[Question #9277] Oral HSV2 Question

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34 months ago
Hello experts!
Some background:I am a gay man living with HSV-2 for about 15 years I have rare but classic genital outbreaks so I know I have the HSV2 genitally. There is a very good chance that I performed oral on whoever gave me the HSV2 so possibly I have type 2 orally.

Here is my question: I was always under the impression that Oral HSV2 was a rarity and that I shouldn't really worry about it re: my partners, but then I came across this study which specifically looks at HSV2 positive gay men: 

https://academic.oup.com/jid/article/194/4/420/1040252

If I am reading the study right there is about a 34% chance that I, as a HSV2+ HIV- man has oral HSV2. The study also states that HSV2 was shed orally on 1.1% of days in men who were HIV neg. 

The study makes the point that viral load plays a part in infectivity but doesn't go into much detail. The study then ends with this:

With the availability of type-specific assays, clinicians and counselors will need to convey a more nuanced message about the natural history of these 2 viruses. Specifically, individuals who have HSV-2 infection should be informed about the possibility of asymptomatic oral HSV-2 reactivation, particularly if they are coinfected with HIV

What should I make of this statement on a practical level? Should I be telling people there is a chance I could pass my HSV2 by kissing them? Or performing oral sex on them? I know that it is my obligation to disclose when partners make contact with my genital region but should I be concerned about transmission from my mouth, given the higher incidence of oral HSV2 found in this study. Or is the viral load from the mouth not high enough to transmit?

Thanks!
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Terri Warren, RN, Nurse Practitioner
34 months ago
Given that the shedding rate of oral HSV 2 is just incredibly low, I personally do not think that you would need to disclose the fact that you MIGHT have HSV 2 oral infection.  I think most herpes expert would agree. I think it is important to note in this study that oral HSV-2 was detected on 148 (2.3%) of 6422 days, which is a really low number.   There will already be a discussion that needs to happen about your genital HSV 2 and I think it's enough to deal with that.  
While we do study viral loads (that is not in blood, like HIV, but in genital skin with and without outbreaks), in a practical application, there is simply no way for a regular person to know, at any given time, how much virus they might be giving off.  I would recommend that you not concern yourself with this particular aspect of your infection as it is never going to be possible, at a given moment, for you to know about how much virus you might be shedding.  There is no "instant" test so in reality, it has no practical implication for this question.

Terri
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