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Genital HSV-1

Dear Doctors,

I have recently been diagnosed with genital HSV-1 via culture. I am quite confused and don't know where to go from here. I hope you can answer my questions:

1) Is genital HSV-1 a one time thing? I understand that the virus remains in your body for life, but I have read on here that 40% of people with genital HSV-1 have no recurrent outbreaks in the future and that the remaining percentage have 1-2 outbreaks in the first few years of infection, then none. Does that make it a one time thing?

2) Why is asymptomatic viral shedding and genital-to-genital transmission low and not zero? Over time, doesn't the virus become less and less powerful?

3) Since I was just recently diagnosed, do you suggest that I use condoms for my first year of infection? Can I ever have unprotected sex again?

4) Is genital-HSV-1 really a big deal? Do I have to tell future partners about my infection? It seems like this infection is a nuisance for only the first few years. Does it get better over time? When can I be less worried about transmitting this to future partners?
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300980 tn?1194933000
Welcome to the Forum.  You are asking good questions and I will do my best to address them.  In addition however, I will point out that questions and information about herpes can be obtained by accessing excellent informational web sites such as the one run by the American Social Health Association (disclosure, Dr. Handsfield and I are both on the Board of Directors of ASHA).  

Less is known about genital HSV-1 than genital HSV-1 for two important reasons - that it is less common than HSV-2 and that HSV-1 recurs less frequently, on average, than HSV-2 at the genital location.  Having said that there are many parallels and there is much information.  i will try to address your questions:

1.  In many people HSV-1 is a 1-time event and there are no recurrences.  For many others however it is not a "one-time thing" but an infrequent occurrence.   In addition, it appears that even in persons who have recurrences of HSV-1 with genital infection, the recurrences occur, on average, less often and there is less asymptomatic shedding.  Finally, transmission of genital HSV to partners is a rare event for two reasons – the biology of the virus and the fact that over 60% of adults have partial immunity to HSV-1 due to pre-existing HSV-1 infection (usually oral herpes) which they are unaware of). This is a result of fundamental differences in the biology of the 2 viruses (HSV-1 and HSV-1) which effect the natural histories of infections caused by them.  

2.  Why are recurrences and asymptomatic shedding not zero?  Don't know.  This is fundamental part of the biology of the virus.  Furthermore, please realize that science and scientific studies never give absolute answers but rather give information on probabilities.  At some times these probabilities are nearly 100% or nearly 0 and therefore are effectively 100% or 0, respectively but there are always "exceptions which prove the rule".  

3.We DO know for HSV-2 however that recurrences and asymptomatic shedding do tend to be more common in the first year of infection than subsequently.  It makes sense that this is likely to be the case for HSV-1 as well.  condoms have many benefits beyond the issue of HSV transmission.  I recommend them and think that for you, using them over the 1rst year may be a reasonable idea.  

4.  Is HSV-1 at the genital tract a big deal?  personally, I don't think so but on the other hand, as you can see from a glance at other posts on this site, some people are totally paralyzed by fear of HSV of any type.  While I find this illogical, it happens.  My advice would be to disclose to partners and discuss what you know about the infection.

I realize that you asked for absolute, "black and white" answers and hope that you appreciate why neither I nor anyone else can give you such responses to these questions.  it's a numbers game.  that said I hope this helps.  Take a look at the web site.  EWH
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Thank you for your response Doctor. The information you provided was very helpful. Just a few more questions:

1) How will I know if I'm one of those lucky people that have genital HSV-1 only once? Is there a certain time period when I can assume I'm "in the clear?"

2) If I am part of the lucky 40% of people who never experience a second recurrence, can I assume that I'm "clean" and continue to have unprotected sex?

3) Why did I contract this genitally and not orally? Cleary I was kissing my partner before we engaged in oral sex. Is it because my partner's lesion spent more time "down there"? Therefore, making it easy for me to contract the virus?
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300980 tn?1194933000
1.  Sorry, there is no way to predict whether you will have recurrences or not.  The longer you go without a recurrence, the less likely it is that you will have one.

2.  Not necessarily. For starters, as I mentioned above, in science we never say never--things happen.  Secondly, even without a clinical recurrence you will almost certainly have occasional asymptomatic shedding of the virus (see the ASHA website for information on asymptomatic shedding).  While most exposures to partners with herpes, even if they do have asymptomatic shedding do not become infected, it can happen.  It would be taking a chance to assume it won't happen to you, even though it is unlikely.

3.  Where your infection occurred was more an issue of luck/chance than anything else.  The penis is not more or less susceptible to infection than the lips.

EWH
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1) As time goes by, doesn't asymptomatic viral shedding lessen? Which means, the risk of genital-to-genital transmission lessens?

2) When do you think it would be safe to have unprotected vaginal sex again? After a year goes by, since asymptomatic viral shedding lessens by then?

3) Since genital-to-genital transmission of HSV-1 is rare and asymptomatic viral shedding is uncommon, I find this infection to be not such a big deal. Can I "put this in the past" or should I always be thinking about this infection?
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300980 tn?1194933000
We are beginning to reach the limits of what can be handled in a single thread.  You clearly are concerned about this and that is an appropriate perspective in terms of your partners and their risk of infection.  Many of these issues are answered as best they can be on the web site I've referred you to and on the related hot line. After these answers it is time for you to seek your answers to further questions there or with your own doctor.  There is only so much that can be done thorough this Forum.  I'm sure you understand.


1.  Asymptomatic shedding is greatest in the first year following infection.  After that, current research suggest that the shedding rates is relatively constant, perhaps declining gradually over a period of years.  Thus, I cannot tell you when it is "safe" to have unprotected sex without discussing this with your partners.  If they already have HSV-1, they are not at risk.,  If they do not, then they are risk.  

2.  see above.  You have asked this question several times and as I've said before, there is no absolute answer.

3.  I've answered this question above as well.  It should not be a big deal.  On the other hand it is for some people.  EWH
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Avatar universal
Thank you so much for your helpful information doctor. One more thing:


1) Let's say I go 4 years without any recurrences. Would you say that I'm "in the clear" or that I could maybe experience another outbreak 5, 10, 15 years later?
(This virus is such a bugger!)
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300980 tn?1194933000
last response.  It would be unlikely but once again, we can never say never.  EWH
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Avatar universal
Thank you for your time Doctor.
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