Partners have different HSV1: genital & oral

My girlfriend and I have been in a monogamous relationship for about three years.  
When I was a kid, I'd get cold sores every few years, but couldn't remember the last time I had it.  
In college, I was tested and they let me know that I was positive for HSV1 - no surprise there, I thought, because I it just meant I had cold sore outbreaks sometimes.  

I felt a tingling on the outside corner of my mouth one night a few weeks ago, thought nothing of it, and performed oral sex on my girlfriend that night.  The next day, I had a cold sore outbreak (oral).  A few days after that, my girlfriend had an oral herpes outbreak (something she's never experienced/had before); she went to her gynecologist and tested positive for oral herpes (her doctor didn't bother distinguishing between HSV1 & HSV2).  

I've done some reading and research and I understand that I have oral HSV1 and not genital HSV1.
My girlfriend now has genital HSV1 which she contracted from me.  

1) Are genital HSV1 and genital HSV2 virtually the same thing?  That is, if she ever has more sexual partners, is this the kind of thing she needs to disclose (I felt like my oral HSV1/cold sores were a nonissue until now)?

2) Does this mean that she can no longer have unprotected sex with anyone who does not have genital HSV1 (namely, me)?

3) Am I completely immune to her genital HSV1 because I have oral HSV1?

4) Can I still perform oral sex on her without worry?

5) What are the risks of transmission of genital herpes type 1 if we have unprotected sex (because herpes is spread by skin to skin contact, is there another form of protection you can recommend)?  Is there a possibility that we can have unprotected sex without me contracting genital hsv1?  

6) My girlfriend is concerned that high estrogen levels can cause an outbreak; she wants to know if she should discontinue birth control or if she can stay on it.

7) Will herpes be curable in the near-future?

Sincere thanks!


  

[H. Hunter Handsfield, M.D.]

Relax.  All is well.  You and your partner need take no precautions to prevent HSV transmission.  There is no need to restrict your sexual practices in any way.

Once someone has HSV of either type, s/he is immune (or at least highly resistant) to a new infection with the same type, anywhere on the body.  That is especially true when both members of a couple are infected with the same strain of HSV -- which certainly is the case if it is true that your partner's genital herpes came from your oral infection.  To the specific questions:

1) No.  Genital herpes due to HSV-1 usually has fewer outbreaks and less asymptomatic viral shedding than HSV-2.  See the thread whose link I provide below.

2) Your partner probably has a low potential for transmission of her genital HSV-1 to anybody.  There is no chance she can give it back to you.

3,4) Yes to both questions.

5) No transmission risk. See above.

6) Estrogen has no known effect on frequency of HSV outbreaks.  With genital HSV-1, your girlfriend probably will have few or no future outbreaks.  See the link.

7) I do not expect herpes to be curable in the foreseeable future.  

Here is the link you should read, which goes to a lot of detail about genital HSVB-1 infections:  http://www.medhelp.org/posts/STDs/Recently-diagnosed-with-Genital-Herpes-HSV1/show/969931

Good luck--  HHH, MD

[H. Hunter Handsfield, M.D.]

My wording above seems to imply I wasn't sure that you transmitted HSV-1 to your girlfriend.  It is very clear that you did, and that the two of you are now sharing the same HSV-1 infection. I didn't mean to suggest otherwise.  And you apparently transmitted the infection to her both genitally (by oral sex) and orally (by kissing).  That is slightly atypical, but not rare.  In any case, it doesn't change any of my opinions or advice.

[IHaveAQuest10n]

I felt a tingling on the outside corner of my mouth one night a few weeks ago, thought nothing of it, and performed oral sex on my girlfriend that night.  The next day, I had a cold sore outbreak (oral).  A few days after that, my girlfriend had an oral herpes outbreak (something she's never experienced/had before); she went to her gynecologist and tested positive for oral herpes (her doctor didn't bother distinguishing between HSV1 & HSV2).

CORRECTION:

A few days after that, my girlfriend had a GENITAL herpes outbreak (where I performed oral sex on her)'  she went to her gynecologist and tested positive for GENITAL herpes.

Does this change any of your responses?  I am sorry for the mixup.  

[IHaveAQuest10n]

Also, I do NOT have genital HSV-1.  

Does this change things?

Thank you so much, Dr.  

[H. Hunter Handsfield, M.D.]

Actually, I misread your original question, but by chance I got it right after all:  our mutual errors canceled each other.  I thought your partner had acquired genital herpes from you, even though you said it was oral.  Then with your follow-up comment, I thought she had acquired it both orally and genitally.  I now understand that you had oral herpes and transmitted it to your partner's genital area.  She now has genital HSV-1.

Despite the initial miscommunication, all my original replies are accurate.  You and your partner no longer have any worries about herpes; neither of you can transmit the infection to the other again, either to mouth or genitals.  It would make sense to avoid sex during painful outbreaks, but only for comfort.

Sorry for my contribution to the confusion.

[IHaveAQuest10n]

Thank you so much Dr.

Is there any possibility that my girlfriend may give HSV1 genital herpes to other partners?

Thank you thank you thank you; you don't know the burden that this has lifted off our shoulders.

[H. Hunter Handsfield, M.D.]

If your girlfriend has sex with other partners, of course there is possibility of transmission.  But it's unlikely.  (Did you read the other thread whose link I posted?  It explains this in detail.)

[sarahsfocus]

A related discussion, hsv1 was started.