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Boyfriend has G-HSV1, please advise!
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Boyfriend has G-HSV1, please advise!

Dear Dr. Warren,

While we were broken up, my boyfriend contracted Type 1 genital herpes, diagnosed by swab and blood test. We are back together now. I was tested 3 weeks, 4 months and 6 months after exposure and each time was negative for both types. How can we have a normal sex life?

1) His initial outbreak consisted of several large blisters on his lower abdomen. The skin looked pink for months but 7 months later he has never had another outbreak. But having seen the blisters there, I am afraid of contact with his stomach, and obviously a condom doesn't cover it. So when we've had sex, in addition to wearing a condom he has also left his boxer shorts on to cover the stomach area. Is that paranoid overkill? Is it even effective?

2) Since his initial outbreak did not occur on his genitals proper, is it less likely that he will asymptomatically shed there?

3) He has never had any oral symptoms. Should I worry about kissing?

4) I would like to give him oral sex without a condom. How risky is this? He just started taking daily suppressive Valtrex to help put my mind at ease. Does that make it safer?

5) I have psoriasis in my genital region which creates some broken skin - does that put me at higher risk?

6) I realize this is subjective, but I'm dying for some perspective. If I stay with him, should I assume I'll catch it at some point? And if I do catch it, is it really a big deal? How careful should I be? Would it be reasonable to have a normal sex life in the absence of any visible symptoms and hope for the best or is that a stupid health risk to take? I keep vacillating between "this is not a big deal at all, it's like acne, who cares" to "why throw my vagina under that bus, as it were, when it could potentially cause pain and complications". Should I err on the side of enjoying life or wrapping him in latex??

Sorry for all the questions, but I don't want to let what seems like a relatively minor disease ruin a great relationship. Many thanks!
55646_tn?1263664409
1) His initial outbreak consisted of several large blisters on his lower abdomen. The skin looked pink for months but 7 months later he has never had another outbreak. But having seen the blisters there, I am afraid of contact with his stomach, and obviously a condom doesn't cover it. So when we've had sex, in addition to wearing a condom he has also left his boxer shorts on to cover the stomach area. Is that paranoid overkill? Is it even effective?

Virus is not shed from thick tissue like the stomach without a lesion present.  I wouldn't worry about that part.


2) Since his initial outbreak did not occur on his genitals proper, is it less likely that he will asymptomatically shed there?

see above.  However, when people have outbreaks in a non-genital area, such as his stomach, they may also shed from the genitals at the same time.

3) He has never had any oral symptoms. Should I worry about kissing?

No, I wouldn't worry about kissing if he's never had a symptom there.

4) I would like to give him oral sex without a condom. How risky is this? He just started taking daily suppressive Valtrex to help put my mind at ease. Does that make it safer?

Yes, it does make it safer.  HSV 1 is infrequently shed from the genital tract.  I think this has to be an individual decision within your self and within your couple.

5) I have psoriasis in my genital region which creates some broken skin - does that put me at higher risk?

Perhaps, it does, yes.

6) I realize this is subjective, but I'm dying for some perspective. If I stay with him, should I assume I'll catch it at some point? And if I do catch it, is it really a big deal? How careful should I be? Would it be reasonable to have a normal sex life in the absence of any visible symptoms and hope for the best or is that a stupid health risk to take? I keep vacillating between "this is not a big deal at all, it's like acne, who cares" to "why throw my vagina under that bus, as it were, when it could potentially cause pain and complications". Should I err on the side of enjoying life or wrapping him in latex??

This is just my perspective, OK?  Just me.  

I would go ahead and have a great sex life with him, if you love him and think you might have a future.  56% of the population in the US has HSV 1, you will most certainly encounter others with this infection in the future.  Are you going to let this be the way you sort through partners?  He is taking antiviral therapy, he has been open with you about this, he can avoid sex with symptoms.  Those are all good things.  If you are more comfortable using a condom as you sort through this as well, do it!  

Another thing - the antibody test for HSV 1 misses at least 1 in 10 cases.  You  may well have it and not know it from the test.  If you are really worried about it, I would order a western blot.  Just to be sure.  It sounds like you are approaching this in a thoughtful way, you just might want to cover all the bases.

Terri
4 Comments
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Hi Terri,
Sorry to be impatient, just want to be sure my question doesn't slip through the cracks. Looking forward to your response. Thanks!!
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Hi Terri,

Thank you so much for your advice, it helps a lot!! I didn't realize that virus wouldn't shed from his stomach - that is a really comforting fact to know! And thank you for offering your perspective - I know no one can tell anyone else what to do in these scenarios, but it's hard to even figure out the reasonable ballpark of a reaction, so I really did appreciate it.  

I just want to follow up about your suggestion for the Western Blot. I've heard of people getting this when they've had low positives on the IgG - is it also likely to catch a false negative?

I'm interested because 7 months ago, the day after we had unprotected sex and one day before my boyfriend broke out into blisters, I had a lot of vaginal discomfort. I went to my gyn and the culture came back positive for yeast  -- which was strange, only because it was the first (and only) yeast infection I'd ever had in my life (I'm 31 years old). In the following two weeks, I lost my appetite completely, dropped 12 pounds (I am quite thin to begin with so that was a drastic weight reduction for me), had a very painful burning/nerve sensation in my upper right thigh (which I treated with a topical pain killer) and had a series of small red bumps on my butt cheek, which never blistered, only flattened and darkened and then disappeared a few weeks later. But when the bumps first appeared, the pain they caused seemed disproportionate to their minor appearance, and reminded me exactly of the pain I felt when I had shingles years ago.

In any case, when my boyfriend's blisters were swabbed and came back positive for HSV1, I was sure that I had gotten it from him. But the negative IgG tests six months out have me thinking that somehow all those weird symptoms were anxiety-based or psychosomatic. (I really didn't think I was that crazy, but who knows!) And the first-ever yeast infection at that exact time seems improbable.

Anyway, if my IgGs did miss an infection, that would finally explain those symptoms- and frankly, knowing I was positive would help me relax and enjoy my sex life again, so I am tempted to go ahead with the Western Blot if you think that's a good idea.

One other specific question (sorry if this doesn't make sense) - the reason it would be comforting to know I had HSV1 is because I'd know I have the antibodies to resist further infection - but if the antibodies aren't prominent enough to be showing up on an IgG, are they also not prominent enough to prevent further infection?
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55646_tn?1263664409
It is a function of the lack of sensitivity of the test, not something in you, if it does turn out to be a false negative.  The western blot is better at picking up HSV 1 infection than the ELISA that is traditionally done.  given your symptoms, I would get a western blot.  Your health care provider can either order the test kit directly from UW or I can order it for you directly at a Quest lab near you.  

Terri
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Westover Heights Clinic
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