HSV1 Genital Transmission

I am a female, 35 and was diagnosed with Genital HSV1 in March of 2007 after acquiring it from oral sex that was performed on me.  Diagnosis was confirmed by a swab my doctor took and tested.  Was negative for HSV2.  I had my initial outbreak which was pretty severe but have never had an outbreak since that time.  I am seeing someone new and we have engaged in very moderate sexual contact at this point.  However, I am interested in going to the next level with him.  My question is do you feel that after 2 years without no additional outbreaks I should inform him of my prior infection?  I know you say the likelyhood of transmission genial to genital is rare but can you elaborate?  Should I use a condom to be safe?  Just looking for some guidance and suggestion. I don't want him to freak out and run for the door if I tell him this at this point in the relationship.
Thank you so much.

[H. Hunter Handsfield, M.D.]

Welcome to the STD forum.  I'll try to help.

I have some good news for your.  If someone has to get genital herpes, HSV-1 is the type to have.  Your situation is very typical.  With HSV-2, almost everybody has recurrent outbreaks a few times a year and everybody has fairly frequent asymptomatic viral shedding, with high potential for transmission to sex partners.

By contrast, 40% of people with new genital herpes due to HSV-1 have no recurrent outbreaks at all, and most of the others have just 1 or 2 recurrences, then no more.  Asymptomatic viral shedding also is much less common with HSV-1 than HSV-2.  These data are valid through 2-3 years, with not much information beyond that time; but most likely there are few recurrences and little asymptomatic shedding after that time.  As a result, transmission of genital HSV-1 to sex partners is uncommon.

As for your current partner, since the chance of transmission is low, an argument could be made that you need not say anything.  On the other hand, you may not want to take even a very small risk of transmission without prior warning.  So it would be wise to inform him of your infection.  But you can also provide the reassuring information I just gave.  (You could even print out this reply and discuss it with him.)  It is unlikely you will ever transmit your genital HSV-1 infection to him or anyone else.

Of course there are no guarantees -- you could be the exception with asymptomatic shedding or a recurrent outbreak at just the wrong time.  But the odds are in your (and his) favor.  In addition, he could have a blood test to see if he is already infected with HSV-1.  It's a good bet he is, since half the adult US population is infected.  If so -- that is, if a blood test is positive for HSV-1 antibody -- then he is immune to catching it again, anywhere on his body.

There are some excellent websites with more information about all this.  Take a look at the information available from the American Social Health Association (www.ashastd.org), CDC (www.cdc.gov/std), and the Westover Heights Clinic of Portland, OR (www.westoverheights.com).  Disclosures:  Dr. Hook and I serve on ASHA's board of directors, and WHC is run by Terri Warren, who moderates MedHelps herpes forum.

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

[heather2000]

Thank you doctor, this is very helpful information.  I do have one quick follow-up question.  If someone is infected with genital HSV1- how long would it take to show sypmtoms?  
Thanks again.

[heather2000]

Sorry, I promise this is my last question/post.  Also, I read an old archive from a previous quesiton and you mention in  your career, you have never seen a case of Genital HSV 1 passed to a partner genitally.  Am I understanding this correctly or has the data changed?
Thanks again.

[H. Hunter Handsfield, M.D.]

I'm glad to be of help.

The statement about my experience remains true, but it doesn't really mean all that much.  That a particular expert hasn't seen a rare outcome doesn't tell how rare it actually is.

With new infections with HSV of either type, symptoms usually start in 3-5 days, rarely later than 10 days.