genital herpes 1 transmission

[tddx]

Thank you in advance for taking the time to answer my questions.  About 6 months ago i developed grouped vesicles at the base of my penis.  I have had no prior history of this or oral herpes.  I got tested by blood for herpes type 2 antibodies at 3 and 4 months after this episode, and both time had negative results.  About 1 week ago, i developed my first recurrence of the lesions.  I assume I have genital herpes type 1.  I would love to get an update on some of your prior responses regarding the transmission of genital hsv 1 (i have read the forum on this carefully).

1)  you have stated that you have never seen a case of hsv 1 genital to genital, or genital to oral transmission.  Is this still true?
2)  I believe you stated there is a 0% risk of genital to oral transmission of hsv 1.
3)  Also, you said there is no increase risk of hiv with genital hsv1 versus hsv2.  Is this true, and why if u still develop sores where the hiv can get in.  I am correct that without active lesions, no increase in hiv transmission exists?
4)  and finally, i guess my main question:  is it necessary for me to tell any future sexual partners that i have genital hsv 1?  Obviously, i would not have sex with any symptoms or active lesions, and would use condoms at other times.   But my lesions are at the base of my penis approaching the scrotum and the condom can roll up at times.  I know i could test the person for hsv 1 antibodies but i'm talking about more casual encounters.  I would like your opinion.  I know you can not say it is never impossible, but if the chances of transmission are so remote then am I ok not to mention this.  If I took someone to a movie in my car, I don't mention about the remote risk of a car accident, or my driving record. Isn't this the same for my genital hsv 1 if the risk is so low, or am i just rationalizing.  thanks again for the info.

tdx

[H. Hunter Handsfield, M.D.]

I will not confirm your self-diagnosis of genital herpes, whether due to HSV-1 or HSV-2.  If you really had grouped vesicles, herpes seems likely.  On the other hand, the base of the penis is less typical than the shaft or head.  You need to see a health care provider promtply (within 1-2 days) if or when your penile lesions reappear, for proper medical assessment and diagnosis.  The rest of my replies are based on the assumption you indeed have genital herpes due to HSV-1, but you may not have it at all.

1) True, to my knowledge I have never seen such a case.  But such transmisison certainly can occur, however rarely.

2) I don't think I ever said that.  Surely that is a rare occurrence, but I'm sure it can occur.

3) Interesting question.  It is true that the research studies have shown no significant association of HSV-1 infection with increased susceptibility to HSV-2.  The reasons are not known for sure, but it probably has to do with the lower frequency of recurrence of genital HSv-1 compared with HSV-2.  The presence or absence of visible lesions may or may not make any difference; it certainly makes no difference for HSV-2.

4) Most people agree that anybody with recurrent genital herpes is ethically obligated to inform their current and future sex partners about their infections.  The risk of transmission indeed is low for any particular episode of sex, but it isn't zero; and the fact that you have had at least one symptomatic recurrence suggests the risk of transmission may be greater than for some people with genital herpes due to HSV-1.  There are no hard and fast rules, however.

I repeat my advice above:  You need to assure the diagnosis is correct, then behave as your consience dictates.

Good luck--  HHH, MD

[tddx]

I hope i am able to ask follow up questions.  First, i am in the medical field and my presentation is classic for herpes, so i am sure i have genital hsv 1.  I think you misunderstood question 3.  i was asking if there is any increase risk of getting HIV (not hsv2) with genital hsv 1.  If the skin is intact, then there shouldn't be any increase risk of getting hiv if exposed?

Finally, i guess i'm asking your opinion if i have no further outbreaks of genital hsv 1, and given such a low risk of genital to genital, and genital to oral transmission (you yourself have never seen a case), is it necessary to tell a future partner.   unfortunately, not everybody reads this forum and is educated on the very rare risk of genital hsv1 risk versus genital hsv 2.  if i was your patient what would you recommend?  for oral hsv 1, most people don't even know if they have it (don't know their antibody status), and it is not discussed before kissing/oral sex.  why is genital hsv 1 different, when it has a lower transmission risk than oral hsv 1?  
thanks again for your time.  tddx

[H. Hunter Handsfield, M.D.]

Sorry, I knew you meant HIV; I just mis-wrote HSV-2.  In no. 3, change the first sentence to "...increased susceptibility to HIV".

You correctly state that the odds are lower for transmission to a partner for genital HSV-1 than HSV-2.  But there are no data to say how much lower.  Probably quite a bit, but no basis for a definitive reply to your question.  I would say exactly the same thing if you were my clinic patient.  You are applying a rational analysis to an issue that many persons--including persons you might date--don't look at rationally, but with fear.  There simply are no definitive answers.  You would do well to speak personally with a herpes knowledgeable provider/counselor about all this; online exchange simply isn't practical as a way to work it out.  Consider contacting the American Social Health Association's Herpes Resource Center (see www.ashastd.org).

[gracefromHHP]

"If the skin is intact, then there shouldn't be any increase risk of getting hiv if exposed? "

Yes indeed having an active lesion is an open portal into the body for anything - including hiv. However part of the increased susceptibility to acquiring hiv when having hsv2 genitally is from changes in the skin from the virus being active more often than hsv1 genitally is ( correct me if I"m wrong HHH or Dr Hook ).  Some terrific articles on it on pubmed if you need a cure for insomnia I mean want to do more reading :)


So when to tell and who to tell? That's totally your own decision.  Once you've confirmed that it's hsv1 genitally you have ( I'm with HHH on this one - don't assume anything - go get a lesion culture done asap ) it's totally up to you to decide if you are going to tell about it or not.  I've been in ltr's and I've had one night stands both - I've gotten in the habit of disclosing my own genital herpes infection prior to both just as a cover my butt thing to be honest.  As open as I am about herpes - it would be impossible to deny that I knew I had it so I disclose it so that they can never come back to me and say I gave it to them whether I did or not.  It's just a choice I've made. I think though when you are having random encounters - there is a heck of a lot of implied risk to them in general - for all parties involved.  Just keep in mind that if you do have hsv1 genitally - you are still susceptible to hsv2 infection so knowing their herpes status in general would behoove you.

grace