[Question #8996] Genital HSV-1 and menstrual period

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37 months ago

I have a primary genital HSV-1 infection, discovered through a severe first outbreak on June 18 2022, following sexual intercourse with a known partner who had a small cold sore on his lips and ignored it. I am on birth control and coincidentally, when the symptoms appeared I was also on my last two days of that month’s pill. Meaning, I stopped the pill on Tuesday, and then on Thursday I had prodrome symptoms together with my period. Friday I couldn’t walk anymore from the itch/burning/pain and Saturday a gyn-clinic clinically diagnosed me with Herpes. 

I am now about to get my period again, and I have a persistent itch (which is not Bacterial Vaginosis or Yeast infection because I tested for it) -- So I am wondering: is it possible that genital HSV-1 flare ups be triggered by menstrual periods like for genital HSV-2, or not because generally people with genital HSV-1 have one or less recurrences per year?

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37 months ago
Hi experts, 
Just wanted to say thanks in advance and add a bit of background. I'm 31, I'm originally from Italy here on a visa, and I am terrified by this news. My genital HSV-1 hasn't been confirmed by a test yet, and I'm at a loss because my insurance in New York is not accepted by many providers, so I haven't found someone that could counsel me properly yet. What happened:

- I didn't have sex in over 1.5 years.
- I had sex with a dear friend (male) I had known for four years on Monday June 13. During the encounter he took off the condom (which I asked for) without letting me know. 
- Afterwards he said he had a little cut on his mouth but it was only a pimple.  I trusted him but I should have known better. 
- I stopped the birth control pill as supposed to, and Thursday 16 , when my period started, an itch started as well. 
- Friday 17 the swelling, itching and burning was so painful that I could hardly walk. I waited for the NY Walk-In Gyn Care to open the next day.
- Saturday 18 the Gyn Care doctor looked at me and said it was herpes. They swabbed me and drew blood. The antibodies igg test came back negative. The dna test didn't come back as they didn't swab me properly and couldn't establish the type. I wasn't told anything about the disease, what to expect, what to do, how to control pain.
- Sunday 19, I was so in pain and in panic (it felt like it was expanding mostly inside, but also on either sides), that I called 911 and went to the Presbyterian's ER. They gave me antibiotics and anxiety meds,  confirmed it was herpes and told me to keep taking valacyclovir. They did not swab me to see the type. In all of this my "friend" left me alone and walked away.
- On Monday June 27 I went to the Walk-In Gyn clinic again. They said the lesions were gone, but I was positive to Bacterial Vaginosis and Yeast Infection. 
- In the meantime, On July 5th, I find out that my "friend" was positive to HSV-1. 

I have educated myself as much as I could, Planned Parenthood, CDC, ASHA, the webinar you did on May 18th, but I am still afraid about what to expect moving forward. I don't know what this persistent itch (if it's not bacterial or candida, it must be the herpes no?)... I haven't felt good down there in 5 weeks and  I don't understand how I can I have a normal sex life again. I am emotionally exhausted by all of this and I don't know how to get through another outbreak if it comes this weekend. I do have valacyclovir 1GM at home, and I took 3 pills daily  already. 
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Terri Warren, RN, Nurse Practitioner
37 months ago
So are you saying that your partner is positive ONLY for HSV 1 via blood antibody test?  If that is the case, then yes, your genital infection, if from him, would be HSV 1.  I am assuming he was the giver of oral sex to you?
HSV 1 genital infection, after the first year or so, is usually quiet.  It recurs rarely, shed rarely, and is rarely transmitted through intercourse.  
The itch is unlikely to have to do with HSV 1 at this point, because you are a month out from the new infection.  Have you tried any topical yeast medication, for example?
If you were given antibiotics (what for?) then it is very likely that the itching does have to do with yeast, as you mentioned as part of your diagnosis.  Treating this appropriately will likely reduce the itching a lot.  
Future outbreaks will be few and far between and will be much milder in their presentation.   This disease is very unlike HSV 2 genital infeciton.

Terri
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37 months ago
Hi Terri, thanks so much for getting back.

Yes, he was positive ONLY for HSV 1 via blood antibody test, and yes he performed oral sex on me.  
I know the blame-game is discouraged -- but I didn't have a sex encounter in over 1.5 years and my antibodies are still not present. I know I have to wait for my antibodies to show up to confirm but.... Who else if not him?

I understand that genital HSV-1 is rarely transmitted through intercourse, but what about oral sex? If a future partner doesn't have HSV-1 on their mouth, can I still be receiving oral sex without being worried that I'll infect them on their mouth area?

They gave me antibiotics at the hospital to prevent any other STD ( I think ). I did take 2 pills of fluconazole, and yet the itching persists. ButI haven't tried any topical cream so I'll give it a shot. 


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Terri Warren, RN, Nurse Practitioner
37 months ago
Genital HSV 1 can definitely be transmitted via receiving oral sex.  And the timing suggests your partner in June is the source of your infection.  
HSV 1 is also rarely transmitted to someone who gives you oral sex because HSV 1 genitally is rarely given off from your body, particularly after you've been infected for about 6-12 months.  

Terri
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36 months ago
Thanks Terri, 
I am so grateful to have found you and for all I have learned. If you are able to answer, these are my additional doubts:

1. Do you have recommendations for Labs where I can go get my blood drawn in New York City? Or alternatively in New Jersey? I want to book a video consult + Western Blot with you later in September, and wanted to get an estimate of the fees for drawing/shipping blood.

2. Could you confirm if these statements are correct in reference to Genital HSV-1?

A)  According to Dr. Christine Johnson's latest presentation, Genital HSV-1 shedding at 3 months out is 7% (or 25 days in a year right?) and at 2 years 1.3%  (4-5 days in a year). 


B)  As per statistics on transmission rates, there are none in relation to genital HSV-1. What we have is in relation to genital HSV2; from positive female to male that would be a transmission rate of 4% if no preventive measure is taken ( 4 uninfected men out of a 100 would get it). 2% if Condoms or meds are taken. 1% if both condoms & meds are taken. Can we can infer that for HSV-1 the transmission rate is lower?



3) On disclosure:

I am with you that disclosure in the case of GHSV1 is less about transmission and more about trust, and I understand that's an individual call. But then I wonder: oral sex is sex, so why don't professionals call oral herpes an STI? It's absolutely enraging that the few percentage of people who experience a genital outbreak have to carry the social and emotional burden of the diagnosis, while those who are aware they have oral HSV-1 (half the country) spread it around freely because they get to call it "cold sores", and therefore held to a different moral standard. 

It's outright unfair and makes makes me feel less inclined to disclose my genital HSV-1 status in a one-night stand situation (given 3 months will have gone by, no symptoms are shown, and condom/dental dam is properly used). Rant aside, my question here would be: 

Isn't it less likely that as a female genital HSV1 positive, I could pass on HSV-1 to a partner's oral or genital area, than it is for someone with Oral HSV-1 (with or without an outbreak) to pass it to a negative partner's genitals?


Thank you, and looking forward to meeting you one day.






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Terri Warren, RN, Nurse Practitioner
36 months ago
Enzo labs will be working with us within the next week and when we are working together, you can go to any of those labs to have your blood drawn for the blot.
2.  That is all correct.
3.  I agree with you.  It is way more likely that someone with a history of cold sores would infect someone by giving them oral sex than you would be, giving HSV 1 to someone through intercourse or through receiving oral sex.
I think in a one night stand situation, everyone who doesn't ask about an STI or requires proof of negative tests is taking a chance.  Including someone having sex with you.  However, I would encourage you to have your partners wear condoms (if they are male) to avoid being infected with other things.

Terri
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