[Question #7328] HSV1

4 months ago
Hello. I’ve recently become sexually active (F45), with a male 44. We’ve discussed our sexual history in advance and I’ve always tested negative across the board for all STIs/STDs. He had been married for a long while before getting divorced over 1.5 years ago. He since then has only had 2 sexual partners but hadn’t been tested, being fairly certain he hadn’t acquired anything. 

To keep my mind at ease, I asked him to be tested to be certain, as well as myself to ensure we were both being safe. His results came back “positive“ for HSV1 (1.99 IGG), and mine came back “negative” (<0.10 IGG).  We also both tested negative for HSV 2. 

The concern I have now is my risk of exposure.  Have I already been exposed, though each time there has been no active outbreak that we’re aware of (assume yes since it’s viral, yet not sure how high the exposure). Should I get tested again in 4-6 weeks? Should we abstain from both protected and unprotected sex until this all gets sorted out?
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
4 months ago
So the IgG test for HSV 1 misses 30% of HSV 1 infections, compared to the gold standard herpes western blot (the gold standard antibody test).  Has he ever had a cold sore?  If yes, then that's why he has antibody to HSV 1.  This is also a low positive (1.99) and could be a false positive.  Have you ever had a cold sore on your lip or in your nose?  About half the population of the US has HSV 1 so I'm sure you've been exposed to HSV 1 in the past if you have kissed others. 

Terri
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Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
4 months ago
Has your partner had cold sores in the past?  That is the most likely reason that someone would be positive.  But people can also have HSV 1 genitally. A positive antibody test can tell you nothing about where one has this infection, only that they are infected.  I think sometimes when people hear the word "herpes" they think of genital infection.  But cold sores are caused by herpes simplex virus type 1, so therein lies the confusion.   About half the US population has HSV 1, so about half the people you've kissed in your lifetime have been infected with HSV 1, so have you been exposed?  yes.  Probably both in the past and currently.  Also, the IgG test that you took misses 30% of HSV 1 infections compared to the gold standard herpes western blot. 

If by chance he is infected genitally, then HSV 1 is rarely transmitted via intercourse.  Could it happen?  Yes, but very rarely.  I don't see that avoiding any type of intercourse is warranted here.  But ask him about cold sore history.

Terri
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4 months ago
Hi Terri! Thank you so much for your quick response. 

Both of us don’t recall ever having cold sores on the mouth or anywhere else for that matter. 

I fully understand that the likelihood that we both could/should have it, just  by kissing people through our lifetimes is high, and the likelihood that neither of us have it is low, but we both just wanted to be informed and safe. 

He will likely get re-tested with the western blot, and I will too. 

For me, it was just wanted to ensure we were still practicing safe sex. With HSV1 alone, it sounds as if there is no such thing, given how it spreads (kissing, sharing silverware, etc.), and transmitting it via sex is a very low likelihood. 

Anything else we may be missing or focused on? Again, this is the only thing that came up for him, and for both of us, all other STDs were of course negative. 

Thank you. 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
4 months ago
I think you are correct that if you want to kiss each other, it is not risk free.  I surely wouldn't worry about sharing silverware.  I don't think you are missing anything except your true status which I hope you will both obtain.  So what if he's positive for HSV 1 and your aren't, by western blot?

Terri
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