HSV-1 symptoms and transmission

[debben298]

I am a 29 yearold female who had unprotected sexual encounters (including me giving oral) with a man, between 14-18th March. He then went away for a week to his home in the US and was tested for STIs there. When he returned to the UK, he accused me of giving him an STI. He said his symptoms began on 19th March, with frequent/painful urination being the most troublesome. He claimed that he also had swollen glands in his groin, and felt generally run-down and unwell. When my test results came back, they were negative for chlamydia, gonorrhoea, HIV and syphillis and so these can be ruled out as causes. The clinic I went to in the UK did not test me for any other STIs as I have no symptoms. When his US results came back (urine and blood tests I think, no swabs), he claimed all results were negative but that he had a 'low' antibody count for HSV-1, and tried to accuse me of giving him this infection genitally from oral sex. He had his test on 24th March, and as far as I know, he never complained of blisters being present. One week later, he contacted me and claimed he was 'mistaken' about the positive antibody test for HSV-1, and that his test was in fact negative. (I am baffled as to how he could lie about this - are false positives common?). Anyway, I am almost certain that I will carry HSV-1 (although have never been tested in the UK), because both my parents have had cold sores. However, I have not had cold sores that I can remember, and certainly not when I gave this guy oral. My questions are:
1) Do his symptoms sound like herpes? What would a US clinic test for when presented with these symptoms?
2) What are the chances I could have actually given him HSV-1, considering I haven't had a cold sore for over 10-15 years? Surely if I passed on HSV-1 to him through oral sex, he would also have cold sores on this mouth, given that I kissed him?
3) What else could have caused his symptoms if it can't be chlamydia or gonorrhoea?

Thank you very much for your help.

[Terri Warren, RN, Adult Nurse Practitioner]

I'm not sure which brand test he had done, and there are lots more now than there used to be.  The most common test has a cutoff value of 1.1 or greater is positive.  If you can get a look at his test results, it might help.

If you do have HSV 1 oral infection, there is a possibility that you could infected someone by giving them oral sex even if you have no lesions, yes.  But really, HSV 1 is so common that you may well be giving oral sex to someone who already has HSV 1 and then it wouldn't matter.  Or you and a partner might decide that it is worth the risk to have full sexual expression.  In my opinion these are decisions that couples make together as a team.  You might wish to actually test to see if this is indeed something you even need to worry about at all.

Terri

[debben298]

Dear Terri

Thank you for your reply.

Yes, he is definitely worried and is in turn making me feel worried and guilty for his symptoms. I have tried to reassure him that there could be many other causes that we cannot identify, but he doesn't seem to want to listen. As far as I know, none of the doctors he has seen have given him any medication, antivirals or antibiotics, so I think he might be blowing this up out of proportion.

When I said 10 - 15 years, I meant I have not had a cold sore that I can remember. I think I had one as a child like most people have. Because my parents have had them I think I will carry the HSV-1 virus, and like you said, most people do. Can I never give anyone oral sex?! Does the risk of asymptomatic shedding reduce over time since the last outbreak or does it remain constant forever?

I am a bit confused about why he had an antibody test then if most US clinics would not do it - they certainly don't in the UK. Maybe he asked for a full screen or something. Could you tell me what values for antibody tests mean positive? I haven't asked to see his results, but when I do it would help if I understood what the numbers mean - I am pretty sure he doesn't have a clue, since at first he told me it was positive, then changed his mind and said it was negative!

Thank you very much.

[Terri Warren, RN, Adult Nurse Practitioner]

His symptoms could be HSV 1, yes, but with no sores, it seems far less likely.  I doubt that many US clinics would test for HSV 1 in this situation because HSV 1 is so prevalent in the US and an antibody test cannot tell you where you are infected, only that you are infected, so an antibody test for HSV 1, if positive, is not all that useful.  

I thought you had not had a cold sore?  But then you mentioned not for 10-15 years?  I'm confused.  

If you have HSV 1 and passed it to him orally or genitally, it does seem likely that he would have sores, but not everyone does.  

There are many other things that can cause these symptoms, including organisms we can't generally test for yet, but know cause STI symptoms, including ureaplasma and mycoplasma.  He could also have had a UTI, though that is less likely.

If he is this worried about HSV 1 infection, and you keep seeing him, you may wish to get a test and see where you stan on that issue.

Terri