Herpes Confusion

[virgogrl]

Hi Dr.  I know you must be completely sick of herpes questions but there is so much conflicting information on the subject it's hard to come up with a concrete answer so I hope you don't mind the repetition.  I did make a good faith effort to research before I posted but I need some clarity.

1.  I am 100% positive that I have HSV1, I have been tested and the results were positive.  I only get outbreaks inside my nose which is strange but I blister and scab but get frequent reccurences, maybe due to the sensitive area.  Anyway, my first question is since I only have outbreaks inside my nose is there anyway I could transmit it to someone since it is highly unlikely that the other person would never come in contact with a sore?

2.  Since I have HSV1 I have read that I am immune from getting HSV1 on my genitals but I could still contract HSV2, is that correct?

3.  If I were to have HSV2 on my genitals and had oral sex performed on me (not during an outbreak)would my partner then contract HSV2 on his mouth if I happened to be shedding the virus unknowingly?

4.  I have a friend who got contracted genital herpes and her gynecologist told her it wasn't a big deal and a vast majority of single people have it and just don't know it, and to just wear a condom when having sex and don't worry about oral sex.  She also said as long as she practiced safe sex there was no obligation to tell her partner.  On one hand I don't think herpes should control or ruin anyone's life but on the other I don't think it's "no big deal" and I would feel terrible transmitting it to someone by accident.  I guess each individual had to make an ethical decision.  I was just wondering what your stance was on the subject if you are allowed to give an opinion.

Thanks, have a good day.

[H. Hunter Handsfield, M.D.]

I’ll go straight to your questions.

1) Recurrent oral herpes involves the nose pretty commonly.  You should avoid performing oral sex or kissing someone when you are having an outbreak.  I don’t know how often such people have oral shedding of the virus (i.e., in saliva) when not having an outbreak - so it’s hard to give firm advice about the risk when you’re not having symptoms.  The risk for any single exposure undoubtedly is low.  If or when you have a regular partner, it would be good for that person to be tested.  If s/he already is positive for HSV-1, there will be no significant risk of transmission.  But for more casual partners, you will have to make a personal decision about whether or not to inform someone on whom you might perform oral sex.

2) Yes, people with HSV-1 remain susceptible to HSV-2.  There might be slightly reduced risk (the research is conflicting) but it isn’t much.

3) Transmission of genital HSV-2 to the mouth by oral sex is possible.  It’s not all that common; that is, few people who present with oral herpes have HSV-2 as the cause.  But it’s possible.

4) It’s unsafe to comment on third hand information; too much chance that your friend misinterpreted what her doc said, etc.  But around 20-25% of sexually active single people do not have genital herpes, not “the vast majority”.  And I disagree about the doc's ethical advice, as you describe it.  STD experts generally believe that every person with genital HSV-2 has an obligation to inform his or her sex partners.  It’s less clear for genital HSV-1, since recurrent outbreaks and subclinical shedding are less common than for HSV-2.

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

[Jerefrancis]

I think it's in your best interest to inform any potential sexual partner of your current situation regarding herpes.  Why?  For starters if you are drawn to that person emotionally and the partner is a potential companion it would be very problematic to tell them after the fact.  Secondly look at it from the other persons perspective.  Unfortunately talk is cheap when it comes to these responses i'm giving you, because quite frankly if you tell a potential partner of your status that person may call it splitsville before engaging in any sexual actvity.  Understandably that is the primary fear of informing potential partners of your STD situation.  However at the end of the day, I think informing people of your virus will certainly break the ice and perhaps take stress off the situation.  All of this talk is coming from the assumption you have genital herpes, but based on your description it seems as if you don't, but i'm just playing devil's advocate.

[H. Hunter Handsfield, M.D.]

My answer no. 4, second sentence, should read "But around 20-25% of sexually active single people have genital herpes, not 'the vast majority'."

HHH, MD

[virgogrl]

Thanks for your reply.  You stated "But around 20-25% of sexually active single people do not have genital herpes" which would mean that 75% do which would mean the majority, did you mean to say that 25% do have it?

I was under the impression that HSV could only be transmitted by skin to skin contact and not saliva, if I have an outbreak inside the nose how would it ever be transmitted?

[H. Hunter Handsfield, M.D.]

Apparently you didn't see my clarification before you posted your follow-up comment.  I meant 20-25% DO have genital herpes.

Re-read my reply, response to question 1.  It is possible that people with recurrent HSV-1 involving the nose might also have periods of subclinical shedding of virus in the mouth.  This would be similar to people with recurrent genital sores on the labia, who also have subclinical shedding from the cervix.  To my knowledge, it has not been studied for HSV-1 around the mouth and face.  Therefore, I cannot say whether you could transmit HSV-1 by exposure to your mouth.  As I said in my original reply, I suspect the risk is low, but there is no way to know for sure.

HHH, MD