HSV 1 Genitally: Shedding and Transmission

[yogini3]

Doctor(s):


I am heterosexual female, in my early 30s.

Recently had a specific blood test after knowing I have HSV for 11 years. Results: HSV 1 lgG, Type Specific 5.25. (HSV 2, Type Specific <0.91).

My questions are:

1) Since I've had this for 11 years, had only one OB (the initial), what is the percentage of shedding per year?

2) What is the likelihood of transmission to an HSV 1+2 negative partner via intercourse with condom.

3)  Transmission risk when receiving oral sex?

4) Transmission risk if male uses hand on my genital then on his?


I do not want to pass this on to anyone.



Thanks for your time and effort.

[H. Hunter Handsfield, M.D.]

Welcome to the STD forum.  I'll try to help, but precise data do not exist for most o your questions.

Your story is quite typical for genital herpes due to HSV-1.  About 40% of persons with a new initial episode have no recurrent outbreaks at all in the next 2-3 years and most of the rest have 1-2 outbreaks and then no more.  What happens after 2-3 years has not been formally studied, but probably most have few if any recurrent episodes over the years.  There also are relatively few data on asymptomatic genital shedding, but it seems to be uncommon, as does genital-to-genital HSV-1 transmission.  To my knowledge, in 30+ years in the STD business, I have never had a patient who acquired genital HSV-1 through intercourse, only by receiving oral sex.  To the specific questions:

1) My guess is that after 11 years, you have little asymptomatic genital shedding of HSV-1, but I emphasize guess:  there are no data on the frequency of sheding over the long term.

2) I'm not sure what you mean by the status of your partner.  When someone already has HSV-1 (i.e., positive blood test|), s/he is highly resistant to a new HSV-1 infection.  That person's HSV-2 status makes no difference, as far as is known.  In other words, such a partner is not at risk for transmission from you.  Half of all adults in the US (90% in some countries) have HSV-1; thus at least half of all your potential partners (in the US) are at no risk, regardless of your sexual practices.

3) In what direction?  Since your infection is genital, there is no risk from your mouth to a partner's genitals.  There is a theoretical risk to a partner who performs oral sex on you, but the transmission risk probably is extremely low.

4) Hand-genital HSV transmission is extremely rare, if it occurs at all.

All things considered, there probalby is very little risk of your transmitting your infection to new sex partners.  It would be a courtesy to inform future partners of your infection, but it can be done with reassurance that the risk is low.

I hope this helps.  Best wishes-  HHH, MD

[yogini3]

Dr.Handsfield,

Thank you for your prompt reply and the information you provided. I appreciate the stats and personal experience you have provided!

You have answered my questions and confirmed my thoughts.

Also, thanks for all the work you do on these boards!

[yogini3]

To clarify my second question, "2) What is the likelihood of transmission to an HSV 1+2 negative partner via intercourse with condom."

I meant: What is the likelihood that I will pass on my HSV 1 (genital) infection to a parter that is HSV 1 negative via intercourse using a condom?

Thanks!

[H. Hunter Handsfield, M.D.]

As I explained above, if there is no obvious outbreak, tranmission by intercourse is extremely unlikely to result in transmission even without a condom.  With a condom the chance is even lower.

[yogini3]

Great.

Thank you, Doctor!