[Question #7795] Did I give GHSV-1 to myself?

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52 months ago

Last month I had sex with a new partner (including oral and vaginal penetration) and 5 days later developed painful lesions/ulcers on my anus and vagina. I was diagnosed by swab with HSV1 and began valacyclovir for 10 days. Symptoms were aligned with a classic primary outbreak. 


Neither of us had any kind of cold sores, outbreaks or lesions at the time, but I did cut myself shaving before having sex. Partner has never had a cold sore or any bumps/blisters anything on his penis in his life, and to his knowledge hasn’t been with anyone who has had a cold sore, or who has developed these symptoms after sex.


I thought I had cold sores orally since a teen, so at first we assumed that I must have given HSV1 to myself during our encounter by my saliva being so present in the area of my cut. But upon learning how rare it is to be infected twice, I came to suspect that I have never had a cold sore and that I actually have recurring Angular Cheilitis (as my experience has been 1-2 times per year, mild cuts in the corner of my mouth that went away within a week- never blisters and it’s never left the corners of my mouth). I had an IgG antibody test about 2 weeks from infection and tested negative for HSV1 (indicating that this is a new infection and perhaps I am correct that I’ve never had a cold sore). 


I have heard though that if you get cold sores infrequently your antibodies can disappear over time and you could test negative.


In any case, my understanding is that I’ve developed GHSV1 under extremely rare circumstances. My partner can’t get a blood test until 6-8weeks from our encounter, and he still has no symptoms at all and has been examined by a doctor.


My question is, in your opinion, which scenario of transmission is more likely?


A) even though I didn’t have a cold sore when we had sex, my own saliva is the source of this infection? In that case it would mean I do in fact have a history of cold sores, but because my last “outbreak” was 8 months ago, plus I was on antivirals at the time of the test, the blood test showed negative?


B)  my partner has transmitted it to me asymptomatically, and all his partners before were also asymptomatic


I appreciate any insight or stats you can offer on this situation, as on Google there is so much conflicting info.

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Terri Warren, RN, Nurse Practitioner
52 months ago
The far more likely scenario is that your partner has HSV 1, probably doesn't know it, and gave you HSV 1 by giving you oral sex.  Your previous symptoms do sound like angular chelitis, yes. 
It is slightly confusing because the IgG test misses 30% of HSV 1 infections, but aside from that, I still think the odds are 98% or higher that you got it from your partner.  While I have seen people get HSV 1 in a new location, it's been only once as a clinician and once someone told me it happened to them online.  However, at least in the case in person, their history was a bit sketchy, and slightly like yours - thought I had HSV 1 as a teen, cracks in the corner of the mouth only. 
The thing you are talking about where you lose antibody is called seroreversion.  It happens rarely, never with the western blot, only with the IgG test.  The virus is still active, even if you don't get outbreaks and the immune system continues to  respond.

Terri
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52 months ago
Okay, so to summarize- your opinion is that regardless of the results of the igG test, it is still much more likely that I didn’t give this to myself and that I contracted this from an asymptomatic partner via oral sex.

What are the chances that this was dormant in my body from a previous asymptomatic partner, rather than from this new partner (and the outbreak was triggered by sex, stress and high arginine collagen I just started using).  Are there any stats on dormancy/delayed primary outbreaks?
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Terri Warren, RN, Nurse Practitioner
52 months ago
Your first sentence is correct, yes.
we can't tell you that.  The only way to know the answer to that is to have a herpes antibody test right after the outbreak.  If you were antibody negative and swab test positive, that suggests a new infection.  However, that is complicated by the fact that the traditional IgG test misses 30% of HSV 1 infections compared to the gold standard western blot.

Terri
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52 months ago
Thank you for clarifying. That’s exactly why I pushed for the antibody test, when I did. 

What does someone with HSV1 need to know in terms of viral shedding/transmitting to others? I need to know specifically for these scenarios:

A) does someone with asymptomatic oral HSV1 need to worry about kissing their child/sharing drinks. 

B) With either oral/genital (asymptomatic) HSV1, if in close contact like wrestling/professional fighting would they need to worry about their saliva, sweat from the affected area or blood transferring it?)

C) I have read that GHSV1 is rarely shed ( <6 months = 13%, > 6 months = 7%, after 2 years = 4 days out of the year, and so transmission to a discordant partner is rare even without condoms/dental dams?

Thank you so much, this is all very helpful and I appreciate your time and thoughtful insight.
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Terri Warren, RN, Nurse Practitioner
52 months ago
A) does someone with asymptomatic oral HSV1 need to worry about kissing their child/sharing drinks.
I thought your infection was genital.  But in answer to your question, kissing a child without a cold sore should be OK as should sharing drinks - not with a cold sore but otherwise, extremely low risk

B) With either oral/genital (asymptomatic) HSV1, if in close contact like wrestling/professional fighting would they need to worry about their saliva, sweat from the affected area or blood transferring it
Generally, if someone is asymptomatic, herpes gladitoroium (wrestlers) is not an issue.  And certainly not a worry from their sweat or blood

C) I have read that GHSV1 is rarely shed ( <6 months = 13%, > 6 months = 7%, after 2 years = 4 days out of the year, and so transmission to a discordant partner is rare even without condoms/dental dams?

Correct

Terri
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