Negative genital HSV-1 Culture, False Negative?

[winnebago]

Thanks for all of your input on this site, Terri!

I've been pondering the same issue for many years & would love your input. I have oral HSV-1,  since I was in high school--roughly 15 years, confirmed by viral culture & blood test. I am HSV-2 negative. My outbreaks were often severe & crossed vertical & horizontal axis, which I've been told is rare/impossible, i.e. I've had it on the left and right side of my face as well as in my eyes & on my chin & neck. Never on my lips. My case did not get any less severe over the years and I would typically get at least four outbreaks per year. I started taking daily acyclovir 3+ years ago & it has proven very effective. I went 1-2 years, perhaps more, without any outbreaks.

While I was in college I & a doctor at the university clinic thought I had spread it to my genital area. In her opinion it looked very much like genital HSV-1 & instructed me to continue to take the acyclovir that I had started a few days earlier because of a small outbreak in the corner of my eye. They took a viral culture but it came back negative. After all these years, I still can't quite drop it due to false negative rates.

I have never had any other genital symptoms as far as I can tell. Nor am I aware of any past partners getting symptoms after sleeping with me. I have since that time had several run down periods in which I got terrible facial outbreaks, including getting it in both eyes at the same time. I kind of think that if I had it genitally it would have popped back up at some point, as my immune system has a hard time with the virus. Should I tell potential partners about the false negative test and the potential that I have asymptomatic genital HSV-1? Am I one of the many people walking around and potentially spreading genital herpes?

Also, how much should my current boyfriend & I be concerned with oral asymptomatic shedding as it pertains to oral sex?  He is a rare case of negative for HSV-1 and 2 via blood tests.

Thanks in advance!

[Terri Warren, RN, Adult Nurse Practitioner]

Thanks,you too.

Terri

[winnebago]

Thanks for your input. All the best.

[Terri Warren, RN, Adult Nurse Practitioner]

I don't think there are any studies about that, unless you could find some that relate to oral HSV 1

Terri

[winnebago]

Thanks again Terri! And I know that with antiviral therapy the shedding rates are reduced even more. I have yet to be able to find a study that specifically notes shedding reduction for genital HSV-1. Anyhow, keep up the great work!

[Terri Warren, RN, Adult Nurse Practitioner]

Usually, shedding rates are described as the percent of positive days of some set amount of days swabbing.  For example, if you shed 9 days out of 100 days swabbed, that would be 9% shedding.  If you shed 5 days out of 50 days swabbed, that would be 10% shedding.  Genital HSV 1 shedding is about 5% of days (that would be about 17 days a year).  Oral shedding rates are not as well summarized, but might be about 15% of days.  These numbers are without antiviral therapy

Terri

[winnebago]

Thanks for your reply, Terri!

While rare, I am still suspicious about the negative result, especially because there was no alternative explanation of what it could have been. But I will use your advice to allay any anxiety.

I am definitely aware that I can still transmit it to my partner orally through kissing or oral sex. I actually tell folks before kissing or sharing a drink that I sometimes get cold sores. I would be grateful if you can explain asymptomatic shedding rates for both oral HSV-1 and genital HSV-1, especially with acyclovir as a daily suppressive. I've seen various statistics and am not quite sure if there is a difference in days of the year versus days observed or however it is worded. I would be grateful if you can word it in approximate days per year.

Thanks for your concern for my eyes. I've been aware of the level of seriousness since my first outbreak. The good news is over the years the outbreaks in my eyes became very rare. I had a great opthamologist who took it very seriously and whose treatment prevented any lesions from ever forming on my cornea. He was the one who told me about acyclovir, which I started taking in high school when I would get an outbreak. I was prescribed viroptic from him and ironically it took many, many years to realize that i was rather allergic to it. I always thought the crazy swelling and such was all part of the herpes outbreak.

Thanks again!

[Terri Warren, RN, Adult Nurse Practitioner]

It would be rare for you to get HSV 1 genitally after having it orally.  I would believe the negative culture from the genital area.  

If your partner is HSV 1 and 2 negative (not uncommon), then you could transmit HSV 1 to him by giving him oral sex. People who have oral HSV 1 can transmit the virus via oral sex or kissing even if they have no cold sores at the time of contact.  You taking daily therapy is a wise move to try to reduce his risk of infection via either route.

However, my biggest concern is your eyes!  If you have been diagnosed with ocular herpes, you should be on daily therapy.  I can't tell from your post if that is the case, but if not, it should be.  HSV is the leading cause of infectious blindness in the US, so please, take this seriously.  

Terri