odds of viral shedding over time

[thomasj368]

Hi -- I am negative for both HSV 1 and HSV 2. I am seeing a girl who is positive for oral HSV 1.

I have two questions:

1. Regarding the risk of oral-to-genital HSV 1 transmission through viral shedding. I understand that the risk is low if she's not having an outbreak (and she hasn't had one in several years.) But hypothetically, if we're practicing oral sex repeatedly over a year or so, even if the prevalence of viral shedding is only 1%, don't the odds suggest I would eventually contract genital herpes? (especially since I don't have prior immunity through oral HSV 1).

2. Is it possible for me to catch both oral and genital HSV 1 during the same encounter if she's virally shedding on a certain day? Or would the infection "pick" only one place at a time?

Thanks.

[H. Hunter Handsfield, M.D.]

Welcome to the forum.  Directly to your questions:

1) The frequency of viral shedding in oral HSV-1 is extremely variable, from none at all to quite frequent (up to 5% of the time). It is impossible to accurately predict in any particular person, but probably it's usually zero in people with longstanding infection without recent outbreaks.  Even when shedding is present, the infection isn't necessarily transmitted.  HMost sex partners of HSV-1 infected people never catch it, either orally or genitally, even after years of regular sex and kissing.

2) Yes, it is possible to be simultaneously infected at both sites.

But what would be the big deal if you caught it?  If oral, you would simply join the 50% of the population with oral herpes, probably with no serious health outcomes.  If genital, you should know that genital HSV-1 rarely causes recurrent outbreaks and is infrequently transmitted to new partners.  Nobody wants genital herpes due to either virus, but if it happens, HSV-1 is far preferable to HSV-2.  Whether oral or genital, if the symptoms are bothersome, effective treatment is available.  If the relationship is imortant to you, then a partner's HSV-1 should not be a significant worry.

I hope this helps.  Best wishes--  HHH, MD

[H. Hunter Handsfield, M.D.]

There's a tongue-in-cheek element of every physician's training:  If you hear hoofbeats, expect a horse, not a zebra.  Once in a long while, a zebra might have escaped from a nearby zoo -- but generally hoofbeats mean horses.

In other words, if an uncommon disease and several very common ones cause similar symptoms, the common one is the more likely cause.  For sore throat without sores/blisters, colds, allergies, and other standard causes of sore throat probably are hundreds of times more common than oral herpes. Same for back pain, which more likely is due to muscle strain etc.

If you become infected with HSV, you should expect blisters and/or open sores at the site of exposure, i.e. most likely mouth or penis.  In their absence, you can reasonably assume that any future symptoms you may have are not due to herpes.

[thomasj368]

Thanks very much for the helpful answer. As a very quick followup, a few days ago I developed both a mild sore throat that lasted about 24 hours, and lower back pain that lasted about 24-48 hours. No other noticeable symptoms, and no blisters or lesions.

Is there any chance this represents an initial HSV infection in either location, considering I've been sexually active with my partner recently? Thanks.