transmission of hsv 1

[bkbkbkgirl]

Hello Dr.

I have asked you a question in the past regarding herpes blood tests but I have some questioins regarding transmission. Some of the experts have answered many of my questions but I guess I am going the extra step and asking a doctor as well.

My fiance has HSV 1. His IGG was 5.8 ( approximate) but has never had a cold sore. I was negative for both HSV 1 and 2 IGG. My concern as of lately is how possible is it that I contract HSV 1 genitally via oral sex? I am aware of the shedding process but how often? I saw hsv1 shed ~2% of the time as well as 18%.

2.  I read that over time people with hsv 1 may never have another outbreak. Is that becuase of the antibodies produced? That being said, with my fiances being 5.8 does that decrease the shedding period?

3.What are the typical symptoms of genital hsv 1? I have become very anxious about this topic to the point where any soresness from sex, or  sensation i feel, i want to check myself.

I know this is unhealthy but i really would like a good some further clarification to put this into perspective.

thanks

[Edward W Hook, MD]

Last answer.

If your question is, if a person with a cold sore (i.e. oral HSV-1) kisses and has oral sex with a partner on the same occasion are they more likely to get oral or genital infection, the answer is that there are no studies or data to answer this question.  Both happen.  

With HSV-1 there are far more oral infection than genital infection.  With oral HSV-1 infections regularly can spread infection to others.  Persons with genital HSV-1 rarely spread their infections to others (at any site).

This concludes this thread.  If I have not answered your question, then we have a failure to communicate which apparently cannot be overcome.  EWH

[bkbkbkgirl]

Dr. Hook
i agree this post needs to end and it will now. However, Im confused with some points, you mentioned at the beginning at that most cases of HSV 1 are in fact oral.

It was also mentioned that sexual transmission of HSV1 is quite uncommon and far and in this last post you mentioned that most cases of HSV1 are transmissted through oral sex.

Are you saying that its easier to spread HSV 1 throough oral sex than kissing? and even less of a chance to spread it if someone had it genitally and they were to have gential sex with someone else?

[Edward W Hook, MD]

Most HSV-1 infections are transmitted through oral sex. The risk of transmission from oral infection is higher when a lesion is present than when if it is not.   thus your partner could, at least in theory, give you genital HSV-1 through oral sex. The risk is low but not non-existent.  

Just as I answered for HSV-2, there are two contributors to people with HSV-1 not knowing they are infected.  One is misidentification analogous to the situation described above for HSV-2.  The second is that persons may have had an infection (recognized or not) as a child that they do not remember)  Finally, a small proportion of person do acquire infections without symptoms.

And with this, it is time for this thread to end.  I hope my comments have been helpful. EWH

[bkbkbkgirl]

Dr. Hook,
I am not sure if you are no longer accepting questions from me about this butI would greatly appreciate if you do as this is my last straw at getting my anxiety under control.

[bkbkbkgirl]

Ok I understand that genital HSV 1 almost never spreads during sex but does that hold true if someone has hsv1 orally? My concern is that if my fiance has it orally ( hsv1) since a child, although never had a visible sore, what are the chances it can be given to my genital area via oral sex. Is it far more common to get it from oral to oral contact as opposed to oral to genitally ?
The question under " one more" is if hsv 1 is pretty common in many adults and you say they typically would show symptoms, how is it that some people would say they never had an outbreak all while being with someone who does have outbreaks of hsv 1 orally?  

[Edward W Hook, MD]

While most people show signs of infection, there is a tenedency to attribute them to things other than HSV.  So genital herpes might be mistaken for a yeast infection, folliculitis, chaffing from improper fit of clothing etc.

Your second question (the one after "1 more") is unclear.  One last try.  When people have HSV-1 in the genital area, on average it recurs far less often than when they have genital HSV-2 and therefore genital HSV-1 is almost never spread to sexual partners.  EWH

[bkbkbkgirl]

also, you mentioned that reooccurance rates and viral shedding of genital HSV 1 is less common than genital HSV . Does that also refer to oral hsv1 shedding and transmitting genitally?

i do not mean to be redundant at all. I am just trying to answer all of my questions to help myself

[bkbkbkgirl]

thanks that has helped a lot.. 1 more...

if most people who accquire HSV show signs how is it that many people say they never had a cold sore or outbreak? For ex, in any given couple, chances are at least one of the partners has the HSV 1 virus and its safe to say the other would have contracted it from them at some point, but some people still woild say they never had a cold sore. For example, my parents. my mother had a cold sore i think twice in her life but my father never has. Im just trying to figure some things out........

[Edward W Hook, MD]

I think yiou are overthinking this.  I'll try to directly answer your questions but there is little to be gained by embarking on a series of "what if questions".  

The antibody number has nothing to do with the duration of infection.

I'm not sure where you go the 66% figure. Over 60% of American adults have HSV-1 and most do not know it. Perhtaps this is what you are referring to.  

The fact is that recurrence rates and asymptomatic viral shedding due to genital HSV-1 is far less common than recurrences or asymptomatic shedding of genital HSV-2.  As a result, sexual transmission of HSV-1 in quite uncommon and far, far less common than transmission of HSV-2.  

Most people who acquire HSV infection show signs of infection but not all.  
The role of genetics in this is not well understood.

There are no data on whether the location of infection influences the likelyhood of showing symptoms of infection.  

I hope these responses will help you to move forward.  This is clearly worrying you a lot.  Too  much in fact.  EWH

[bkbkbkgirl]

Hello Dr. H
I was recently retested for HSV 1 IGG and the results were positive (3.23). In many of my previous posts i mentioned that i was  negative for HSV 1 and 2 IGG in April but my fiance has HSV 1 so i retested this month just to see. ( HSV 2 is still negative)  One of the experts mentioned that there is a risk of having a false negative result and its possible this is not a new infection. I had a few additional questions that I am bringing to your attention. Any additional insight would be greatly appreciated as I have  severe anxiety over the possibility that i could have it genitally. I am seeking some reassurance on the the likelihood that it is orally. i have never had an outbreak in either area. No swollen lymph nodes in my genital area, no tingling or itching there either.

Just for fyi, obviously my fiance and i kiss often however he performs oral sex infrequently; maybe twice a month. Also, he has never had a cold sore in his life as i mentioned in my above post. Questions:
if the hsv1 igg tests often misses ( 1 out of 10) is it  likely that i could have had the HSV 1 for a long time like most people?

Does the number have anything to to do with the amount of antibodies produced indicating that it is nothing new?

also, i thought  it was mentioned that 66 % of new genital herpes is Type 1. If that is the case, i am confused with how it is still considered an overall low risk of transmission of hsv 1 genitally. Sorry, i am not debating your expertise.

Also, it was mentioned that genetics has a lot to do with whether or not someone has an outbreak. That beingsaid, if i just recently accquired this, would i have shown signs? or not always due to genetics? From my understanding, people can have type 1 their whole life and not have an outbreak, however with type 2 its more virulent and aggressive.

Does location have anything to do with it?  For ex, having it genitally, chances are, one would show signs moreso than orally?

[Edward W Hook, MD]

Welcome to the Forum. I'll try to help.  Going straight to your questions:

1.   If your fiancé has oral HSV-1, which is where most HSV-1 infections occur, there is a small chance of him giving it to you either through kissing (you would get a cold sore) or oral sex on your (you would get genital HSV-1) There are risks of transmission both through direct contact with lesions or through contact while he is experiencing asymptomatic shedding.  Precisely how frequent asymptomatic shedding of HSV-1 occurs is difficult to say as it is less well studied than for HSV-2. For genital HSV-2, shedding when tested for using the most sensitive measures possible, occurs about 10% of the time.  Shedding of HSV-1 is no higher and perhaps less frequent.  It is also important to point out that most contacts with partners who have asymptomatic shedding of HSV do not lead to transmission.  

2.  Yes, we presume that the reason that most HSV infections recur less over time is because of the development of immune responses.

3.  the symptoms of genital herpes due to HSV-1 are identical to those of HSV-2.  

I agree that you seem to be worrying more about this than you need to.  I'm by no means hoping or suggesting that you want to get HSV but should it happen, it is by no means the end of the world. there are more important things to worry about.EWH