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HSV1 - Asymptomatic Shedding Risks - oral and genital
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The STD Forum is intended only for questions and support pertaining to sexually transmitted diseases other than HIV/AIDS, including chlamydia, gonorrhea, syphilis, human papillomavirus, genital warts, trichomonas, other vaginal infections, nongonoccal urethritis (NGU), cervicitis, molluscum contagiosum, chancroid, and pelvic inflammatory disease (PID). All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.

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HSV1 - Asymptomatic Shedding Risks - oral and genital

I have started to date a new woman who has informed me that she has oral herpes - she has had it since she was a kid, is in her early thirties now  and gets outbreaks infrequently, in fact, she said usually only if she mistakenly gets hit in the the lip hard while playing sports.

I am in my thirties, was tested by my doctor and I do not have oral herpes (or any herpes)  - came up negative in my recent blood test.

So, here is the question - I have read much of the information on the site, but realistically, if I do not kiss her when she's having an outbreak, do I have a real concern about getting it if we only kiss when it's not visibly present?

My main concern is with asymptomatic shedding I guess as the information on it seems confusing.

1) Have studies been done showing what the real world risks of getting oral herpes through asymptomatic shedding from adult to adult is through kissing?

2) Since I'm in my 30's and I have not yet gotten it, could I be immune?

3) This woman seems great and I could see us starting a long term relationship - if we do and we keep kissing, are the chances that eventually I will get an HSV1 infection from her?

4) In terms of transmission to the genitals, should a condom be worn at all times, even when no lesions are present?

Basically, what are my real world risks of getting it from her?

Trying to decide how to move forward safely, or if I should "just be friends" with her, despite her being really cool.

Thank you.
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My first reaction--and my closing one, as you will see below--is that your priorities seems backward.  Half of all Americans have oral herpes.  Most don't know it.  The fact that your partner has a known history of oral herpes doesn't make her any more risky to your health than half of all other women you might have dated in the past or might have sex with in the future.  Yes, there is a possibility you could get oral herpes by kissing her; the odds are very low if she isn't having an outbreak, but they aren't zero.  Same if she performs oral sex on you.

To your specific questions:  1) No, there are no data to give you an estimate of the risk, except that it's low.  2) A negative blood test for HSV-1 proves you are not immune.  The opposite:  you are fully susceptible.  3) There is a good chance you would go a lifetime and never get HSV-1 either orally or genitally.  But certainly you might be infected somewhere along the line.   But so what?  Most HSV infections are asymptomatic, so you might not even know; the symptomatic ones usually are mild; and if you get prominent symptoms, effective treatment is available.  4) Your prospective partner probably does not have genital infection, so I see no reason for condoms.  I suppose you could use condoms if/when she performs oral sex on you, but that's not a realistic option for most people.  It makes sense to avoid oral sex when she has an outbreak, but otherwise I wouldn't worry about it.

The risk of herpes, either genital or oral, rarely (if ever) is a valid reason to forego an otherwise promising sexual relationship.  Sexual and romantic fulfillment are much too important and most cases of herpes much too trivial to allow the one to get in the way of the other.  But if at some gut level you feel otherwise, you probably should avoid getting into the relationship.  Or consider counseling to help you put your priorities in order.

Good luck--- HHH, MD
My husband has type 1 coldsores. Been with him 14 yrs and I don't have it. I did find out I have hsv 2 though recently adn he doesn't. It is so weird. I have wondered and thought I must for reasons like itchiness, redness and tears. He is hsv 2 neg. It is so weird. I think maybe we each must have enough antibodies from the type we have to block ourselves from getting the other type from eachother? I don't know. I do want another type 2 herpes select test as I am just having a tough time believing I have it. We both touch the tears and I have had him inspecting it when I get irritated for yrs. We don't get it on our hands and he never got it from me. I was so worried about his cold sores and low and behold my suspicions were right and I have hsv, apparently anyway. Never any classic lesions. How and why he doesn't, I will never know. He gets a prodrome with his cold sores. I never do with this vaginal irritation business. It just comes on. I would almost have rather gone on believing I was fine and it was all in my head. At the same time it gets old thinking you are paranoid and it is in your head. So many doctors missed it for yrs, yet it was always in the back of my mind. I do hate the diagnosis though. Apparently, nothing will change. Committed relationship since 93 and all is well so I guess with a great family, Why should I worry so much, eh? I wouldn't worry if I were you. Ask her to tell you for sure when she feels the prodrome, itchy and tingly feeling coming on and to warn you right away.
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H. Hunter Handsfield, M.D.Blank
University of Washington
Seattle, WA
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