Herpes & Cold Sore Issue, possible exposure

[barnyardmt]

Hi Dr.,

Wanted to get some feedback from on a situation I am experiencing.

Background:

I have oral herpes (fever blisters) usually 3 times a year.  My wife has never had Oral Herpes, and neither one of us have ever had any genital herpes that we know of.  We have always been very careful not to engage in any contact sexually when I have had an active fever blister

The issues in question's  & Time line is below:

10pm, gave vigorous oral sex to my wife with a lot of contact for about 10 minutes.  Then we had intercourse and then she gave me oral sex to finish off

9am this morning, I get that familiar feeling of a cold sore coming on.  It has developed on my upper lip kind of off to the side, but not in the corner of my mouth.

My concerns are these:

1) how much are we at risk in that the cold sore was not noticeable last night but may have been in the early active stages when I gave her oral sex. ie the potential that I could have given her genital herpes?

2) Is it possible that she has had an inactive non-outbreak genital herpes and that is what caused me to have the cold sore today?

3) How should we proceed with monitoring/assessment and protective measures

Any help and advice will be greatly appreciated.  THANKS!!!!

[barnyardmt]

One addendum follow up to my question.......let me know if I owe you another $15  ; )

So are you indeed saying that since I get cold sores I obviously have HSV 1, and due to that, I cannot be affected genitally from any contact from my wife if she is HSV 1 genitally because i already have it....meaning that I could never have a genital HSV 1 Outbreak?

THANKS for all your help Docs!

[barnyardmt]

Sorry Dr. one more question,

Which is the best Type Specific Blood Test we should look for at the different testing centers?

THANKS!!!!

[H. Hunter Handsfield, M.D.]

In the absence of symptoms, I cannot judge whether or not your wife might have been infected back then.  If her blood test is negative, then you'll know she was not.  If positive, she could have caught it from you, either orally or genitally, or somewhere else entirely; you will never know when and by whom.

[barnyardmt]

Last Question for now and I'll let you help others

i seem to remember we had a similar situation years ago when we were dating...am I safe in thinking that since she never got any symptoms then....then that is at least something on the positive side of things in that she may indeed already have the HSV-1  ...THANKS again, and I will definitely have her go get a blood test for HSV-1
Thanks!

[H. Hunter Handsfield, M.D.]

1) True.

2) It takes at least 3-4 weeks for the blood test to be positive.  It would be a good idea for her to be tested soon.  If it's positive, you'll know for sure she was infected in the past and is no longer susceptible.

3) There is no need for condoms to protect either your wife or yourself.

Thanks for the thanks--  

[barnyardmt]

Thanks for the response dr. Hansfield.
Please allow me to list some follow up questions:

To Clarify:

1) If I did indeed, and god I hope not! transfer HSV-1 to her last night, she can never give it back to me in anyway through a genital to genital contact in the future?

2)Would it make any sense for her to get a blood test tomorrow to see if she has HSV-1, or is it too late in the sense that the contact/exposure we just had last night could already show up in the blood?.....ie we have to wait it out and see if she has any symptoms before we get a test......also, how little time or how long a time should we wait for symptoms before we feel safe again?

3) Also, playing off question 1, should I wear a condom during intercourse now or should we abstain?

THANKS for your help Dr. Hansfield!  I really appreciate your expertise!

[H. Hunter Handsfield, M.D.]

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

The risk of HSV transmission in this situation can be broken down into 2 components:  the likelihood you were shedding virus and that the exposure could have transmitted it; and whether or not your wife is susceptible to HSV-1.

Let's take the latter first.  If your wife already is infected with HSV-1, she is highly resistant to catching a new HSV-1 infection anywhere on her body.  Half of all adults in the US (more in many countries) have HSV-1, usually dating to childhood.  Absence of symptomatic oral herpes makes no difference; it's 50% even in people without known oral herpes.  The odds your wife has HSV-1 is higher than average, since she could have caught it from you before now, either by kissing or by oral-genital contact.  Again, since most cases of HSV infection are asymptomatic, her lack of symptoms doesn't mean she isn't infected.  For these reasons, the odds are better than 50:50 that you couldn't give HSV-1 to your wife even if you tried.

The first question is easier:  there is a very good chance you were shedding virus during the sexual activities you describe, since shedding often starts several hours (up to a day or two) before symptoms start.  And the relative vigor of the exposure that you describe might increase the possibility of transmission.

Now to your specific questions:

1) If your wife is not already infected with HSV-1, there probably was a high chance of transmission.  If she is infected, the risk was very low, probably zero.  With the information currently available, it isn't possible to estimate the actual risk.

2) Even if your wife has genital HSV-1, there is no risk to you.  You are immune to catching a new HSV-1 infection.  Also, asymptomatic genital herpes is uncommon due to HSV-1, so even if your wife had a genital infection, she is not likely to transmit it in the absence of symptoms.

3) Your wife should be on the lookout for symptoms that suggest genital herpes, i.e. blisters/sores of the genital area.  If symptoms appear, she should see her doctor immediately, i.e. within a day or two, for diagnosis and treatment.  Second, if she doesn't develop any symptoms, she should have a blood test to determine whether or not she has been infected with HSV-1 in the past.  If so, she is not at risk for a new infection, for the reasons explained above.

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