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HSV2 disclosure and kissing
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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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HSV2 disclosure and kissing

Dear Doctors,

I understand that a person has a responsibility to discuss HSV2 infection with their partners before exposing potential partners to their 'boxer shorts' region.

However: If, hypothetically, a person has Oral HSV2 (which I know is rare-but, again, this is a hypothetical) Would they be obliged to warn their partner before even engaging in a kiss?

My question is really focused on the risk of asymptomatic oral HSV2 shedding and kissing, because obviously most people wouldn't be making out with someone if they had an active legion on their mouth regardless of what type of HSV it was. I believe one of the doctors on this forum mentioned that Oral HSV2 sheds on about 1% of days.

Thank you for your time!
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Welcome to the forum.

This hasn't been subjected to careful study.  The known facts are that 1) oral HSV-2 is uncommon, but it certainy occurs and probably is present in a few percent (1-5%, as a guess) of people with genital HSV-2; and 2) that both oral asymptomatic viral shedding and symptomatic oral outbreaks are less frequent for oral than genital HSV-2.  I'm not sure I can endorse your figure of 1% of days with asymptomatic shedding of oral HSV-2.  The more frequently any particular site is sampled, and the more senstive the PCR assay used, the more commonly HSV-2 can be detected, wither oral or genital.  However, not all PCR postive results necessarily mean a high risk of transmission.  The dose of HSV required to transmit infection may be a lot higher than the minimal detection level by PCR.

My advice is that anyone with known oral HSV-2 should inform his or her partners before intimate, sexual kissing (prolonged, open mouth, etc).  I don't think it's necessary for social kissing, i.e. a brief peck on the cheek or even mouth when greeting someone, interacting with their children, etc.

I hope these comments are helpful.  Let me know if anything isn't clear.

HHH, MD
11 Comments
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239123_tn?1267651214
To clarify:  even social kissing should be avoided in the presence of an overt oral HSV-1 outbreak.  My advice above is strictly limited to infected people without symptoms at the time and in the few days before the kiss.
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Avatar_m_tn
Dear Doctor,

I refrained from telling my actual story because i didn't want to bug you with an extensive post, but maybe I should go ahead, as it might clear up exactly whats going on with me.

After years of getting screened at my local free clinic where HSV was not tested for, I finally got screened in a doctors office. Low an behold, I came back HSV2 positive. Because my test was not sought in reaction to seeing an specific symptom, I technically don't know where my HSV2 lives. I DO understand that logic/statistics make it likely (I'm guessing more than 50%) that my HSV2 is genital. But I have wracked my brain to try and remember some outbreak in the past that I may have mistaken for something else, but I can't think of anything.

All this has led me to question how to handle my sex life...right on down to the most basic intimate activity of all: kissing.

If you have any further advice now that you have a more complete story, I would welcome it! I have a pretty clear picture (thanks to my doctor and the posts on this site) about being safe with genital type 2, but as I can't be 100% sure where my infection lives, the oral aspect is confusing me and I don't know how to handle oral activities with the next person that comes into my life
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Avatar_m_tn
PS-I am a gay male, if that effects/changes any advice you might have.
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239123_tn?1267651214
Give me the details of your positive blood test:  the specific brand name, if you can find it, or the lab where it was done (e.g., Labcorp? Quest?), and the numerical results for both HSV-1 and HSV-2.

Assuming your HSV-2 result is definitively positive, you can safely assume your infection is genital or anal, depending in part on your usual sexual practices over the years -- and probably not oral.  
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Avatar_m_tn
Dear Doctor Handsfield,

Thanks for the follow up. I can't seem to find my HSV1 paperwork. I may have thrown it out because it came back negative and I wasn't worried about it. As for my HSV2 paper work-Here is the info you requested:

HSV2 IGG HERPESELECT AB  
My result:  'Out of range >5.00'  
The reference range was listed as 0.00-0.89
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Avatar_m_tn
Sorry, I forgot to mention the lab was Quest.

I am curious about something you mentioned above: That a small percentage of people with HSV2 have it both genitally AND orally. Is this because the virus can travel throughout the body? Or is this because a person might aquire HSV2 in their genitals and mouth from anal/vaginal intercourse and oral intercourse with the same infect person? Most full on sexual occurrences contain both oral and penetrative sex.
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239123_tn?1267651214
That's a definitive result -- there's no doubt about your infection.

HSV-2 doesn't travel through the body; oral infection occurs only by direct oral exposure.  As upi siggest yourself, most oral HSV-2 infections are acquired at the same time they are infected genitally or anally.  However, asymptomatic oral infections probably are less common than anogenital ones.  Therefore, if you nver had an episode of obvious initial oral herpes -- typically severe sore throat accompanied by multiple painful lesions in and around the mouth -- it's qute unlikely you have an oral infection.  I think you can safely assume your infection is strictly anal or genital.

You should be on the lookout for mild genital/anal symptoms; about 60% of people with apparently asymptomatic infections come to recognize mild outbreaks.  If you are sexually active with an uninfected partner, or have more than one partner, you also could consider suppressive anti-herpes therapy, which would reduce the risk of sexual transmission.

Finally, you may be aware that having HSV-2 roughly doubles the risk of catching HIV if sexually exposed.  Symptoms or lesions are not necessary; simply having a positive blood test is sufficient.  Assuming you currently are not HIV infected, you should be especially attentive to safe sex with other men.
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Avatar_m_tn
Thanks again doctor.  I think TV, movies, etc. had me operating under the impression that a herpes outbreak is very painful and borderline unmistakable. It is interesting to hear you say they can be mild. I probably assumed my initial outbreak was chafing or something to that effect. I always wear condoms and never plan on stopping that.

Thank you for taking the time to answer my many question! It is greatly appreciated.
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Avatar_m_tn
Dear Dr. Handsfield,

On the off chance that my HSV2 is oral does he heightened HIV risk apply? Or is the heightened HIV risk only associated with anal intercourse + genital type 2?

(I'm guessing your answer is going to be 'no' insofar as oral herpes 1 is so prevalent and yet oral transmission of HIV is low.)

Please advise me if this new question warrants a second payment. It is certainly not my intention to take advantage of this forum.

Best

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239123_tn?1267651214
Only sexual transmission has specifically been studied in relation to the elevated risk from HSV-2, i.e. no data about oral HSV-2. My guess is that oral makes little difference in HIV risk.

HSV-1, whether oral or genital, has no documented influence on HIV transmission.  The effect is strictly limited to HSV-2.

That should end this thread.  And I would suggest not asking any additional questions in a new thread.  There isn't likely to be anything more you might ask that is likely to change the opinions and advice you have had here.
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