Herpes Expert Forum
HSV-1 Questions
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Welcome to the Herpes forum. This forum is for questions and support pertaining to herpes simplex virus infections (HSV-1 and 2) and herpes zoster (shingles) and the virus that causes it, varicella zoster virus. Questions about genital herpes are welcome both here and on the STD Forum.

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HSV-1 Questions

Hello,
I have questions pertaining to HSV-1.  First a little background: I have been in a totally monogamous relationship for 1 year and 5 months.  She is the 3rd girl I have had intercourse with in my life.  I have had numerous blood tests done in the past and all have been negative, negative, and negative for both types.  About a month ago I had some symptoms of herpes, a few red bumps that broke open in my genital region.  I saw 3 different doctors who said it didn’t look typical; they all first thought it was folliculitus (folliculitis).  I had a swab test and blood test done anyway.  The blood test was negative for both but the swab test came back positive. I need to stress this last point that in the year and some moths we have been together we have never had oral sex.  I mean never!  I had my GF get tested and her blood test came back positive for HSV-1. She has never had any symptoms of herpes.(that she knows of) Needless to say after many nights of minimal sleep and episodes of anxiety, its time I should ask some questions.  
1)Given my above scenario would you agree that I acquired Genital HSV from my GFs genital infection? (I really don’t see how it could have happened any other way)  Have you seen cases of genital to genital HSV-1 transmission through asymptomatic shedding?
a.I should note that she has never had any symptoms of herpes.(that she knows of)
2)I know for HSV-2 many don’t know they have it, is that the same for genital HSV-1? Or if some if someone acquires HSV-1 genital are they more likely to show symptoms?
3)Other doctors have told me that genital HSV-1 isn’t really anything to worry about, what are your recommendations for genital HSV-1?  How do they differ for those who have HSV-2?
Like I stated about I really am having trouble dealing with this diagnosis.  I never thought it would happen to me.  I have always been tested and always been in a monogamous relationships.  I can’t wait to hear back from you, and more importantantly....Thank you!!!!
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1)Given my above scenario would you agree that I acquired Genital HSV from my GFs genital infection? (I really don’t see how it could have happened any other way)  Have you seen cases of genital to genital HSV-1 transmission through asymptomatic shedding?

There are several things that could have happened here:
1.  You could have new infection from your girlfriend:  Most often when we see a positive swab test (in this case HSV 1) and no antibody to that same type (HSV 1) this indicates new infection.  However, with the HSV 1, there is an additional complicating factor.  The HSV 1 antibody test only picks up 91 our 100 cases of HSV 1, so basically it misses one out of 10 cases on screening.  So its possible that you've had it right along and the tests just never picked it up.  We know you have it genitally because of the positive swab test, so it is unlikely that you have it orally since infection in two locations is not common, unless they are both acquired at the same time.  In other words, it would be unusual to have a well established history of cold sores and suddenly get HSV 1 genitally.  If the antibody tests that you've had in the past didn't pick it up, then you could have infected her.  Its possible her infection isn't genital.  You may have gotten this from receiving oral sex from someone else.  There are so many possibilities.  If, however, you do an antibody test for HSV 1 in 3 months and its positive, then I would suspect that yes, you got it from her.  If it continues to be negative, then I think the test just didn't pick it up over the years, and any scenario is possible.  

Probably most people who have HSV 1 don't know it (just like with HSV 2) and this is especially true for HSV 1 genital infection because it recurs infrequently and is less infectious to sexual partners than HSV 2.  What to do about it is tricky.  If you're having sex with someone else who has HSV 1, then I wouldn't worry too much about it.  However, if you are having sex with someone who is negative for HSV 1 and 2, you may wish to consider daily therapy to reduce the risk of transmission.  And remember that if you are having sex with someone who is HSV 2 positive, you can still get their HSV 2 infection; having genital HSV 1 doesn't protect you.

Terri
3 Comments
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Hi Rusty, I just wanted to tell you that once a person has the antibodies for herpes type X anywhere, they are unlikely to catch it again in another area.  I think the prevalence of HSV-1 is 80% of US adults, so if you where to break up with you gf and get into another relationship, just get them tested by the blood test to see if there is any risk.  Also, genital HSV-1 is less contagious than oral HSV-1, because the virus is outside of it's preferred location.  Hope this helps.
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Terri,
Dr. Hook in the STD forum has recently begun stating that the Herpeselect IGG for type 2 is only approx. 80% acurate at 6 months for people with a prior HSV-1 infection. is that in line with your experience ? If it is, the 98% acurate at 16 weeks only applies to people with no prior HSV-1 infection, is this true ?

thanks for your input...
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Westover Heights Clinic
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