STDs Expert Forum
HSV1 transmission risk
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HSV1 transmission risk

Hello,

I have HSV1 and tested negative for HSV2 I get cold sores once or twice a year (usually once in winter and that's it)

Look at the information from this article I found from Univ of Maryland School of Med:

"To infect people, HSV-1 and HSV-2 must get into the body through broken skin or a mucous membrane, such as inside the mouth or in the genital area. In addition to the fluid from fever blisters, each virus can be carried in bodily fluids like saliva, semen, and fluid in the female genital tract. Both herpes viruses may cause genital infections that are clinically indistinguishable, and both can be contagious even if the infected person does not have active symptoms or visible blisters.

Also, a mother can pass the infection to her baby during vaginal birth, especially if there are active blisters around the vagina at the time of delivery."
I am looking for statistics and numbers or just an overall "that would be very RARE"
It says that both can be contagious without symptoms.
1) If my partner and I have unprotected sex trying to get pregnant, what is the risk or chance he will contract HSV1 genitally from my body fluids (even though I've never had genital lesions).  Is it 80%?  99.9%?  Is it rare?  
2) What if I have a rash or a cut down there i.e. break in skin.   Can he get it?  What are the statistics?
3) What are the statistics about passing HSV1 to my baby (again, I have never had any lesions, I"m just concerned it's also in my vaginal tract).

I talked to another practitioner and she said no, since I have HSV1 ORal and we have sex he can't it genital to genital from me becuase I've never had symptoms and it's not like the cold sore virus (which lives in nerves near my head) will "TRAVEL" down to my genital area and give him an infection.

He has blood tested negative for HSV1 and 2.  Am I just being completely paranoid and nuts?
Confused
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Welcome to the STD forum.  Congratulations on being conscientious about your partner's health in relation to your HSV-1 infection.  But you really should have no worries.

First, "another practitioner" -- by whom I assume you mean Grace's reply on the herpes community forum -- is exactly right.  HSV doesn't travel through the body to sites other than the region where it was aquired.  Assuming your oral HSV-1 infection began in childhood, as for most people, then you can be sure you do not have a genital area infection.

THe information you quote from the U of Maryland website also is correct, but with one clarification.  Although the symptoms of HSV-1 or HSV-2 are identical, either during the initial infection or a recurrent outbreak, there is a crucial difference between them:  HSV-2 generally causes much more frequent outbreaks and has asymptomatic shedding (i.e. infectious periods without symptoms) than HSV-1.  Your oral herpes outbreak frequency of 1-2 times a year is typical.  In contrast, most people with symptomatic genital herpes due to HSV-2 have 4-8 outbreaks per year.

To your specific questions:

1,2) Almost certainly you don't have a genital infection and cannot transmit your infection to your partner except by kissing or performing oral sex on him.  The presence or absence of a non-herpes genital area rash or irritation will make no difference.

3) By far the highest risk for neonatal (newborn) herpes occurs when the mother acquires a new genital HSV infection in the last 2-3 months of pregnancy.  Transmission to the baby is very rare when the mother has longstanding herpes, even a genital infection; the mom's antibodies against HSV are highly protective (although not 100%) for the baby.  In your case, the main risk is if you have an oral herpes outbreak before the baby is a few weeks old -- so if and when you have a child, you'll need to be alert to recurrent oral herpes and avoid kissing the baby (and use careful hygiene) until the outbreak heals.

To be super safe, if and when you are pregnant, tell your obstetrician about your oral herpes -- and the baby's pediatrician following birth.  But the overall risk is extremely low; after all, half of all women giving birth have HSV-1, and yet there are only a few hundred cases of neonatal herpes every year in the US.

For all these reasons, the main transmission risk here is to your sex partner, and will come not from intercourse but from kissing and performing oral sex on him.  The risk will be low if you are careful to avoid such contact when having an outbreak -- but it could occur in the absence of an outbreak.  On the other hand, because of the lower recurrence frequency and other factors, genital herpes due to HSV-1 is not usually a big deal, so this isn't something he and you should be especially worried about.  In case you are interested, here is a thread that goes into detail about genital HSV-1 infections:    http://www.medhelp.org/posts/STDs/Recently-diagnosed-with-Genital-Herpes-HSV1/show/969931

I hope this helps.  Best wishes--  HHH, MD
3 Comments
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239123_tn?1267651214
You mistakenly posted a follow-up question on another person's thread.  Here is what you posted:

Hi Dr. H

Thank you and Grace for answering my questions.  I have two follow up questions.

I have oral HSV-1 and am HSV2 negative. I take 400 mg of Acyclovir 2x day to help reduce asymptomatic viral shedding of cold sores.  I know it's not foolproof with shedding but should help a lot.  We use condoms for oral sex.  

Transmission:
1a) My partner mentioned he saw something in the blogs about if I do have an active outbreak and touch him or myself on genitals or other areas of the body, that I could give it to myself genitally or he could get it genitally or other areas.

Can you pls. send me a link to that discussion?  P.s. Im very good with hand hygiene and know if I touch a cold sore to apply medicine, to wash my hands thoroughly before and after.  Anyway, that has led to some concern.  

1b) Part 2 of this question (and you may have already answered this in the blogs) is when I’m shedding the virus WITHOUT an active outbreak (and we don’t know when I shed but I’ve had the virus since childhood and take the suppressive therapy), and let’s say I touch my lips and then touch his hand or kiss him on the cheek during that one day a month when I’m shedding, can he get it?  My understanding is if I kiss him on the lips when I’m shedding or active outbreak (which I would not do, of course) he can get it.  But what about other body parts of if I innocently kiss his forehead during shedding?  

Prevention:
2) My partner is HSV1&2 negative.  I know there is not a vaccine that will prevent him from getting oral or genital HSV1 from me.  Most likely he would get oral, if anything.  In lieu of a vaccine, what if he was to take the Acyclovir daily along with me?  Could that possibly prevent the virus from 'taking hold" i.e. have there been any research studies?   If so,  would he have to take 400 mg or 800Mg?  Or would that be overkill in general.  Just curious.

Thanks!
Confused 2023
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239123_tn?1267651214
And here is my reply, which I deleted from the wrong thread:

Taking acyclovir probably will reduce oral recurrences and shedding somewhat, but we don't really know how effective it is.  HSV-1 is less susceptible to acyclovir and related drugs than HSV-2, so larger doses might be necessary.  But in the absence of research, it is difficult to judge whether there is benefit and the proper dose.  (Almost all research on this has been done on genital HSV-2 infection, with few if any research on HSV-1 or on oral herpes.)

1a) Self infection is called auto-inoculation.  It is rare in recurrent herpes; almost all such cases occur during the initial HSV infection.  Common-sense hygiene should be used during oral outbreaks -- try to avoid touching the lesions then other body parts, especially the eyes; and use frequent hand-washing or alcohol gel.  However, if you forget these things, almost certainly nothing would happen. This isn't worth any worry.

1b) Such indirect exposure is unlikely to carry enough virus to transmit it.  In general, simple contact with HSV is not sufficient.  The virus has to be massaged into the tissues.  That's why initial genital herpes usually involve the sites of maximum friction during sex -- penis in men, labia minor and vaginal opening in women.  Just avoid kissing or oral sex when you're having an outbreak, and otherwise don't worry about transmission.

2) The effectiveness of acyclovir and related drugs by uninfected persons to prevent HSV is not known.  Likely it would reduce the risk, but no such research has been done.  For all the reasons discussed in all my replies, I don't think this is necessary and I don't recommend it.

That will end this thread.  Take care.
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