Transmission of HSV 1 genitally

[Shunt]

50 yr old female with genital HSV1. Only have had a few minor outbreaks in the past 21 years and the last one being a few years ago. I am in a relationship with a 48 yr old male. Don't know his HSV statis. Long distance relationship and was with him for 4 days last week (1/3-1/6). Had unprotected sex numerous times over the 4 days. I was experiencing soreness but thought it was due to the frequent sex. Found out today that I may be (did a culure and awaiting results) in the throws of an outbreak (and also bacterial vaginosis) outbreak is more severe than any of my other outbreaks including the primary. I am very concerned that I could have transmitted it to my partner.
You have said that genital to genital HSV1 is rare and chances at his age he already has HSV1 perhaps orally. I know you don't have a crystal ball but how high are the chances he could have gotten it from me and when would the signs show up.
Thank you in advance.

[Edward W Hook, MD]

Cipro could be a contributor, as could a yeast infection related to the Cipro use.  I think we're both decidng that this is not likely to be herpes.  EWH

[Edward W Hook, MD]

This entire outbreak sounds highly atypical for recurrent genital HSV-!.  I hate to raise the possibility but is it possible that you have acquired HSV-2 and this is the initial episode?  The other thing that comes to mind is whether or not there might be a drug reaction of some sort in play.  The more you describe this, the more it sounds like something other than a recurrence of your genital HSV-1.  I think that given the situation being on valtrex is the right thing while awaiting cultures.  Please let me know the results of the culture and whether the valtrex seems to help.  EWH

[Edward W Hook, MD]

Reading your post tells me that you are a caring person.  In most cases, with the history you've given, I would have expected you to be concerned that he might have given you something rather than that you might have given him your infection..

I think the danger here is assuming anything.  I stand by my (our) repeated statements both that genital to genital transmission is very rare and that recurrences of any form of genital herpes, when they occur, tend to be milder than initial episodes.  Thus from my perspective I would anticipate that it is likely that your symptoms do not reflect a herpes recurrence but perhaps something else such as severe bacterial vaginosis or a result of minor trauma in the setting of repeated sexual encounters.  A question and then some suggestions:

1. Does he know that you have genital HSV-1?  If so, I think the thing for you to do as your relationship moves forward is for him to be tested.  This would allow you to sort out your relative risks (or non-risks) depending on your antibody status.
2. Wait for your culture results before assuming that you are having an outbreak.  BTW, what makes you now think you hare having an outbreak?
3.  If it turns out you are having an outbreak, he needs to be told so that you can figure out what to do from here.  Transmission to him is still not too likely if you are having an outbreak but the odds are higher than if you were not.

I realize this does not give you a numerical risk estimate but I hope it helps.  Feel free to ask additional clarifying questions related to your situation.  EWH

[Shunt]

Thanks..I went and got some Benadryl. I suspect it will most likely clear up soon.
Thanks for all your advice. It was greatly appreciated and helped me think rationally and listen to myself...I know my own body pretty well.

[Shunt]

One more question: I took Cipro for 7 days and 5 days after my last dosage I started with the soreness/irritation and lesions popping up. Could Cipro cause this and if so do I just let the reaction run it's course?
The more I think about it this is not anything like my other infrequent OB's. I don't these are herpes lesions.
Thank you and I promise this is my last question.

[Shunt]

Highly unlikely I have HSV2. He was in a longterm marriage and I trust him completely on that one. I have only been with him for the past year so I wouldn't have gotten it anywhere else. No drugs that I'm taking. I did have a UTI 2 weeks ago for the first time in my life. Was on cypro for 7 days. Going through Menopause so don't know if my body is just changing. I will await the culture and let you know. I started my treatment for the Vaginosis last night. I have also noticed I am sore inside the opening of my vagina which is a first too. I am hoping it's just the Vaginosis. All very strange to me right now.
Thank you for your input and I will keep you posted.

[Shunt]

Thank you for your response.
No he is not aware that I have HSV1. Due to the infrequent OB's I did not divulge this information.
I went to the Nurse Practitioner today for the culture and asked if the Vaginosis could have caused the sores and she thought no, that they were most likely herpes lesions knowing my history of a diagnosis already. I wasn't sure it was an OB but these sores are "popping" up even in areas that were not the primary OB. A new one popped up today (5 days after the first one appeared). I realize she is not an expert as she gave me info that contradicts what I have read on this forum (telling me that I could have transferred to the other areas while having sex, etc). The sores are not typical of past ones in the sense they are not in clusters but spread around my vagina and labia in areas I never had them before but they look like sores so I "assumed" an OB. She did give me Valtrex and meds for the Vaginosis. Again, I realize you are not examining me but does this sound like a recurrent OB to you?
I will await the culture results and be on pins and needles until then as I really care about this man and would be devastated if I transmitted it to him. Thank you.