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HSV 1 Positive Blood no History
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HSV 1 Positive Blood no History

I have a question about HSV 1. Previously I have always tested negative in Serum tests for HSV 1 and HSV 2. I have never had any symptoms I am aware of but I have had single tingly pinpoint blisters on my lip line. I thought they were just irritated hair follicles because they were very small and isolated. In May I had a lot of testing done because I was going through a divorce and my husband might not have been faithful. I was negative for everything, HSV 1 and 2 serum tests included. I also tested negative for HSV 1 with both of my previous pregnancies.

Two months ago I had a new sexual partner and we didn't use any protection. I was also dating another man at the time who had a cold sore so he waited to kiss me until it had resolved; I am no longer seeing him. I decided just in case I should get some testing done. The testing was done 20 days after any potential exposure to HSV 1 and 8 weeks after I had unprotected intercourse with my new partner (who I am still dating). I have not had any lesions that I know of, but my physician just told me that a Western Blot came back positive for HSV 1.

Can you be HSV 1 positive with no history of symptoms? I am wondering if I have had it most of my life with very mild symptoms and the three previous tests I took were false negatives. What does that mean for me if I am positive for HSV 1?  Will I get symptoms some time in the future? How do I know if it is genital or oral HSV 1 if I have never had a lesion and I was exposed in both places? Should I be telling my potential partners I have HSV 1? Are my partners at risk for catching genital herpes from me since I don't know where I am infected and I have never had any symptoms? Should I repeat the test to rule out a false positive if I don't get any lesions in the next few months?
Avatar_m_tn
First, the WB is as definitive as you will find. There is little point in retesting as it will say the same thing. If there was doubt in the way you test panned out, it would have come back equivocal. HSV1 antibodies were detected in your blood beyond reasonable doubt.

Commercial testing on the other hand misses about 1 in 10 HSV1 infections. The most probably explanation is that you have had HSV1 since your youth and just recall or align symptoms to cold sores. Your immune system is dealing very adequately with the virus as it does for most people. Maybe what you describe is in fact cold sores, sometimes they are little more than a pin head large on a red base of around 1/8 of an inch.

If you contract HSV1 genitally as an adult, this more likely would not go unnoticed although for some people it can.

There is no reason to suspect that you future with HSV looks any different to your past. This is another reason why absence of lesions is not evidence you are not infected. Illnesses that impact your immune system may give the virus more scope to be active.

If you have never had a lesion, then one way to capture it is potentially to swab over a period of time, say a month, in both places, and see what transpires. I see little reason not to assume this is an oral infection however.

You partners are at risk of genital HSV1 regardless with a combination of oral or vaginal sex.  It is not known which has the highest transmission rate, although logic suggests that oral sex is a greater risk of transmitting HSV1 than vaginal sex with the 'matching' infection.
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