[Question #7986] Genital HSV-1
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50 months ago
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Hello,
We've spoken before and the advice you gave me before was very helpful, although I wanted some clarification on genital hsv-1 (which I contracted oct 2018, confirmed hsv-1 antibodies through 3 tests over the past 3 years):
-Am I still contagious to others? I remember you saying it was a small risk, but how small? Are there documented cases of genital hsv1 spreading to partners years after? Obviously right after, but after 2 years you said less than 4 days of shedding per year; does other literature cite shedding/transmission later in life?)
-Does antibody-protection fade away over one's lifetime (meaning I become less protected as I age)? And if not, am I immune to oral hsv1 since it is more common than oral hsv2 (and on a sidenote, is oral hsv2 different in its symptoms or more/less contagious)?
-Since hsv1 prefers basal ganglia, should I tell casual partners there is some risk with unprotected fellatio? Or is it not worth the uncertainty/stress on them? I know this goes without saying with serious relationships, but casual encounters have been tricky due to the stigma/anxiety in others.
Thanks for your help in advance!
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Terri Warren, RN, Nurse Practitioner
50 months ago
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We really have limited information on the transmission and shedding of HSV 1 genital infection. I sure wish we had more so I could share this with you and others.
It is most likely that if you did not contract HSV 1 oral infection when you contracted HSV 1 genital infection, that you won't get HSV 1 orally. Oral HSV 2 has the same symptoms as HSV 1 oral infection but is far less common.
I think you can safely give oral sex to someone else, just being aware that we can't say with 100% certainty that you don't have oral infection. If I were in your situation, with only genital outbreak (is that true?), I wouldn't tell people I had oral herpes.
You mention that you have antibody to HSV 1 - how do you know it is genital?
Terri
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50 months ago
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Correct. I had a single genital outbreak in Oct of 2018 which is why I got tested for herpes. I had a few lesions on the penis shaft (versus the groin or skin surrounding that area). I remember testing positive for IgM herpes antibodies and negative for IgG antibodies. Three months later I went to get tested again and I tested positive for IgG herpes antibodies (although the index was only ~1.1). More recently (so over 2 years later), I was tested again and tested positive for HSV1 IgG antibodies and the index was 5.00+.
I’m not concerned about *giving* oral sex, I’m more concerned about receiving it from casual partners. Also, for serious partners, how do I describe genital HSV-1 to them? Do I say I have an STD or an STI? And would you say it’s genital herpes or “oral herpes down there”? Would you see genital HSV1 as more comparable to other infections like chickenpox/mono than other forms of herpes?
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Terri Warren, RN, Nurse Practitioner
50 months ago
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It is unlikely that a partner would acquire HSV 1 orally from giving you oral sex as HSV 1 is shed so infrequently from the genital tract.
I think you might say something like "I have the cold sore virus, but I have it genitally, not orally". It isn't really comparable to the other herpes viruses, no.
clinicians really vary about whether to disclose your genital HSV 1 infection at all, and even more variation about whether to tell casual partners. My position is that at least serious partners should be aware of your infection, yes. And as someone who gets consulted about many legal cases involving herpes, I think that is true both from an ethical and legal point of view. In some states, if you have an STI and don't disclose and someone gets infected, it's a legal matter.
I appreciate your clarifying how you know for sure you have HSV 1, thank you so much
Terri
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50 months ago
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Thank you for clarifying, that makes sense. Have you ever seen a case of someone transmitting genital HSV-1 to another person orally (or even genitally)? Are both modes of transmission equally unlikely because of the infrequency of the shedding from the genital tract? Or have you seen the transmission (if any) prefer a part of the other person's body? Also, is genital HSV-1 considered an STD or STI? And is it "genital herpes" or "oral herpes on the genital tract"? Why is there so much more stigma surrounding genital herpes than oral herpes? Aren't they both permanent? Aren't other common diseases (i.e. chickenpox, shingles, CMV, mono, etc.) also permanent?
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Terri Warren, RN, Nurse Practitioner
50 months ago
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No, I've never seen someone acquire oral HSV 1 from giving oral sex to someone else. Nor have I seen genital to genital transmission but we can't be 100% sure about that because often people receive oral sex and have intercourse at the same sexual encounter. Yes, both modes are unlikely due to infrequent genital shedding. Also, because about 1/2 the population already has HSV 1 infection. Genital HSV 1 is considered an STI, correct.
Perhaps it has more stigma because it is acquired through sexual activity rather than kissing or virus spread through air.
Terri
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