Genital HSV1 Questions

[TedBell22]

Dear Doctor,

1) A few days ago, a man performed fellatio on me and he had cold sores. He mistakenly told me they were razor burns from shaving and later admitted the red marks around the right side of his mouth were probably oral herpes. I have never had a cold sore in my entire life and I am 21 years of age. I was wondering how long it would be before I had the symptoms of genital herpes showing up. The incident happened on Friday the 18th.

2) Are the symptoms of a genital herpes outbreak caused by HSV2? What are the similarities and differences of the two?

I did try to get a blood test for HSV done a while ago, but my doctor told me that the only way we could test for herpes was with a swab test. I asked him about the blood test and he declined. I'm sure this was due to insurance reasons. So I am honestly not sure if I ever had HSV1 to begin with.

3) Also, what are my chances of having the disease asymtomatically? And if I am asymptomatic, what obligation do I have to tell future sex partners about this?

Thank you for your time.

[H. Hunter Handsfield, M.D.]

Despite your lack of symptoms of cold sores, there is a good chance you already have HSV-1; almost half of all people catch it during childhood.  If that applies to you, you are immune (or at least highly resistant) to catching a new HSV-1 infection anywhwere on your body.  Also, most people with genital herpes due to HSV-1 only have the initial outbreaks plus maybe 1 or 2 addtional outbreaks over a year or two, then nothing more.  In comparison, 90% of people with HSV-2 have recurrent outbreaks that average 3-6 episodes per year for many years.  So genital herpes due to HSV-1 really isn't a big deal for most infected people.  So don't lose too much sleep over this event.

Your doctor is being cautious because he knows that a negative blood test for HSV-1 wouldn't prove you weren't infected, unless done at least 6 weeks later; and a positive result would probably just mean you were infected in childhood.  So the odds are good the result wouldn't help much one way or the other.  However, if it were positive this soon after exposure, it would prove you had it before, and probably are immune to catching it again.  You might discuss this aspect with your doc and see if he would reconsider ordering the test.  (I doubt insurance coverage had anything to do with his advice on this.)

1) There are no data to predict the chance you were infected.  But most exposed people aren't infected.  If you were infected, symptoms usually would begin within 3-7 days, sometimes as long as 3 weeks.

2) The symptoms of genital HSV-1 and HSV-2 are identical, except for the frequency of recurrent oubreaks.  

3) There are no data on asymptomatic genital HSV-1 infection.  It probably happens.  But just as recurrent symptoms are uncommon with genital HSV-1, asymptomatic viral shedding is uncommon.  For this reason, genital to genital HSV-1 transmission is rare.  I have never seen a case.

Bottom line:  I suggest just sitting tight and waiting for symptoms.  If none appear within 3 weeks, consider yourself home free, with no need to say anything to future partners.  As I said, you might re-discuss having an HSV-1 blood test with your doctor.

Best wishes--  HHH, MD

[TedBell22]

Thank you for your time doctor.

[H. Hunter Handsfield, M.D.]

You're welcome.

My statement that there are "no data" on HSV-1 genital shedding is wrong.  There is much less information than for HSV-2, but a few studies have been done.  They indicate that asymptomatic shedding of HSV-1 is much less common than for HSV-2.

[TedBell22]

Hello doctor. I got tested and I was negative for HSV1 antibodies a week after exposure. It's been four weeks now. Would I probably have had sores show up by now?