HSV 1 transmission, symptoms

Dear Doctors,

First off thank you so much for your time. The background to my situation is that my ex boyfriend performed oral sex on me about 4 years ago. I ended up with the typical ulcers ( a few of them) and got tested. I just today got my results.....my doctor was/is unhelpful and just told me I had genital herpes.....the results said I have HSV 1. I did research after my initial visit with her and i'm a little confused b/c what I expected has not happened. I don't present like I think I should.

First thing is that I haven't had an issue since that first one in four years. Maybe one in my mouth but I've had them since I was little b/c my parents transferred them to me. I have no symptoms or problems what so ever, especially since I left my ex which seems weird to me.

Second of all, I have had other partner which I've told the worst case senario and again have not had issues, outbreaks or have transmitted it to them. How likely is it that I will being that I don't ever have symptoms or present with issues?

Assuming that they will get it by shedding will it present orally or genitally for them and is it more likely for male or female to get infected with the virus?

My doctor said she could swab me again since the blood test will always be positive knowing that I've had it since I was little, is there any point to this....I feel like this will come up negative to be honest. I would like to know if I'm making this a bigger deal than what it is being that I now know I have HSV 1 and what type of risks and issues I should be expected. I don't want to freak anyone out or cause me more years of undo stress when it's not needed. Thank you again so much for your time.

Beth

[H. Hunter Handsfield, M.D.]

Welcome to the STD forum. I'll try to help.  The main take-home message is good news:  most likely you won't have any further trouble with your genital herpes and probably are not at high risk for transmission to your sex partner(s).

Herpes is the most common cause of genital ulcers, so combining that history with your positive blood test is strong evidence that you indeed had an initial genital HSV-1 infection 4 years ago.  However, half the population has positive HSV-1 blood tests, usually going back to HSV-1 infections caught during childhood; and not all genital ulcers are due to herpes.  If you ever have a new genital outbreak, the lesions could be tested directly for HSV-1 -- but the odds are good that will never happen.

Genital herpes due to HSV-1 has important difference compared to HSV-2.  Whereas almost all persons with initial symptoms due to HSV-2 go on to have fairly frequent recurrent outbreaks (average 4-6 times per year), among those with HSV-1, 40% have no additional outbreaks at all and most of the rest have 1-2 outbreaks in the next 2-3 years -- that's all.  In addition, asymptomatic shedding of the virus is much less common, so there is little risk of genital-to-genital transmission to sex partners.  (In my 30+ years in the STD business, to my knowledge I have never seen a case of genital HSV-1 that was not acquired by oral sex.)

Most likely your occasional oral symptoms are not herpes.  Most likely your infection is genital only.  However, this also is somewhat uncertain.

Since you have hasd no recurrent genital outbreaks in the past 4 years, most likely it will never happen.  If it does, outbreaks probably will be infrequent.  And most likely there is little risk of transmission to partners.  However, nobody can say the risk is zero, and you should plan to tell your future partners about your infection.  But you can do that in a way that reassures them that the transmission risk is low.  (In addition, you can expect that at least half your potential partners will already have positive blood tests for HSV-1.  Those persons are immune to catching it again, so no transmission risk at all.)

For more detailed discussions of genital HSV-1, use the search link; here is a recent thread you can start with:  http://www.medhelp.org/posts/STDs/Recently-diagnosed-with-Genital-Herpes-HSV1/show/969931

Finally, for detailed, ongoing discussion about living with herpes and what (and how) to say to partners, see the herpes community forum.  The moderators there are experienced herpes counselors.

I hope this helps.  Best wishes--  HHH, MD