[Question #7662] Discordant GHSV-1 Couple Sexual Intercourse Next Step

54 months ago

Me 21/M

Ptnr 21/F, GHSV-1

Ptnr initial outbreak (extreme) in Dec 19. A doc diagnosed it as herpes and gave her acyclovir, though did not swab. A week before, her ex had redness on his genitals before having sex w/o condom. Due to proximity b/w events, we assume he gave to her. Since the initial outbreak, she had outbreaks in Feb 20 (medium, lesions on sides), May 20 (no lesions, prodrome tingle) and a Jan 21 (2 tiny lesions, prodrome tingle). She started acyclovir (400mg, x2 a day) in Dec 20, and stopped over Christmas when apart (triggered outbreak?).

IGG tests: I came up as -ve HSV-1 (val: 0.11) & HSV-2 (0.5). She was +ve HSV-1 (41.2 diff scale?) and - for HSV-2 (val: 4.3). This concludes she has GHSV-1.

My ptnr insists that her ex did not perform oral sex. The last time she had oral sex was months prior.

We haven’t had sex yet, but want to. I suffer from sexual anxiety and my Qs are:

· As GHSV-1 is rare to transmit G-to-G, do you think that it was transmitted to her in this way? If it was, should I worry about G-to-G transmission from her?

· Chance of transmission in our case specifically? Ie: She has had GHSV-1 for just over a year, has had 3 outbreaks, if I always use a condom and she remains on acyclovir etc.? Is acyclovir the best drug for her HSV-1? How effective are condoms in protecting an uninfected man from a GHSV-1 woman?

· Is there anything else that we can do to protect ourselves? Can more pubic hair help prevent transmission? Should she take lysine?

Terri Warren, RN, Nurse Practitioner

54 months ago

Redness on his genital is not a herpes presentation alone.

Genital to genital transmission of HSV 1 is really rare, I would be very surprised if that happened.

So no swab testing was done with any of the above-described outbreaks? It should be so you know exactly what is going on here. No question she has HSV 1 but it doesn't say where.

· As GHSV-1 is rare to transmit G-to-G, do you think that it was transmitted to her in this way? If it was, should I worry about G-to-G transmission from her?

I think it is unlikely that it was transmitted in this way but not impossible.

We don't have condom use data on transmission of hSV 1, but if we can extrapolate from HSV 2 data, it reduces transmission of HSV 1 by 65%. I would say since HSV 1 is so rarely shed from the genitals, the percentage of protection is far higher

· Is there anything else that we can do to protect ourselves? Can more pubic hair help prevent transmission? Should she take lysine?

More pubic hair won't help. And Lysine probably won't either.

She needs a swab test at the very start of the next outbreak to confirm her symptoms are HSV 1 genital infection

I think using condoms and her taking antiviral medicine (if using acyclovir, the dose is 400 mg twice a day or using valtrex it is 500 mg once a day), transmission to you is really unlikely. Also, the IgG test for HSV 1 misses 30% of infection compared to the gold standard western blot so you may already have HSV 1 and the test isn't picking it up.

Terri

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54 months ago

Thank you very much for your reply, Terri - I have read a lot of your information online.

Regarding the genital to genital transmission, I also think it sounds unlikely. No swab testing was done on the initial outbreak, and subsequent outbreaks have been so short that she hasn't had a chance to have one of the tiny lesions swabbed etc. In any case, she has never had a cold-sore or any oral symptoms as far as she is aware, so GHSV-1 seems like a sure diagnosis?

I also have never had a cold-sore even in childhood, and never had any genital signs either so I believe my results of not having HSV-1 at all. I know the western blot is the gold standard but we are both in the UK and therefore not too much of an option for us. (When I did my IGG I semi-hoped it would come up positive for HSV-1 as it would have made things convenient!)

I have also come to the conclusion that transmission is really unlikely. Would you be able to put a best guess at my percentage/quantitative risk? I think it is less than 1%, am I correct in saying that?

Terri Warren, RN, Nurse Practitioner

54 months ago

HSV 1 and HSV 2 outbreaks last essentially the same amount of time, so the outbreak being short is not definitive in any way, if she was thinking that to be true.

I would say the risk of you acquiring this through intercourse is probably around 1% without any intervention so, with condoms and antiviral medications, it's likely lower.

Terri

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54 months ago

Thanks again Terri. I think that you may have misread my point about my partner's HSV-1. Essentially, her outbreaks are so short and so small that she doesn't have time to get one of the tiny lesion/bumps swabbed before it scabs over/disappears (which I then have read makes a swab very inaccurate). Also her initial outbreak was extremely bad and classic to the point that a Doctor visually confirmed it was herpes - we have read that initial GHSV-1 outbreaks are usually very bad in this way, so we're both confident it is GHSV-1 at this point. She must have got it from a previous partner before her ex who performed oral sex on her.

Finally - thank you for saying the risk is less than 1%. Can you quantify that risk? Is it 1% risk per year? Or 1% risk per sexual occurrence?

Thanks so much!

Terri Warren, RN, Nurse Practitioner

54 months ago

Sorry, I can't quantify any further than an educated guess of perhaps 1% per year. We just don't have data on this question specifically and I hate to guess about things we don't know enough about.

Terri

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54 months ago

Thank you for your replies and information - my mind is at rest now and I can enjoy the sexual relationship safe in the comfort that transmission is extremely unlikely :))