shed virus on about 4 days a year.  But if you are having outbreaks 1-2 times per year, you are likely shedding more than that.  The dose for suppression is 400 mg twice a day of acyclovir or 500 once a day of valacyclovir.  There is really no need to take daily antiviral medicine unless  1) you are having sex with a person who doesn't have HSV 1 and is concerned about transmission or 2) the number of outbreaks you are having per year bothers you.  It is certainly safe to take suppression daily.

Terri
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4 months ago
It’s been so long I believe it may be once a year that I had a breakout I’m just guessing1 or 2. I’m going to start keeping track, but it’s not often.  I think I have HSV1 because that’s when I was diagnosed after I had oral sex.  If I have HSV1 and I’m shedding less infrequently you think I still may be shedding  more than 4 times a year? Since I had it for over 27 years does that decrease my chances as well? 
4 months ago
Sorry I meant to say 4 days a year not 4 times a year. 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
4 months ago
Yes, I think if you have one outbreak per year, you are shedding more often than 4 days a year because an outbreak itself probably lasts longer than that.
Since you don't know for sure if you have HSV 1 or HSV 2, if you were my patient, I would suggest that you get an antibody test and find out for sure.  After 27 years, the very typical person with HSV 1 might not be having that many outbreaks.  That's a generalization for sure - there is a wide variation between people, but I would recommend an antibody test to find out for certain.  If you had ever had intercourse in your life prior to that oral sex exposure, then the test would help clarify your status.  If you have never had intercourse prior to that, testing is less important for sure.

Terri
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4 months ago

Hi Terri,

No, I haven't had intercourse prior to that oral sex exposure.  I believe I reached my limit for questions, so thank you so much for all your help.

4 months ago
Or, I'm I allowed one more question? I was reading some of the past questions about HSV1 on the genitals and it seems as though HSV1 is much more milder than HSV2  as far as recurrences and transmission.  Is HSV1 on the genitals less likely to recur or be transmitted through intercourse especially if you had it for 2 years or more like me over 20 years? I guess HSV1 reacts differently than HSV2 once it's on the genital area.
4 months ago

Hi Terri,

I hope all is well. I just had another question and I haven't heard back, so I'm just checking in.


Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
4 months ago
Yes, you had reached your max but I'll answer:  HSV 1 genital infection is less likely to recur and far less likely to be transmitted via intercourse.

Terri
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