HSV 1 questions.

[beccy2010]

Hi doctor,

I contracted hsv 1 approx five years ago after a one night stand with a family friend.
Onset was around twelve days after sexual contact. Originally I was diagnosed with follicilitis (sp?) I sought a second opinion and was consequently diagnosed with genital hsv 1 through a blood test and cultures.
My questions are as follow:

1. I confronted the male I'd had sex with shortly after the lesions began to appear. I noticed he had one oral herpe on his lip. He said he'd never had one before, which I find hard to believe. However, my question is this: we never had oral sex. We kissed and then had intercourse in which he did not ejaculate. Is it possible that I could have contracted hsv-1 from kissing and it just showed up on my genitals? Theoretically, is this possible?

2. I got two small sores twelve months later. Yesterday afternoon  I noticed I have had another outbreak, four years since the last and five years since the first. My current partner of almost four years is aware that I have herpes as I told him at the beginning of the relationship.  Yesterday morning no lesions had yet appeared although I had some tingling in my genitals. It's been so long since my last outbreak that it didn't even cross my mind...my partner briefly performed oral sex on me before we had intercourse. I'm concerned I may have passed it on to him now. From my own research I have read that generally transmission of hsv 1 is oral to genital or oral to oral. I haven't found anything on genital to oral hsv 1. How likely is it that he now has it?



Thank-you doctor, in advance, for your reply.

[Edward W Hook, MD]

Glad to help.  Take care.  EWH

[beccy2010]

Thank-you very much for your prompt replies. You have provided information that was both helpful and reassuring. I guess sometimes it can be awkward to ask my own gp these questions and its been so good to get my answers in an anonymous fashion.
Thank-you again, and best wishes for the new year :)

[Edward W Hook, MD]

the data on GH due to HSV-1 are limited. It is harder to study because there are fewer recurrences and it is osmetimes difficult to determine whether or not persons with evidence of HSV-1 have oral or genital infections. A good place for additional information is the American Social health Association (ASHA) web site.  (Disclosure. Dr. Handsfield and I are both members of the American Social Health Association Board of Directors.)   EWH

[beccy2010]

Sorry for posting twice, it didn't appear to go through the first time from my end.

[beccy2010]

I apologize for not being clear. I currently have lesions. The morning that I received oral sex no lesions had yet appeared. By the afternoon they had begun to appear. Does this information change any of your answers?

Also, could you provide me with any links to web sites with detailed information about genital hsv 1?

[Edward W Hook, MD]

Thanks for the clarification and sorry for my misunderstanding.  I don't think this changes any of my thoughts however.  EWH

[beccy2010]

I apologize for not being clearer, I do currently have lesions. The morning I receive oral sex I did not, by the afternoon they had started to appear. Does this change any of your answers?

[Edward W Hook, MD]

1.  That genital HSV-1 is rarely transmitted does not mean that it is not transmitted.  Assuming that the virus you had was tested properly this is the most likely possibility.  Your history is certainly more consistent with HSV-1 than HSV-2.  Asymptomatic viral shedding (i.e. having virus present in the absence of lesions) occurs in the area of infection, not over the entire body.  

2.  No, I see no obligation to tell your partner at this time.  He knows that you have HSV and you do not know for sure if this was truly a recurrence or not (as I understand it, you still do not have lesions).  There is little to be gained with generating fear.

3.    There are no data to indicate that menses consistently changes the nature of outbreaks.  I would not however advise you to stop taking the pill. this could make you vulnerable to pregnancy.

EWH

[beccy2010]

Thank-you for your prompt reply! Your answers definately helped. I would like to ask a couple of further quick questions...

1. To follow on from my first question: seeing as I didn't receive oral sex could you provide a possible theory on how I contracted genital hsv 1? I thought it had to be direct contact with the site of infection? Also, I have read about viral shedding which I don't entirely understand. Is it something that happens only at the site of infection or is it a whole body thing?

2. I haven't told my partner about my current outbreak. I feel that its never been a problem in the past, and in all likelihood won't come back for another couple of years if at all. To tell him would make him paranoid about having sex with me for months, over something that will be over within a week. Do I have some kind of ethical obligation to tell him about each episode?

3. Final question: I am abstaining from sex while I have lesions present. I am on the pill and was planning on not taking it to induce a period so I had a better excuse to abstain. I have read, however, that menstration can lengthen and worsen episodes of hsv. Is that true?

Thank-you doctor.

[Edward W Hook, MD]

Welcome to our Forum.  I'll try to help.  Your history and questions are very clear so I'll go directly to the questions:

1.  HSV is a local infection which occurs at the site of contact.  The virus then enters nerve cells which is where it resides from then on.  The virus is spread only through local contact.  Thus, with the exception of people who are profoundly immunosuppressed such as those who have received major cancer chemotherapy, HSV does not spread throughout the body in blood.  The possibility that you acquired HSV from kissing which was then somehow spread to your genitals is not a biologically realistic possibility.

2.  Most exposures to partners with genital herpes, even if lesions are present, do not lead to transmission of infection.  Furthermore, unless he has been tested, there is at a more than 50/50 chance that your partner already has HSV-1 but does not know it.  Transmission of genital infection to the mouth occurs very, very rarely and in all instances that I am aware of, this has been due to HSV-2, not HSV-1.  The likelihood that the tingling you experienced yesterday was a HSV recurrence and that you gave it to your partner either through receipt of oral sex or through genital sex is very, very low.   I would not worry.  

I hope that my comments are reassuring. they are meant to be.  EWH