herpes

Hi, thanks for taking my question.
In November 1997 I contracted genital HSV-1, presumably from oral sex with my then boyfriend.  He had a cold sore on his lip.  Neither of us thought anything of it (bad mistake).
Anyway, I had all of the classic herpes symptoms; flu-like symptoms, painful genital blisters, swollen lymph nodes in groin.  Had one much milder outbreak in October of 1999 genitally/one cold sore on lip in July 2004.
  My questions are:
1) In the absence of blisters, am I contagious to any future partner I may?  Like, for example, this month is 5 years since I last had a genital outbreak. (touch wood) and the last thing i ever want to do is give it to someone else.  How contagious am I to  someone else?  Is this something that I have to warn any potential sexual partner about?  I'd rather just not ever have sex again:(  Please help.  also I wanted to know how herpes enters the system; in other words, at the time of my initial infection, I shaved pubic area.  so does the virus enter throught the possible razor cuts on my skin or just merely skin contact?  thanks.

[H. Hunter Handsfield, M.D.]

As you have experienced, many new infections with genital herpes are due to HSV-1, more commonly the cause of oral herpes (cold sores, fever blisters).  The frequency is rising, probably due to increasing frequency of oral sex.  But there is a good news aspect:  If you are unlucky and get genital herpes, but lucky enough to catch HSV-1, you are much less likely to have recurrent outbreaks.  About 30-40% of persons with initial HSV-1 genital infection have no recurrences at all, and the remainder typically have 1 or 2 more outbreaks over 1-2 years, then nothing.  Asymptomatic shedding of the virus is similarly infrequent, so sexual transmission to new partners is a much lower risk than for HSV-2 infection.  There are exceptions, but they are rare.

So to answer your specific questions:  No, you probably are not very contagious to future partners.  Having had no recurrence for 5 years, you probably will never have another one and probably are not shedding virus asymptomatically.  My opinion is that you are under no ethical obligation to inform future sex partners about your herpes, unlike the obligation for HSV-2 (or for HSV-1, if you were in fact continuing to have recurrent outbreaks). [But even with these facts, think how a future partner might feel if he didn't learn about your infection until 6 months into the relationship.  I'm not saying you shouldn't tell, only that you are under no ethical obligation to do so before initiating sexual activity.  In any case, I wouldn't worry about it for a partnership that is unlikely to continue into the future.]

Yes, shaving a day or two before sexual exposure might increase the risk of catching herpes if exposed.  There are no available data on this, but it makes sense from a biological standpoint; HSV is more likely to be acquired in the presence of abrasions or microscopic nicks than in their absence.

I hope this helps.  You can relax a bit!

Good luck--  HHH, MD