HSV-1 transmission

[unluckyone]

Hi,
About 8 months ago, my boyfriend and I spent a night away, and thinking that his cold sore had healed, he performed oral sex on me. A few days later, I developed some sores around my vagina and went to the doctor, but they didn't think it was HSV at all, and sent me home. A few days later my symptoms worsened, my lymph nodes became enlarged, and the sores began to crust, and I was sure it was HSV. I went back to the doc, at which point they did a swab test, and I found out I was positive for HSV-1.

I have not had a recurrence of HSV-1 symptoms since (it's been 8 months) despite the fact that I've been highly stressed out from grad school applications and a bad break up, haven't been eating well, and spent pretty much the whole summer out in the sun (which I hear can all be triggers of recurrent outbreaks). When I've posed the following questions to doctors, they've all given me different answers, and left me more confused than I was at the beginning.

If I have sex with a new partner (assuming they've had no previous exposure to HSV of any kind at all) ... what are the chances I might transmit it to them during an asymptomatic phase through genital contact? Do I need to tell them I have genital herpes, or is genital HSV-1infection a one-time thing ... like getting the chicken pox?

Also: What are the chances that I will have an outbreak in the future? Do most people with genital HSV-1 have recurrent outbreaks, or is there a chance that I might not have an outbreak again?

Thank you so much!

[Edward W Hook, MD]

Thanks for the clarification.  I'm afraid this does not change my advice however.  While genital herpes due to HSV-1 has fewer recurrences and less asymptomatic shedding than for HSV-2, less is not none so there is a chance, albeit it a low one of contracting an infection that is, as you are experiencing, in general, not too troublesome.  

We do know that genital HSV-1 can be transmitted sexually from one person to another and that even more rarely, that someone with cold sores can then get GH from HSV-1 as well.

So the question really comes down to the fact that the odds are far better than for genital herpes due to HSV-2 but there is still a chance of transmission so, just how much of a chance do you want to take.  I am not trying to sound glib here, just want to be clear on the facts.

I hope this helps. EWH

[unluckyone]

I think I should clarify that at the time I became infected with HSV-1 my immune system was weak (we were drinking and high on ecstacy)... and I feel this may have contributed to my vulnerability to the virus.

I'm also thinking that since the virus is outside its site of preference, the likelihood that it could be transmitted to someone else's genital area (again outside its site of preference) is very low... probably lower than if someone infected with oral HSV-1 but who doesn't have a cold sore, were to kiss someoneelse?

Finally, if my new partner has had a cold sore previously, doesn't this mean that they already have antibodies to HSV-1 and cannot be infected genitally?

[Edward W Hook, MD]

The natural history of genital HSV-1 is different than when genital herpes is caused by HSV-2 in several important ways.  These include fewer overt recurrences and less asymptomatic shedding of the virus.  This however does not mean that you will not have asymptomatic HSV-1 shedding or that you cannot spread it to a partner but that it will be less common than for a person with HSV-2.  Condoms will reduce this risk. As a result of the biological differences in the infection when caused by HSV-1 there is not a firm recommendation for chronic suppressive therapy with antiviral therapy (i.e. acyclovir, valacyclovir or famciclovir) in this situation.  that said, there may be some benefit (as well as cost to you for medication).  

Genital HSV-1 is not a one time thing however and you may have outbreaks in the future (everyone is different-- your chances of having future outbreaks are substantially lower than if this was HSV-2).  Many people do not have recurrences.

I would recommend condoms for sure and disclosure, while difficult, is always the best path.  

Hope this helps.  EWH