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What are the chances of transmission if I GF have HSV2 and my BF has HSV1?

Hi there
I have HSV2, tested positive 10 years ago.  I experienced lesions at the base of my spine (sacral herpes, I think this is called?), but have not had noticeable lesions for many years.  I am seeing someone now, and he has tested negative for HSV2, but positive for HSV1 - which surprised him.  He does not remember getting cold sores, but his ex-partner did, so it is highly possible he contracted it from her.  He does get mouth ulcers occasionally, so this could be HSV1 symptoms, from what I understand, but at this point it is not confirmed if his HSV1 is oral or genital.
My questions are:
1.  If I have HSV2, am I pretty much immune to and dont have to worry about acquiring HSV1 from him?
2.  If I am at risk of acquiring HSV1 from him, and I get it orally, (assuming his is oral) is there then a risk of me giving it "back" to him via oral sex and he then gets it generally as well as orally?
3.  If my HSV2 lesions have always been at base of spine and no-where near my "front parts", is there any risk of him acquiring HSV2 since there will be no skin-to-skin contact at the site of where the lesions have occurred?  When there is asymptom
1 Responses
Avatar universal
Sorry - that question was truncated!!   To finish off -
When there is asymptomatic shedding of HSV2, does the shedding occur from the site where lesions occur (i.e at base if spine) or can the shedding occur from anywhere around my genitals even if no lesions ever occurred there?  
We are trying to work out risk associated with kissing, oral sex, and intercourse, and best way to prevent further transmission.  There is very little clear info on risk of transmission when 1 partnere has HSV2 and the other has HSV1.
12 Comments
1.  If I have HSV2, am I pretty much immune to and dont have to worry about acquiring HSV1 from him?

Yes, this is correct. Hsv1 is not a concern here. He may have gotten hsv1 from his ex, or in childhood like most people, and never known it. He'll never know it now, and it really doesn't matter.


2.  If I am at risk of acquiring HSV1 from him, and I get it orally, (assuming his is oral) is there then a risk of me giving it "back" to him via oral sex and he then gets it generally as well as orally?

See #1, but just for reference - he has it already, so he has antibodies which protect him from getting it in another location. The same is true for you and hsv2.


3.  If my HSV2 lesions have always been at base of spine and no-where near my "front parts", is there any risk of him acquiring HSV2 since there will be no skin-to-skin contact at the site of where the lesions have occurred? When there is asymptomatic shedding of HSV2, does the shedding occur from the site where lesions occur (i.e at base if spine) or can the shedding occur from anywhere around my genitals even if no lesions ever occurred there?  

Yes, genital herpes infects nerve groups. Genital herpes infects the sacral ganglia, which affects the "boxer short" area. This means that even though your outbreaks are generally at the base of your spine (and I hear those are pretty painful - I'm sorry), you are still shedding the virus from your genitals, even if you've never had any outbreaks there.

So let me break this down for you, in practical terms.

Kissing - no risk for either hsv1 or hsv2

Oral sex - no risk for you, since your hsv2 protects you against hsv1. VERY slight risk for him for oral hsv2. Oral hsv2 is RARE. If it happens, it usually results in just one outbreak, rarely recurs, rarely sheds. (I'll give stats on that in a minute.)

Intercourse -

So I'm assuming you're female, based on your name, and that your partner's ex was female. If I'm wrong, I'm sorry and please let me know. We don't have studies done on same sex couples, but I can address some other things if you are in a same sex relationship.

Shedding for hsv2:

Shedding rates: (and you can find all this in the herpes handbook - https://westoverheights.com/herpes/the-updated-herpes-handbook/)

HSV 2 genital 15-30% of days evaluated

HSV 1 genital 3-5% of days evaluated
  
HSV 1 oral 25% of days evaluated

HSV 2 oral 1% of days evaluated

This means that on 15-30% days of the year, asymptomatic viral shedding happens, and you can still transmit. (Don't panic yet.) Shedding doesn't automatically equal transmission.

Transmission rates:

Ghsv2 transmission, female to male, over the course of a year, assuming sex 2-3 times a week:

Only avoiding sex during an outbreak - 4-5%

Adding condoms OR daily suppression - 2-3%

Adding condoms AND daily suppression - 1-2%

(Daily suppression is taking valtrex or acyclovir every day. This can reduce shedding and help prevent outbreaks, both of which reduce transmission.)

So if all you do is avoid sex during an outbreak, you have a 95-96% chance of NOT transmitting it.

(For comparison, if you take the birth control pill exactly as directed - same time every day, using a back up when you take antibiotics, etc., etc., it's 99% effective against pregnancy. If you take it like most people do, it's about 91% effective. https://www.medicalnewstoday.com/articles/322799.php)

I hope this helps, but let me know if you have any questions.
Thank you for such a detailed response!

I am females, yes, and I am in Valtrex, to reduce risk of transmission.  

He is also on suppressive medication for the HSV1, and to reduce risk of transmission to me.  However, ifIme having HSV2 provides enough protection against HSV1 already, do you think he could stop takin the Valtrex?  I mean, is there any point if him continuing if there is no risk of HSV1 to me?

Another question on tests, I hope you can comment on.  I have been to the doctor for tests to look into another health issue, and looking at past years of testing for various things, he (my doctor) commented that I had tested negative twice for both HSV1 and 2!!!   Once was about 12 months ago and another time 4 years ago.  I asked if these were IGG or IGM tests and he said both were done and both negative.    My original diagnosis was at a different clinic and was via a swab off a lesion, and I was told positive for HSV2.  I know blood tests can be false negative (and false postive) and that swabs are more conclusive than blood tests, so I should go with the original positive diagnosis.  But, my question then is - if 2x blood tests have been negative, does this indicate a drop in antibodies in my system?  I haven't had noticeable lesions for many years.  And if this is the case, am I in fact somewhat susceptible to my current partner's HSV1 (and so should he continue the Valtrex)?

If repeated lood tests are false-negative, and so many people are asymptomatic, there must be loads of people doing the right thing and doing STI tests before engaging in sex with a new partner, but are actually positive for HSV without knowing it!!!   Actually believing they are negative, based on test results.  This is really bewildering to me!  
I mean, is there any point if him continuing if there is no risk of HSV1 to me?
- if he is taking them only to prevent transmission to you, and not to reduce outbreaks or anything, then I see no reason for him to continue taking this (unless you don't have it, but I'm coming to that later).

Do you have a copy of the swab test results? Usually, a swab is the gold standard, but testing negative on the IgG test twice years later is strange.

The only thing I can think of offhand is that your swab test came back positive for hsv, and someone called it hsv2 because of the location. (This is way more common than you'd think, even today, and especially years ago.)

The IgG misses about 30% of hsv1 infections, so that would make some sense.

The only things I can suggest are to go off the Valtrex, and see if you get an outbreak. Sometimes going off Valtrex after being on it for a long time can trigger an outbreak. If you get an outbreak, get it PCR swabbed and typed. Let your doctor know you are doing this so they know you may need to get in for an appt ASAP, as timing is critical. PCR swabs and cultures are best done within 48 hours.

The other thing is you can get a Western Blot test. Your doctor can order this. It's a different type of test used to help confirm confusing results like yours. If your doctor won't order it, you can go through Terri Warren, who wrote the Herpes Handbook I quoted above.

Herpes testing is FRUSTRATING at times. Sometimes it's because of human error, sometimes it's because the tests aren't perfect, or a combination of those, but it's not always easy getting answers.
Thank you again for your response.  :)  

I dont have the original swab test results to confirm if it is definitely HSV1 or 2 - I will try to contact the clinic and see if I can obtain the information.  

I haven't been on valtrex for long, and hadn't had outbreaks for a long time - I am only on it now due to having a new partner.  If I stop taking it even though it has only been for a brief time, do you think it could still trigger an outbreak?

It would be so much easier if I actually had HSV1 - the same type as my partner!!!!   I will start with the clinic and see what I can find out.    
How long have you been on it? Everyone differs, but sometimes people get an outbreak after only taking it for a short time.

I don't want to get your hopes up - you could have hsv2, and something is wonky with the testing, you could have hsv1, and the blood test missed it, and maybe it's something else entirely. Unfortunately, it seems like it's going to take some digging and time to figure it out.
Do the results are in -  most recent blood test showed +ve for HSV2, which supports the original swab test result (not sure why the other 2xblood tests came up negative).   So that's that - back to square 1:  that is, me staying on suppressive medication, and taking care and aware of outbreaks.  
I am still getting conflicting advice from GPs (3 so far!!!)   that HSV2 does not at all give me any protection from HSV1 - all 3 have said "no! They are 2 different strains"  you can definitely get both!"
Did your test give you a number, or only a "positive"?

Yes, they are two different strains, but there's this, from Terri Warren, in the Herpes Handbook:

"It is also important to know the viral type because a person who has HSV 1 genitally can still acquire HSV 2 genitally (the reverse almost never happens). " https://westoverheights.com/herpes/the-updated-herpes-handbook/ (pg 5)

I can't find more right now, but I have seen more that says hsv2 offers significant protection against type 1. I will do my best to look for it later.

I'm sure your GPs are awesome in all kinds of ways, but GPs aren't always well versed in STDs, and to be fair, they aren't specialists. They don't need to know the nuances. They should, probably, if they are giving out information, but it's hard for them to keep up to date on every single condition they see.

Thank you again!!!!!  
I felt also that the GPs (fantastic as they are) were all a bit vague and "general" in their advice around HSV.  

Can you confirm/clarify something for me - the herpes handbook paragraph you quoted refers to genital HSV1, and if genital HSV2 is acquired first then this rarely leads to acquiring HSV1 genital on top of that.  What about if my partner has Oral HSV1?  Does genital HSV2 still hive this level of protection against Oral HSV1?

Also - I thought that whilst you can acquire HSV2 after acquiring HSV1, that this would only typically occur in a different location, i.e if he has HSV1 oral, he could get HSV2 genitally but that the 2xsttains don't like to live in the same location, so that if my partner actually has HSV1 genitally (still to be determined) that he would be unlikely to acquire HSV2 genitally, but the Herpes handbook says different.
Thank you again!!!!!  
I felt also that the GPs (fantastic as they are) were all a bit vague and "general" in their advice around HSV.  

Can you confirm/clarify something for me - the herpes handbook paragraph you quoted refers to genital HSV1, and if genital HSV2 is acquired first then this rarely leads to acquiring HSV1 genital on top of that.  What about if my partner has Oral HSV1?  Does genital HSV2 still hive this level of protection against Oral HSV1?

Also - I thought that whilst you can acquire HSV2 after acquiring HSV1, that this would only typically occur in a different location, i.e if he has HSV1 oral, he could get HSV2 genitally but that the 2xsttains don't like to live in the same location, so that if my partner actually has HSV1 genitally (still to be determined) that he would be unlikely to acquire HSV2 genitally, but the Herpes handbook says different.
What about if my partner has Oral HSV1?  Does genital HSV2 still hive this level of protection against Oral HSV1?  - this is what I was looking for yesterday. I've seen it written as more of a blanket protection  - against any hsv1 infection in any location, and then there's that statement in the handbook, which is very specific, but in context, it fits what's being written about.

Your next question is harder to determine, for a few reasons. If he has oral hsv1, he's unlikely to get oral hsv2, but hsv2 doesn't like the oral area in general, whether or not someone already has hsv1 or not.

If he has hsv1 genitally, yes he could still get hsv2 genitally, but the existing hsv1 infection (in either location) would likely make his new hsv2 infection milder.

So essentially, what this boils down to is risk and are you both comfortable with it. Obviously, no one wants to get herpes. Both of you already have one strain of it. You have to determine if you both are willing to take the chance that transmission may happen one day. The chances are low, precautions can be taken, but it can still happen.

There are no right or wrong answers. There are only answers for you. I always say that herpes is never a good enough reason to stay in a bad relationship, nor leave a good one, but I say that with 15+ years of experience with dating and herpes. I don't have anxiety or worry about the stigma. I'm also old-ish and don't give a single crap about things that matter more when you're younger. (I do hold firm on not staying in a bad relationship, especially because of herpes, though. Life is way too short.)

You can analyze it forever, but in the end, it's odds.

Thank you so much for your feedback and information.  

I think I have as much information as I can get now, and just need to minimize the risk of transmission as much as possible.

I am not particularly phased about getting another strain if HSV, I have lived with gHSV2 for 10 years  without any real impact on my life - it has been slightly annoying when lesions appear, but not particularly painful or anything more irritating than than a slight sniffle might be.

I am "oldish" too (lol) so I am not as concerned as I may have been when I was younger.   The relationship so far is great, and if I end up in a great relationship but an extra strain of HSV, well, I am still doing well!    

Thank you again for your help, I feel as equipped as I could be to put into place practical approaches to lowering risk where we can,  but then forgetting about it for the most part and concentrating on the relationship.  :)  
I agree with your approach entirely. Since your "old-ish" too, you already know that great relationships aren't so easy to come by.

I wish you both the best. :) We're here if you have any questions.
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