Herpes Expert Forum
Relationship and HSV-1
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Relationship and HSV-1

Hello,

I am in a wonderful relationship with a woman I care about very much.  Two months ago, 5 months into our relationship (and because of an episode of the Office!) she mentioned that she has oral HSV-1.  I was very upset, and felt that she had not been honest with me initially.  She said she had her first outbreak in 07, and has had one mild outbreak a year since, but not yet in 2010.

She said she hadn't told me because she hadn't really thought about it since her last outbreak.  She says she always gets the prodrome tingling, and would never have kissed me if she felt it coming on.  She said since I am older and have had many more partners than she had, she figured that I was positive.

I tested negative 2 months ago.

I have so many questions:

1.  What is the HSV-1 seroprevalence for young adult middle class Americans?

2.  What are my chances of acquiring HSV-1 from her if the only precaution we take is to avoid kissing and oral-sex during outbreaks, assuming we kiss frequently?  Does it help to wear Chapstick, use Listerine, to wash up after kissing and oral sex?

3.  How often is she likely to be asymptomatically shedding?  Is there anyway to tell when she is asym. shedding?  Or is there anyway to tell how prone she is to it?  Can I take any solace in the fact that I was negative after 5 months?  If I kiss her while she is asym. shedding, how likely am I to acquire HSV-1? Am I more exposed when I have canker  sores in my mouth?

4.  Would it be better to have HSV-1 orally or genitally?

5.  What are the ethics of oral HSV-1?  When are you supposed to tell a partner? I am struggling with the fact that she did not think HSV-1 was worth mentioning.  It seemed more ignorant than malicious.

6.  How much will it affect my life if I acquire it?  Would I be able to kiss my future children?  Perform oral sex on my future wife?

7.  Is it foolish to expose myself to HSV-1 if I'm not totally confident we'll get married?

8.  Could HSV-1 affect my (mild) Crohn's?
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55646_tn?1263664409
1.  What is the HSV-1 seroprevalence for young adult middle class Americans?
Very common - 56% of people between the ages of 14-49 have HSV 1 infection.

2.  What are my chances of acquiring HSV-1 from her if the only precaution we take is to avoid kissing and oral-sex during outbreaks, assuming we kiss frequently?  Does it help to wear Chapstick, use Listerine, to wash up after kissing and oral sex?
We don't have statistics about the risk of transmission via kissing or receiving oral sex.  I doubt that it would help to use Chapstick or Listerine or washing after kissing or oral sex.

3.  How often is she likely to be asymptomatically shedding?  Is there anyway to tell when she is asym. shedding?  Or is there anyway to tell how prone she is to it?  Can I take any solace in the fact that I was negative after 5 months?  If I kiss her while she is asym. shedding, how likely am I to acquire HSV-1? Am I more exposed when I have canker  sores in my mouth?
Yes, she probably is shedding from time to time.  There is no way to know when she is shedding, no, by definition asymptomatic viral shedding is just that.  I don't know how old you are, but if over half of the US population in that age group is infected, we know it is even high than in people who are older than that.  Be aware that the test for HSV 1 antibody (I'm assuming that's the test you did) misses one out of every 10 people who are infected.  Unknown if your canker sores make you more vulnerable.

4.  Would it be better to have HSV-1 orally or genitally?
Well, having it orally is so common, most people don't worry much about it.  Having it genitally means less viral shedding.

5.  What are the ethics of oral HSV-1?  When are you supposed to tell a partner? I am struggling with the fact that she did not think HSV-1 was worth mentioning.  It seemed more ignorant than malicious.
I'm not at all clear that most people with oral infection share that with partners.  I would not really fault her for not telling you about this, I think she is with the majority of the population on this who have HSV 1 orally.  Most people have no idea that cold sores are herpes, actually.
6.  How much will it affect my life if I acquire it?  Would I be able to kiss my future children?  Perform oral sex on my future wife?
If you get it, you will have cold sores from time to time.  If your "future wife" doesn't have HSV 1 and you do, you could infect her by giving her oral sex, that is, if you acquire this orally.

7.  Is it foolish to expose myself to HSV-1 if I'm not totally confident we'll get married?
That's an individual decision, of course.  My opinion?  With this being SO COMMON, it would be foolish to select a partner based on whether or not they have HSV 1 infection.  You're might have to go through several women to find one without HSV 1.  

8.  Could HSV-1 affect my (mild) Crohn's?
Nope.

Terri
4 Comments
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Avatar_m_tn
Hi Terry,

I haven't had a response yet.  Did I post my question properly?  I am very anxious to hear your response.  Should I post in the STD forum instead? I'm new here, so I don't know the routine yet.  Thanks for your help.  Have a great Thanksgiving.

Thanks!
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Avatar_m_tn
Thanks Terri,

Happy Thanksgiving.  Some follow up questions on each of your points:

1.  What is the source of your statistics for seroprevalence of HSV-1?  I've seen soooo many different numbers.  Does it vary by race, or region, or socioeconomic status?

2.  Are there no studies about rates of transmission between HSV-1 discordant couples?  Are there any strategies at I all I can use to minimize my risk?  For example, am I more susceptible when I'm sick or run down?

3.  I'm 32.  I've had the HerpesSelect antibody test twice in the last year and in each case was negative for HSV-1 and HSV-2, I've never had a cold sore, no has anyone in my immediate family, so I'm confident I'm HSV-1 negative.  If my girlfriend is asympomatically shedding, am I as likely to acquire Herpes as when she has an outbreak?  Assuming she acquired HSV-1 in November 2007, and has one outbreak a year (but none in 2010), what can we assume about her rate of shedding?

4.  It is definitely not my experience that most people don't worry about oral HSV-1, whether or not they should is another story.

5.  I feel like if I acquired oral HSV-1, I would be under an ethical obligation to inform a potential partner before kissing, because, though it is usually a minor infection, it can be serious, and it is permanent.  Even if I am not having an outbreak I could infect someone with one kiss.  I am frankly astonished that the medical community does not insist that people are under an obligation to disclose.  Furthermore, widespread disclosure would probably help reduce rates of transmission.  Am I wrong?

7.  For whatever it's worth, I don't think it is quite as common as you suggest among highly educated young professionals, and besides, people routinely rule out potential dating partners for all sorts of arbitrary reasons (religion or hair color or hobbies).  So my question is more potential impact on future relationships.  Would HSV-1 have enough of a negative impact on my future dating opportunities or relationships, that I should avoid exposing myself in a relationship, no matter how good, if I have reason to think it won't be my last relationship?

I really appreciate all of your advice.  I have been struggling with this, and I am relying on this forum to help make sense of it all.

Thanks for your help!
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55646_tn?1263664409
1.  What is the source of your statistics for seroprevalence of HSV-1?  I've seen soooo many different numbers.  Does it vary by race, or region, or socioeconomic status?

The NHANES study, the most recent author I believe for this data is Xu, there might be one more recent.

2.  Are there no studies about rates of transmission between HSV-1 discordant couples?  Are there any strategies at I all I can use to minimize my risk?  For example, am I more susceptible when I'm sick or run down?  No, there are no studies.  If your partner is on daily suppressive therapy, that reduces the risk of transmission.  You may be more vulnerable if your immune system is down, like when you are ill.

3.  I'm 32.  I've had the HerpesSelect antibody test twice in the last year and in each case was negative for HSV-1 and HSV-2, I've never had a cold sore, no has anyone in my immediate family, so I'm confident I'm HSV-1 negative.  If my girlfriend is asympomatically shedding, am I as likely to acquire Herpes as when she has an outbreak?  Assuming she acquired HSV-1 in November 2007, and has one outbreak a year (but none in 2010), what can we assume about her rate of shedding?

We can assume her rate of shedding is somewhere between 5-18%, though those statistics are all over the place.  

4.  It is definitely not my experience that most people don't worry about oral HSV-1, whether or not they should is another story.
Each person views this very differently - it is for sure a personal decision.  What I can tell you is that in the course of physical problems, this is unbelievably minor.

5.  I feel like if I acquired oral HSV-1, I would be under an ethical obligation to inform a potential partner before kissing, because, though it is usually a minor infection, it can be serious, and it is permanent.  Even if I am not having an outbreak I could infect someone with one kiss.  I am frankly astonished that the medical community does not insist that people are under an obligation to disclose.  Furthermore, widespread disclosure would probably help reduce rates of transmission.  Am I wrong?

Again, this is a personal decision.  Since well over the half the population is already infected with HSV 1, and most have no idea and most have no symptoms, I'm not sure there is a clear and definitive answer about this.

7.  For whatever it's worth, I don't think it is quite as common as you suggest among highly educated young professionals, and besides, people routinely rule out potential dating partners for all sorts of arbitrary reasons (religion or hair color or hobbies).  So my question is more potential impact on future relationships.  Would HSV-1 have enough of a negative impact on my future dating opportunities or relationships, that I should avoid exposing myself in a relationship, no matter how good, if I have reason to think it won't be my last relationship?

I'm sorry, but I can't help you with that decision.  I can tell you that if I were in your situation, and there was someone I really liked that had cold sores, I wouldn't rule them out as a partner because of it.  There are people with far bigger problems than cold sores that would make me not want to be with them in any way.  This would not rule someone out for me, but neither would genital herpes.  If you decide not to kiss anyone with HSV 1, I think you will need to have all future kissing partners tested, since 70% of those infected with HSV 1 have no clue and no cold sores.  But if that works for you, then do it.  As I said, its very personal.  And that in itself is an issue because the test only picks up 9 out of 10 people with infection, so it will miss 10 out of 100.  It all gets very complicated, doesn't it?



I really appreciate all of your advice.  I have been struggling with this, and I am relying on this forum to help make sense of it all.

Terri
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