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Genital to Oral HSV 1 Transmission

Dr. Hansfield,

First of all I want to thank you for the sound advice and information on this forum. When I first noticed my genital herpes in May 2015 I thought my life was over. I have been since diagnosed genital HSV1 and have had one very minor outbreak since. After this diagnosis I started dating a woman and notified her of my predicament. She got tested and was negative for HSV1 and 2. We have been sexually active (oral and genital) only when I was asymptomatic. Last week she developed sores on her lips and is presumably now oral HSV1 positive. My question is if genital HSV1 shedding is so rare how did I infect her? Is HSV1 infection more likely genital to oral than genital to genital?

This discussion is related to Genital HSV 1 Transmission.
12 Responses
Avatar universal
Your diagnosis is not clear. Did you have a swab at the time of outbreak? How was it that you were subsequently diagnosed and not at the time of outbreak?

Your partner should obtain a swab straight away to determine if this is herpes?

Can genital to oral happen, yes it does, rarely but it can happen.
Avatar universal
I first noticed the blisters on my penis in late May on 2015 approx two weeks after the sexual encounter in question. I went to a clinic a few days later and the Dr. said it looked like herpes but the blisters were too dried up to do a swab test. Instead I took a blood test for HSV2. It came back negative. After studying up on herpes I realized that sufficient antibodies might not be present so I did another blood test a week later. It was HSV1+ HSV2-.  About 2.5 months later I did another blood test and it was also HSV1+ HSV2- . The first week of Nov I had a 2nd much less severe outbreak.

My partner was tested after I told her and before we had sex and she was HSV1- HSV2-. After our last encounter (oral and vaginal) she developed three blisters on her lip. She has not been tested but they definitely look like herpes.

Am I more likely to pass HSV1 from oral or vaginal sex?
Avatar universal
Thought it might be something like that.

This is important. Exactly how many days from the sores appearing until blood was drawn for the test that showed HSV1+?
Avatar universal
I went back and looked at my actual calendar. Here is the exact timeline.

Day 0. Unprotected one night stand (suspected infection)
Day 37. Protected sex with another partner who has since tested negative for HSV1&2
Day 43. Blisters appeared.
Day 50. Blood test HSV2-
Day 55. Blood test HSV1+ 2-
Day 114. Blood test HSV1+ 2-
Day 195. 2nd outbreak (much less severe)
Day 225. Sex with current partner who tested HSV1- 2-
Day 230. Current partner developed blisters on lips.

Avatar universal
If this is an initial outbreak on day 43, then partner from day 0 is in the clear most likely. I think they can be forgotten.

Did the blisters appear in the area covered by the condom? Did you receive oral sex at all on Day 37 or anywhere in that vicinity? Did this partner have the correct IgG testing?

Where was this second outbreak relative the first in Day 195?

Did your current partner have the correct IgG testing?

I think we are close now to the true answer!
Avatar universal
The blisters appeared near the base where the condom ended. Yes I did receive unprotected oral sex. As far as I know her test was legit. We are still friends and she showed me the results. Same for the current partner. All days are referenced to day 0.
Avatar universal
The odds are pointing to that you do not have genital herpes. Your HSV1+ blood test probably identifies an oral infection from your youth. This means you are immune from a genital HSV1 infection.

In what you describe, provided everyone has had IgG testing and not IgM, PCR on blood etc., then there isn't really a source for you.

If you were infected Day 0, most likely the blisters would have formed Day 2-10 and not Day 43.

If you were infected on Day 37, then you would not test positive on Day 55, that is too soon to recognize antibodies.

It follows that you most likely have had HSV1 since your youth as mentioned above.

Hence if your current partner has just been infected with oral HSV1, then it has come from you kissing her.
Avatar universal
What else could explain the two outbreaks? The blisters looked exactly like herpes from pics I've seen on the Internet. During the first outbreak I even had some of the other symptoms: mild fever, swollen lymph nodes, shooting nerve pain in my leg a few times.  The tests I did on day 55 and 114 were for 8 different STDs and each time I was only HSV1+.
Avatar universal
Blisters are not unique to herpes. Many things mimic. These include molluscum, scabies, zoster, fungus, irritation, folliculitis, fordyce spot inflammation... The list goes on.
I'd be convinced you have had HSV1 since your youth. I'd test once to confirm HSV2 is negative then you are much more likely to have experienced something other than herpes genitally.
Be careful of online herpes pics, many are not herpes at all!
Avatar universal
What is the likelihood of asymptotic genital to genital HSV1 infection?
Avatar universal
Unknown but estimates place it at 1% per annum.

It is unlikely you have.a genital HSV1 infection based on your history.
Avatar universal
One last question. I am trying to rule out genital HSV2.  Given that I tested negative for HSV2 on day 114, would that be enough time for sufficient antibodies to show up on the test if I contracted it on day 0 or day 37?

Thank you.
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