HSV-1 Transmission Rates

[agentone]

I feel awful. I contracted HSV 1 genitally at the end of October. This past Sunday morning after a drunken evening with someone, I had unprotected sex twice. I had intended to take it very slow with this individual. Wanted to make sure it was the right persona and pick the right time prior to sex to explain my status. I made it clear to this person that I did not intend on sleeping with him. We were fooling around. Neither one of us had a condom and in the heat of what was going on, he decided we were both "clean" and before I could say anything, he was already inside me. I didn't want to freak him out as I know the transmission rates are so low and I have only had the one outbreak. We had sex a second time a few hours later. I'm so disappointed in myself and will feel awful if he gets this. I am trying to figure out if I will see this person again. And if I now need to say something. I think I almost certainly need to if I do see him again. Given I have only recently contracted this myself, what are the chances that he contracted it genitally? What are the chances that he contracted from giving me oral sex? If he did contract it either way, would he most likely have symptoms by now or have them over the next several days? I really do not want to scare this person by saying something now if the chances of him contracting it from me are extremely low. I'm also concerned that he's not going to remember the evening quite the way I do. I don't want to look like I was malicious in keeping this info from him. Also, I've seen the odds sourced to you in the following articles a number of different places... http://www.dynamiclear.com/blog/herpes-transmission.htm I'm assuming those figures will change for someone who is HSV-1 positive. Do you have those? I would like to give any future partner all the information about the odds. I know many, many people are already infected orally. I am 43, and was not one of the 50+% of the population that has antibodies already.

[Terri Warren, RN, Adult Nurse Practitioner]

Yes, I would say that is a good strategy.  Get partners tested and if they are positive, I would put this issue aside.  An IgG ELISA is the test that they want - type specific antibody.  The dating websites often have HSV 2 positive folks that attend, yes.

Terri

[agentone]

Thanks Terri. The website used the 4% per year transmission rate for HSV-2 and determined the likelihood of transmitting per encounter when symptoms are not present. No condom no antivirals, I believe was 1 in 10,000. Anyway, would it be best to suggest partners be tested to see if they are positive for HSV-1? If they are positive, what is the possibility that I would pass it along to them either by genital contact or oral sex (performed on me)? If they are to be tested, which test should they ask for? Assuming that most men I date are going to be positive. I can't find anyone on the "positive" dating sites who only has HSV-1.

Agree with you on the disclosure for this particular person. And likely anyone. I just can't imagine not saying anything and then having it come out later on in the relationship.

[Terri Warren, RN, Adult Nurse Practitioner]

The situation with genital HSV 1 is somewhat different than it is with HSV 2 since such a large portion of the population already has HSV 1 and because HSV 1 is so much less frequently shed from the genital tract.  I believe you will see differing opinions from experts about disclosure of genital HSV 1, at least that's what I hear at meetings.  My personal opinion is that this information should be disclosed, just like HSV 2 should be disclosed to partners.  People aren't perfect at this, just like you weren't perfect.  But I do think if you have sex with him again, you should tell him.  If I were you, I would start by asking him if he has ever had a cold sore on his lip, if the answer is yes, then it is extremely unlikely that he will contract this genitally.  You have that to say.  

I think the chances of him contracting this orally or genitally are low, but we do not have data on transmission rates.  I don't what the dynaclear website says, but if I was looking for scientific articles, that is definitely not a source I would use.  Perhaps they reference another article, I don't know.  But we just don't have data on HSV 1 transmission rates.  To sort that out would be so much more complicated than HSV 1 due to large prevalence in the population already and the infrequent rates of shedding.  I know that is frustration for people with genital HSV 1, not to have firm numbers but we just don't.  

In my opinion, your best move, if you are seeing this guy again, would be to disclose with an apology.

If he was going to have symptoms, they would normally occur in the first 10 days and would be genital sores or blisters at the beginning.

Terri

[agentone]

I am a female by the way.