Genital HSV-1 through my saliva?

[jm_worried]

Hi there,

Three weeks ago I had a small cold sore on the edge of my upper lip. I refrained from kissing my girlfriend (who has never had a cold sore) and having oral sex BUT I did use my finger to stimulate her vaginally. Here's the stupid part...I lubricated my finger with my tongue before touching her. I thought that if I avoided the cold sore it would be okay.

Now, after learning more about HSV-1, I'm riddled with guilt - please help:

1) What are the chances that I transmitted HSV-1 genitally to my girlfriend through the saliva on my finger?
2) It has been over 20 days since the encounter and she has not had any noticeable symptoms...though I heard that symptoms can be very mild and go unnoticed...or it may even be years before the first outbreak. At what point can we breath a sigh of relief?
3) We had unprotected sex right afterward (we are each others firsts). What are the chances that I was infected genitally from my own saliva on her vagina? We both showered immediately after sex.
4) Can we continue having unprotected sex?  We're both clear of other STDs.  We are both just scared of the risk of contracting herpes.

I have been through your site and others extensively and know that you've answered questions like this many times. But it would do a lot of good if you could help address my specific situation. I am kicking myself for being uninformed and doing something that put someone I care deeply about at risk. Thanks.

[H. Hunter Handsfield, M.D.]

I'll go straight to your questions.

1) Such indirect transmission certainly could occur theoretically, but it probably is very rare.  I have never seen a case of herpes, either oral or genital, in which there wasn't direct genital or oral contact.

2) After almost 3 weeks with no symptoms, you and your partner can safely assume you did not infect her.

3) People with herpes of one body site are very resistant (mostly entirely immune) to reinfecting themselves at another body site.  In other words, you'll never transfer your own oral herpes to your own genitals.  In fact, you can assume you are immune to ever catching another HSV-1 infection, even from another person.  (Such self-infection, called 'auto-inoculation', can occur during a person's very first herpes outbreak, but is very rare in long-standing infection.)

4) There is no reason to suppose that unprotected genital sex would put your partner at risk.  Cunnilingus may or may not be a risk for her.  Half the population has HSV-1, even if they have never had cold sores.  If your girlfriend has previously had HSV-1, she is at least highly resistant--maybe totally immune--from catcthing your oral HSV infection, even with oral sex.  But if she has not had it, she will always be at risk from cunnilingus--even if you avoid it when having an outbreak.  In other words, you probably have periods of asymptomatic viral shedding from your mouth.  If you and your partner wish, she could have a blood test to determine whether or not she has previously had HSV-1.

Having said all that, don't kick yourself too hard.  Genital herpes due to HSV-1 isn't such a bad deal, most of the time.  Most people have only the initial outbreak and no recurrent outbreaks, or only 1 or 2 recurrences then nothing.  It's not nearly as big a deal as genital HSV-2.  I'm not saying to take no precautions--just to be aware that the risk of a bad outcome isn't as great as you might think.

Good luck--  H3

[jm_worried]

Thanks doc!  That went a long way in helping to alleviate fears.  I know you rarely answer follow-up questions, but maybe you're feeling generous...or someone else (like Grace) is willing to answer, so...

...assuming my girlfriend is completely clear, what are the chances that I can infect her through oral sex asymptomatically?  Should we discuss using protection like a dental dam? I have other friends who get cold sores, are they obligated to tell their partners of the potential risk from oral sex as well?

I know not to expect an answer, but thanks again.  This site is an invaluable asset.

[gracefromHHP]

We really don't have the info to say just how likely it is that you'll transmit your hsv1 to her genital area. If she hasn't been tested yet for hsv1 she should do so. If she's already hsv1+ then it's a non-issue though of course don't perform oral sex on her when you have an cold sore - for both your protection and hers. A cold sore is an open portal into the body for bacteria.  

If she's hsv1- then she might also want to look into the herpevac vaccine trials ( google it ).  

It's up to the two of you if you want to utilize barrier protection for oral sex or not. You don't have to use dental dams or oral dams - you can even use saran wrap if you both think it's warranted.

grace

[jm_worried]

Thanks for the prompt response Grace!

I'm a bit hypersensitive now knowing what I know.  If you allow me one last follow up question (I swear this is the last time) can I ask....will it be obvious if my girlfriend or I contracted genital herpes?  For me, I have a condition where I can't pull back my foreskin....so I can't even tell if my penis is fine even if I had a blister.  Would the pain be excruciatingly noticeable?

[jm_worried]

Hi Dr. & Grace,

I just noticed you responded to my initial post in the patients forum and wanted to say it was much appreciated.  I have a meeting with my family physician in a week, but I'm still so nervous so I'll explain why I'm still posting questions:

two days ago (the same day I first posted on this forum), I started developing some symptoms around my genitals.  I tried to ignore them, hoping they were psychosomatic, but they've been pretty consistent now for those two days:

- dull pain between the groin and right thigh
- a small white discoloration on my foreskin (does not look to be attached to the penis)
- a red dot at the base of the foreskin that's very itchy
- a small red cut between my groin and left thight that's extremely itchy (I have treated the itch with polysporin)

Not the classic signs of a herpes infection I know....I'm just worried that these might be milder symptoms that my doctor might misdiagnose.  And because of my condition, I can't even retract my foreskin to check for signs on my penis.  Is there cause for concern?

[monkeyflower]

I don't know, but that sounds more like a fungal infection to me--especially since you're uncircumcised and can't retract your foreskin. If it is, you can use the same cream you'd use for athlete's feet/jock itch.

As for the inability to retract your foreskin, is it that it's too tight? If so, have you tried stretching it?

[jm_worried]

Thanks for the tip monkeyflower.  I started washing more than once a day and using anti-bacterial cream, which has stopped the itching for the most part.  

I'm just worried about the sharp twinge I feel once in a while and that general dull pain in my penis (on the right side where the white discoloration is).  I wish I could retract (and I've tried stretching every day but no luck) so I can check for symptoms...so it's really the fact that I can't that bothers me.  There could be a blister or redness hidden under my foreskin and I wouldn't be the wiser.