[Question #989] HSV1 asymptomatic transmission and during pregnancy

97 months ago

History: 38 years old & have oral HSV 1 since the age of 16. First ~8 years, recurrences were frequent - once or twice an year below the lower lip. Infrequent - once in 2 or 3 years for the past ~14 years. Last 4-5 occurrences have always been on the upper lip. Manage them with acyclovir and have lately used lysine (2 years now) as prevention whenever I feel it coming up. I don't take this everyday as suppressive therapy.

Incident: After 12 years of marriage, ended up giving my oral HSV1 as genital HSV1 to my wife in Jan 2015 (vigorous oral). First outbreak was severe and in the entire vagina. Confirmed to be (Genital) HSV1 via positive HSV1 ELISA IgG test in Oct 2015 (post one borderline positive value in Mar 2015 and a false negative in Sep 2015). HSV2 ELISA IgG was always/is negative. Since Jan 2015, I guess She has had 2 recurrences. Outbreak was much less severe and very near the anus opening (2 and 4 blisters respectively). Presume it has to be HSV1 recurrence as I don't know what else it could be (didn't bother to do a swab test to confirm)

Questions:

1) Would it be HSV1 recurrence or could it be something else? She's now 6 months pregnant.Understand She already has HSV1 antibodies and if we go with C-section (first child was C-section so higher probability), there shouldn't be ANY risk to the baby. Do you agree or have any additional suggestions on how to manage any minimal (even if it's 0.01%) risk beyond discussing this with her doctor? Seeking your expert advise here.

2) Since I learnt about asymptomatic shedding after giving it to my wife, i was extremely worried about giving it to my 8 year old daughter. Did her HSV1 IgG test mid-last year (negative). I am now very careful of not kissing her hard on the cheeks like I used to before. Kissing now is gentle and more like touch and go. However, I still cuddle with her while sleeping ensuring to keep my lips away but still she sometimes ends up kissing my cheeks / eye (with her tongue touching my eyes/eye-lids).

Given I’ve always had cold sores on my lip, can I shed asymptotically from my eyes/cheeks? Are eyes/cheeks nerve endings common/same as lips? Asked alternatively, from what all areas on my face would I shed virus?

Terri Warren, RN, Nurse Practitioner

97 months ago

If she has a c-section before her water breaks, there should not be a risk to the baby, no. I think to be safest, it would be good to talk to her doctor about this and I hope they will consider putting her on daily suppressive herpes medicine at the end of the pregnancy. The situation in which you gave this to your wife is totally different than the kind of contact you would have with your daughter. You can certainly kiss her on the cheek. You will not shed from your cheek, no, the skin is too thick. And you will not shed from your eyes, though herpes virus has been recovered from tears (not in sufficient quantities to infect someone else). Simply do not kiss your daughter on the lips when you have a cold sore and you should be just fine.

Terri
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97 months ago

Thanks Terri. I'm just coming out of a cold sore recurrence from12 days back (the day after I posted the question!). Few more follow up questions to clarify uncertainties:

1) Based on your responses, are you confirming that I'd asymptomatically shed ONLY from my lips (site of occurrence) and NO other part of my face causing transmission risk ?

2) Does Lysine help as preventive therapy ? For my case (occurrence once in 2 or 3 years), what should be the recommended daily suppressive acyclovir dosage if I'd want to take it? I would rather take a pill everyday than risking transmitting symptomatically or asymptomatically. 200, 400 or 800 mg ?

3) Anything better than Acyclovir that could reduce the healing time from 8-10 days ?

4) Does cold sore ONLY spreads from kissing (as per your suggestion below) ? Can it be transmitted through pillow covers, duvet, door knobs, towels, utensils (spoon? Glass?) If so, what are the realistic chances? I thought I read the Virus dies as soon as it comes in air contact ?

Terri Warren, RN, Nurse Practitioner

97 months ago

1. It is also possible to shed virus in tears
2. Lysine has not shown to be effective at suppressing the herpes virus. The suppressive dose of acyclovir would be 400 mg twice a day
3. No all antivirals have about the same rate of working. The trick is getting started on dosing as early as possible, when you feel an outbreak coming, if you were not taking it every day
4 . Oral herpes can be transmitted via kissing or giving oral sex or also to a nipple if there is broken skin on the nipple with mouth to nipple contact. It is not transmitted via the things you mentioned. I would also take are about sharing lipsticks.

Terri
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97 months ago

Terri,

Last set of questions as I wanted some explicit clarity reading through your 2 responses w. r. to shedding from tears:

1) Did you mean that shedding from tears (and NOT from plain eyes) is possible as virus had been recovered from tears BUT not in sufficient quantity to infect someone? So would it be safe to conclude that one would NOT end up transmitting oral HSV 1 through eyes or tears ?

2) Given the frequency of my recurrence (once in 2 or 3 years), what would be my asymptomatic shedding % rate in a month (i.e. number of days I'd shed in a month). And how much it would reduce by if I take daily suppressive dosage ? Any long term side effects for my use case in terms of daily acyclovir usage ? Your recommendation ?

3) Is all the information in Internet wrong then that HSV 1 can be transmitted via towels, sharing utensils, pillows etc.

4) In summary, I can kiss my daughter on her cheeks / forehead when I don't have a cold sore and she can also kiss me on my cheeks / forehead as I won't shed from there ? Would you leave eyes out if there is slightest of risk? Please clarify.

Thank you very much.

Terri Warren, RN, Nurse Practitioner

97 months ago

1. Yes that is what I am saying
2. HSV 1 sheds on 9-18 out of 100 days. Valtrex daily would reduce that by around 50% - not exactly but maybe close. No long term side effects.
3. yes
4. You most certainly can

Terri
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