Very confused about HSV-1

[mellowage]

I am in my 50s, and have never had oral or genital herpes symptoms that I am aware of. I recently had a small pimple/cyst on my pubic area, and went to a local clinic to have it checked. They said it did not look like herpes at all, but because I was concerned they tested the spot and did blood tests as well. I went ahead and had an overdue PAP smear while we were at it. They gave me an antibiotic script for the pimple.

All the test results were completely normal, except that I tested positive for antibodies to HSV-1. The PA at the clinic was very dismissive of any concerns about it -- "probably got it in childhood," "very common," "don't worry about it at all," etc. I called an STD clinic hotline and basically got the same message. They said there was a very small chance of a completely asymptomatic person like me passing it on through kissing or oral sex, but the virus so common that they actually recommend against routinely testing for it because it creates unnecessary anxiety.

I understand that the virus IS very common in people my age and older, but much of the online info I see about HSV-1 is far more alarmist than the advice I've gotten.I see some people recommending taking medication to prevent viral shedding of HSV-1, as well as always using condoms for both intercourse and oral sex. I'm confused about what I should do, and how much I should worry about passing along to virus to a partner in my age group. I understand that there's nothing to worry about if a partner has a history of cold sores, but what about someone who doesn't? Should I really send that person off to get tested for HSV-1 before we have oral sex without a condom? FWIW, I have only had two sexual partners in my life, and I feel pretty confident that my infection was oral, although of course I can't know for sure.

I don't want to be irresponsible, but I also don't want to make a big deal out of a risk that is vanishingly small. Thanks for any clarification you can offer.

[Edward W Hook, MD]

Welcome to our Forum.  I'll be happy to address your questions.  Your concerns are common ones.  Persons get blood tests, find they have HSV-1 and then go to the internet for information and get misled by the all too common mis-information they have.   Your assessment sounds to be on target and thus the problem is what do you tell your partner.  

It sounds to me as though the health care providers you have interacted with are well informed and approach things as I do,  There is no reason for you to worry or to change your sex practices based on your test result.  I agree that it is statistically likely that your infection was acquired long ago, probably in childhood and that there is little chance of your transmitting infection to him, if your partner is even susceptible to infection (well over 60% of adults in the U.S. have HSV-1, even though most do not know it).  

The dilemma here is not what to do (that’s easy, don’t change a thing and don’t worry) but what to tell your partner.  You now have information that you probably wish you did not have.  The chance that your partner is at risk is low and even if he is, the chance that you will transmit infection to him is tiny.  The big question however is that, now that you have the test results, how would he deal with the fact that you were, through no fact of your own, tested for HSV and found to have HSV-1.  I cannot answer.  Disclosure is always the best course although, sadly, on occasion it can have untoward consequences.

I hope this comment is helpful.  EWH

[Edward W Hook, MD]

Thanks for your thanks,  I'm pleased we could help.  EWH

[mellowage]

Dr. Hook, I just wanted to let you know how much I appreciate the work you and Dr. Handsfield do here on the forum. Since you answered my question a few days ago, I have searched through the archives for information about other concerns I have, and it has been so helpful and reassuring to be able to access your expert advice. It is a great antidote to all the hysteria and misinformation out there. Thanks again.

[Edward W Hook, MD]

I'm glad I could help.  EWH

[mellowage]

Thanks so much for the prompt and reassuring reply. It is immensely helpful. I have already disclosed to my partner and I will share your answer with him.