[Question #8444] Oral to genital transmission

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44 months ago
Thank you for having this site, I really appreciate it.
I have some questions regarding hsv1 oral to genital transmission.

Some context for my questions: 

I have had hsv1 for 7-8 years now, with outbreaks always appearing in my nostrils. Prior to outbreaks I feel a slight pain in the corner of my eye preceeded by numbness/a burning sensation in the nose where the outbreaks appear. These symptoms usually occur 24 hours before the outbreak.

My girlfriend has no history of cold sores as she recalls. 

This weekend i performed oral sex on her, and at the time I did not notice the pain in my eye/tenderness in nose. However, shortly after (it may have been a couple of hours, but im not sure if this already had begun when I performed the oral on her) I noticed the symptoms starting to appear. Around 24 hours later my nose turnet slightly red, with some sored appearing on the inside of the left nostril.

Im always conscious of not touching her genital area with my nose, but Ive read on your forums that shedding may still appear from the mouth even if thats not the area of outbreaks.

So:

1. if my outbreaks always are in my nose and I gave her oral slightly before or just as the pain/prodrome in my eye/nose started, and i did not touch her genitals with my nose, is it likely that I may have given her genital hsv1?

2. do prodromes increase shedding from all the possible shedding areas of the face, or could it be that the increased shedding only occured in my nose?

3. may I be in the clear since this was early in the prodrome stages and the amount of virus was still low (if i was shedding from the mouth). As I stated, the tenderness was still mostly in the corner of my eye and Ive never had any symptoms from my mouth.

4. when i notice the pain in my eye/face is the amount of virus already high in my nose?

5. is it likely that i have the virus on my lips when i have an outbreak in my nose?

Best regards from a worried guy
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Terri Warren, RN, Nurse Practitioner
44 months ago
1. if my outbreaks always are in my nose and I gave her oral slightly before or just as the pain/prodrome in my eye/nose started, and i did not touch her genitals with my nose, is it likely that I may have given her genital hsv1?
It is certainly possible that you have her genital HSV 1.  You are correct that virus can be shed from the mouth as well as the nares.  Touching her genitals with your nose is not the issue here, viral shedding from the mouth is the issue.

2. do prodromes increase shedding from all the possible shedding areas of the face, or could it be that the increased shedding only occured in my nose?
It isn't possible to know for certain if at that time there was virus shed from the nares alone or the mouth as well, but I think there is a reasonable chance virus was shed from both areas.

3. may I be in the clear since this was early in the prodrome stages and the amount of virus was still low (if i was shedding from the mouth). As I stated, the tenderness was still mostly in the corner of my eye and Ive never had any symptoms from my mouth.
You could be in the clear - it really isn't possible to know until she does or does not exhibit symptoms.  Should we assume that she tests negative for HSV 1 antibody?

4. when i notice the pain in my eye/face is the amount of virus already high in my nose?
The virus is often moving back and forth on the nerves that supply the face.  I think you are conceptualizing this as kind of an "either or" kind of thing that happens - either the virus is there is an outbreak or it isn't.  But the virus can be present on the end of the nerve even when you have no symptoms at all.

5. is it likely that i have the virus on my lips when i have an outbreak in my nose?
I would say that is likely, yes, but I cannot say for sure.

If she is indeed negative for HSV 1 and you are positive, as we know, I would suggest that you consider taking daily antiviral medication to reduce the risk of infecting her by giving her oral sex.  Have you considered that?

Terri


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44 months ago
Thank you for your answer. 

This was soon 5 days ago, and she has not experienced any symptoms yet. I've read that the incubation period is 2-10 days on your forums. If she does not get any symptoms in 10 days, should I assume that I was lucky? I feel so bad and guilty about might giving it to her.

I think she is hsv1 negative, because she has told me that she has no history of cold sores as she can recall. 

It is so typical that I learn about this after stuff like this happens. Always thought it was the infection site that was infectious, but guess I was wrong there. 

I see that you write that the virus often travels back and forth. This might be a stupid question again, but is it possible that shedding is lower in the very early prodrome stages from asymptomatic areas compared to the blister/ulcer stage?


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44 months ago
Also does duration of the oral sex matter? It was probably not more than a minute at max, probably less.
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Terri Warren, RN, Nurse Practitioner
44 months ago
I think if she doesn't get any symptoms with the next week, you are likely out of the woods, yes.  It is certainly possible that there is less virus present early in the prodromal period, yes.
The shorter the time, the less exposure, the less risk, yes. 
I'm hoping things go well for you and for her.  I know this is a challenging time and I'm glad you sought out this forum

Terri
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