[Question #7288] Possible genital HSV-1

6 months ago

I have done research but struggle to understand my own situation with HSV-1.2 years ago I was dating a man (Im female) who had oral HSV-1. Later I broke out into a genital rash which looked like blisters and was itchy/painful. I was getting an abnormal amount of reoccurring UTIs / yeast infections during this time also. At clinic doctor did a swab at the time of the visible for herpes and gave me apo-valacyciover pills/ acyclovir ointment to use-which seemed to help. Yet the swab came back negative. 

Since then, 2 years later & no longer with the same partner-I am dating/wanting to protect myself/others & have had a lot of confusion with research. reading about false negative swabs and how HSV-1 and HSV-2 can be transferred to oral-genital location I got a blood test recently which came back negative for HSV-2 & positive for HSV-1. Doctor said this could be indication that the “rash” I had years ago was in fact genital HSV-1 (from oral sex with my boyfriend) but she said it could also been from yeast infection and that my positive HSV-1 read could be from when I was a child/common for people with HSV-1 to get no symptoms at all- but due to past events most likely to believe it is genital

I read about oral to genital HSV-1 transmission but not  much regarding female genital HSV-1 and transmitting it to a male partners genitals and or mouth. I even read one blog discussing work from Dr. Leone & Handsfield about how asymptotic shedding for genital HSV-1 is rare if at all, especially in regards to female genital-to male genitals or mouth
https://www.thehairpin.com/2013/11/how-i-found-out-i-didnt-have-the-herpes-id-been-living-with-for-four-years/

Do I need to be cautious to use condoms or suppressive daily therapy specifically due to my story?
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
6 months ago
I agree with your doctor that your HSV 1 positive result could be oral or genital and without a positive swab test from either location,  you cannot know the location of your infection.  I am assuming you've never had a cold sore on your lip or in your nose, is that correct?
However, given the genital rash that you describe, I too am concerned that your infection could be genital.
If you have had HSV 1 genital infection for 2 years, the average shedding rate is 4 days a year, from work from Dr. Christine Johnson at the University of Washington.  It is also my experience that genital to genital transmission through intercourse is rare - I personally have not seen a case of HSV 1 genital infection in a person who denies receiving oral sex.

Terri
---
6 months ago
Yes I have never had a cold sore on my lip but my doctor says a swab needs to happen when there are active blisters and when there was- the test came back negative (not sure how accurate this is) Worst case- if I do have genital HSV-1-I know condoms are suggested and I do use them, I just want to know in the absent of them on the odd time without or during oral if I should be paranoid or if this is something I can relax about, OR should I be taking suppressive therapy? Even tho I haven’t had reoccurring outbreaks? I haven’t read much regarding female genital HSV-1 transmitting to a male partner in either his mouth of genital area, it seems to be mostly common reads about those with cold sores on the mouth being the main transmitters in such cases, with females at higher risk- so as a female I just want to make sure I’m doing the right thing- also do not want to disclose My “on the fence” situation if I don’t need to ...
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
6 months ago
The accuracy of the test depends upon when in the course of things the swab was taken - the earlier in the outbreak, the better.  And a PCR swab is more sensitive than a culture.  If you have HSV 1 genitally, you are likely to shed virus very infrequently but not zero.  If you have a partner who does NOT have HSV 1 (half the population is infected with HSV 1), and they are concerned about transmission then suppression should be considered. If you are partner is also positive for HSV 1, suppression is probably not necessary.  Whether is disclose or not is an issue debated by experts.  I don't have a perfect answer, particularly since you don't know if your infection is oral or genital.  I would say this:  would you have wanted to know that your partner had HSV 1 before having sex with them?

Terri
---
6 months ago
If one has genital HSV-1 vs someone with Oral HSV-1 -wouldn’t disclosure be similar if it’s the same strand being discussed-just in a different location?
 Also being a heterosexual female -using daily suppression (which is what I’m leaning towards doing) In reading higher numbers in women getting genital HSV-1, v.s women with genital HSV-1 giving to male partners ...? what are the chances of a man getting HSV-1 from me (on their genitals and or mouth)? And if I say do daily medication for a year or so, does that help lessen shedding if I go off of them after a couple of years? And is there shedding while taking medication? 
I am leaning towards telling partners I have the cold sore virus but I do not feel comfortable saying it’s possibly genital if I don’t fully know/tackling such stigma has been heavy.  

Thank you Very Much Terri! 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
6 months ago
We know that oral HSV 1 is shed more often than genital HSV 1, so my personal recommendation to people with oral HSV 1 is to definitely disclose this status prior to giving oral sex, if that makes sense.
We simply don't have any data on the transmission of HSV 1.  I sure wish we did because HSV 1 is now the cause of more new infections than HSV 2 (more recurrent disease is due to HSV 2). 
Suppression only works while you are taking it.  It doesn't lessen shedding after taking it for a year or so.  However, as time goes by, people generally shed less, so simply having ayear go by might reduce viral shedding.    There can be viral shedding while on medication but the medication reduces viral shedding of HSV 2 by about 70%, so something similar is likely with HSV 1.
I think it's fine to simply say you have the cold sore virus.

Terri
---
6 months ago
Last question, 

If taking suppressive antiviral medication like apo-valacyciover-daily, you say can stop shedding by about 70% out of those already low (assuming 4 days/year)? Are these numbers based on sex with or without a condom? If I’m taking medication can I engage in sex or oral without a condom? Or would I I still need to be worried regarding transmission
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
6 months ago
I'm giving you SHEDDING rates, not transmission rates.  We do not have transmission data.  Whether you can engage in oral sex without a condom has to be your call.

Terri
---