[Question #7596] Genital HSV-1

4 months ago
Hi there, I have a few interesting questions about my case of genital herpes. I caught it a little over two years ago and got an antibody test recently to confirm it. The HSV 1/2 IgG Type Specific test showed:  HSV1-5.20 index, HSV2-0.90 index (and then the IgM was negative for both, as you would hope). This, I'm assuming, means that I am positive for HSV-1 genital herpes. When I had the initial outbreak, it lasted only a couple of days after I was prescribed Valtrex. The lesions were present on the top of shaft of the penis with one or two other lesions on the opposite side of the shaft, but nothing around the pubic area, legs, scrotum, anus, etc. I have had no outbreaks since. What does this mean in terms of my transmissibility to other partners through sex (not oral sex, I understand that unless you have dental dams that's going to be an even bigger risk)? I've had this question asked to me by partners before and I don't know how to answer it. And more specifically, does viral shedding occur in areas where lesions weren't present two years ago? Even with the proper use of a condom, is it pretty much a guarantee my partners will get it over time just from the rubbing of the pelvis/pubic area? I have communicated with partners what I was once told which was that generally there will always a chance (especially when trying to have kids), but my knowledge doesn't go much beyond that. I've heard transmission and shedding of type 1 when it's genital is less frequent/common, but I just don't have an idea of whether long-term partners should pretty much expect to get it from me (meaning I should have Valtrex for them on hand just in case) or whether there's still a chance they don't have to contract it. Thank you in advance!
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
4 months ago
An antibody test that is positive for HSV 1 does not diagnose genital infection.  It simply states that you have HSV 1 infection.  You had symptoms but so difficult to know later if they were due to HSV 1.
Let's assume for a moment that you do have genital HSV 1 infection.  GSHV1 is rarely shed and when it is, it is shed from the shaft of the penis and anus in men.  It is not shed from thicker areas of skin like buttocks, thighs or belly.  And as you have experienced, recurrences are few.  I have yet to see HSV 1 transmitted through intercourse, though we cannot say that is impossible. 
If you are having sex with someone who also has HSV 1, the risk of them getting it in a new location is extremely low.
Research indicates that once you've had HSV 1 for two years, you shed virus on an average of 4 days per year, so very low also.
Please let me know what other questions you may have.

Terri Warren
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4 months ago
Thank you. 

So is it more likely for me to spread it to a partner who doesn't have herpes through oral sex (assuming I have genital HSV-1)? Also, my IgG index was rather high, should I expect that to decrease it over time? Why or why not? I heard from my doctor that for some people it lies completely dormant and is not transmissible (but I don't know whether that is common or not), so if antibodies were not to be present in 10 years (let's say), would that mean the virus is no longer active in the body?

Also, is the incubation period for genital HSV-1 any different than oral HSV-1 and both HSV-2 locations, or are they all 2-12 days (average 4)? I heard that for some people the virus can lie dormant and then crop up much later in an initial outbreak. I understand being asymptomatic is very common, however, how often is it the case where a person's incubation period is much longer than usual?

Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
4 months ago
No, it's not necessarily more like to be transmitted through oral sex.  We don't have data to show that is true (or not true).  It is just that we know more about transmission through intercourse.  And even that, we don't know fully.  I'll say that I've never diagnosed someone with a new HSV 1 infection (positive swab, a negative antibody for HSV 1) who had not received oral sex in the past two weeks.  That isn't a guarantee that it wasn't passed through intercourse, but it seems very unlikely, given how infrequently HSV 1 is shed from the genital tract and how often it is shed from the mouth.  Does that make sense?

Your index value simply represents a well-established infection to which your immune system has produced a robust immune response.  That's all.  You want it high.  It says your immune system is working well, that's all it says.  

The incubation period from infection to symptoms is the same for both viruses.  And not everyone does get symptoms when they are infected and may have a first outbreak years later.  It isn't that the incubation period is longer, it's that they didn't have symptoms when they were first infected OR they missed the symptoms OR interpreted them as something else entirely

Terri
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4 months ago
That's very helpful, thank you.

So with genital hsv-1, when it comes to notifying our long-term partners about the possible risks of them contracting it from us, especially down the line if we're tying to have kids (so unprotected sex), as long as I'm not having an active outbreak (which I haven't had since the initial one) and we avoid oral sex, should they be okay? Or is oral sex not necessary to be avoided with genital hsv-1 because of the low transmission rate? 

I've always wanted my partners to know the risks before intercourse, but I notice that typically when I notify them that it is herpes we tend to both treat it (transmission + symptoms) like HSV-2; the whole notion of "herpes" holds a lot of baggage in general and isn't always easy to communicate. Despite what you've said about genital hsv-1's low rate of transmission, the fact that I've been notifying partners isn't unnecessary, right?

And on another interesting side note - something I've always wondered is, how common is oral HSV-2? Having HSV-1 antibodies has created slightly less fear from me about contracting oral herpes from partners, however, I'm aware I still can get HSV-2 orally and genitally (which is also the form of herpes with worse and more frequent symptoms and which can increase your odds of contracting HIV from others while you have open lesions, right?), so although common sense is that you should never kiss someone with active cold sores, HSV-2 can be spread asymptotically, even orally right? There are a lot of herpes-dating sites where people are transparent about their type and body-location of herpes, so if my partner has oral HSV-2 should I be precautious going into that relationship? (I know this is an oddly specific question but you'd be surprised at how common I've seen this question online!).

Thanks again for your very straightforward/practical answers!

Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
4 months ago
I don't think you need to avoid oral sex. 
The thing is, at some point, notifying longer-term partners about your HSV 1 status, is more about trust than transmission, in my opinion.
Oral HSV 2 is quite uncommon but you are correct that HSV 2 can be transmitted when there are no symptoms. 
In 35 years of practice, I diagnosed oral HSV 2 in perhaps 5 patients.

Terri
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