HSV1 transmission questions

Hello,

I am a heterosexual woman and about five months ago I was diagnosed with genital HSV1 obtained through oral sex. While my first outbreak was intense, I have not yet had a recurrence and understand that they are less frequent with HSV1. I have been doing a lot of research and was looking for clarity on genital-genital & genital-oral transmission risks in two cases :

1) If new partner does not have HSV1 antibodies

2) If new partner does have HSV1 antibodies -  a) has it orally or b) has been asymptomatic so location unclear

In all cases cases, can you speak to precautions required and transmission risk.

I have yet to approach prospective new partner (no longer with person who gave this to me) and I want to be equipped with some answers for them from this forum as there seems to be some confusion out in cyber space around this.

Thank you for your time.

[Edward W Hook, MD]

Thanks for your questions, they address some of the important points regarding genital HSV-1 and the probability of transmission. . The chances are pretty good that even despite the intensity of your initial episode you will not have recurrences.  In addition, as I suspect you know from your own research on the topic your likelihood of transmitting your infection to future sex partners is quite low and far lower than if this were HSV-2.   On the other hand, both because it is less frequent and because it is transmitted to others genitally less often, there are few studies which address your questions in sufficient detail to provide really solid, numerical answers.  Let's work through them one by one.

Even before we get to the specific questions, let’s get to the issue of prevention.   There is no doubt that condoms will reduce the rather low risk of genital transmission of your infection to others dramatically.  Combined with disclosure to partners, these are the mainstays of prevention.  As to whether suppressive therapy with antiviral medications like valacyclovir will reduce the risk even more, there are just no good data; there are several relevant facts however.  We do know that when HSV-1 is causing oral herpes, it requires somewhat higher doses of antiviral therapy to be optimally effective for treatment.  We also know that HSV-1 is effected by antiviral therapy so it is reasonable to expect that suppressive therapy might be beneficial although this might be hard to prove in a scientific study (it is harder to prove effect on rarer events).   Finally, should you opt for suppressive therapy, I would add that we know that the frequency of asymptomatic shedding of HSV-2 decreases over the first year following acquisition of infection.  It is reasonable to think that the same occurs with HSV-1 but unproven.  Thus if you opt for suppressive therapy (this is an individual choice since there are no data, personally I doubt that I would), you might choose to only do it for a year or so.  No for the questions.

1.  We know that having HSV-1 protects from repeated infection and, conversely that not having had infection makes that person more vulnerable to infection.  In considering this however, please remember that over half of adults already have HSV-1 and that most of those do not know it because they don't get cold sores.

2.  If your partner has had HSV-1 they are resistant to repeat infection, no matter where their original infection is located. We have seen very rare situations where people with antibodies have acquired infections at a second site but those are very, very rare events which we consider to be the "exceptions that prove the rule".

I hope these comments hare helpful and I congratulate you on the mature and informed approach you are taking to your infection.  EWH

[Budda23]

A related discussion, HELP ME PLEASE was started.