Risk of HSV-1 in saliva during healing stage

[canIgethsv]

Dear doctor,

Thank you very much for reading my questions.
The girl I started dating recently had a cold sore. It did not look like a cold sore (at least to me) and I assumed it was acne. I have never had a cold sore in my life and we had made out when the outbreak was present. After 3 days, there was just some reddening in that area and she used her saliva to masturbate me. She had informed me it was a cold sore that just healed only the day after that (I had been assuming acne all along). Now I am wondering:

1) What are the chances of oral herpes infection (I am assuming very high - considering that we kissed and made out during outbreak)
2) What are the chances of me getting genital herpes, due to the second exposure (3 days after the first) where she used her saliva on my penis. I should also mention that there was no open sore and I could only see slight red bumps (probably healing stage ?) Is 3 days enough for my body to produce anti-bodies to avoid infection during second exposure ?
3) If I don't get any symptoms for 2 weeks (oral or genital), can I assume I am in the clear ?

Thanks again!

[H. Hunter Handsfield, M.D.]

New HSV lesions can occur anywhere inside the mouth, neither more nor less frequently under the tongue.  Conceivably, the bump is the first early symptom, but it might be nothing at all.  Keep an eye on it.  Don't repeatedly poke at it.  If it becomes progressively painful or ulcerates, or if other similar lesions appear, see a provider right away.  

[H. Hunter Handsfield, M.D.]

Oral herpes (cold sores) is caused by herpes simplex virus type 1 (HSV-1).  The first thing to understand here is that you might not be susceptible to it at all.  That's because half the population in the US (90% or more in some parts of the world) acquires HSV-1, usually in childhood, and usually without symptoms.  Even if you never had recognized cold sores, you might have been infected before.  If so, you are immune, or at least highly resistant, to catching a new HSV-1 infection, anywhere on your body.

But now let's assume you were not infected before and are susceptible.  From information in question 1, apparently "made out", perhaps when your partner's oral herpes outbreak might have been new, could have carried a very high risk of transmission by kissing.  However, hand-genital contact rarely transmits herpes, even when saliva is used as lubricant -- and as you suggest yourself, if your partner's lesion was starting to heal by that time, there might have been no risk at all.  I can't say it's impossible, but in 30+ years in the STD business I have never seen a single case of genital HSV known to have been acquired by that kind of contact.  That doesn't meant it can't happen, but it is very rare.  Saliva itself probably doesn't carry much virus.

Those comments answer both qeustions 1 and 2:  There was a high risk of catching oral herpes, but only if you are among the half the population that doesn't yet have HSV-1.  The risk of genital herpes is very low, regardless of your past HSV status.

Some HSV infections are asymptomatic, so lack of symptoms won't prove you weren't infected.  However, most apparently asymptomatic infections occur because people just don't pay attention -- i.e. symptoms are present but not noticed.  When someone is on the lookout, most will know it if they were infected.  The period needs to be stretched to 3 weeks, not two -- but if you have no oral sores, blisters, or sore throat within that time, you can be pretty sure you weren't infected.

If you want to be 100% certain, don't wait.  See a health care provider within the next couple of days and request a blood test for HSV-1.  (HSV-2 testing will be done more or less automatically at the same time.)  If it's positive, it will have to be from a distant past infection, since it takes a few weeks to become positive.  That would be good news; it would mean you're immune to new infection.  If it's negative, then if you have mild symptoms and aren't certain, or just want to be sure, you could have another test in 3 months.  If it stays negative, you will know for sure you weren't infected.

A final comment concerns your partner's behavior. It was irresponsible of her to kiss you, or anyone else, knowing she had an active outbreak of oral herpes.  She should know that.  Nevertheless, I hope you will discuss this with her calmly and sensitively.  I'm sure she didn't mean to put you at risk; most likely she just got turned on and made a mistake in judgment.  Still, she should know not to do it again, with you or other partners.

I hope this helps.  Best wishes--  HHH, MD

[H. Hunter Handsfield, M.D.]

I agree with not treating you for such a mild symptom, even if suspected as herpes.  If that's what it was, it probably wouldn't have cleared up so quickly.

Symptoms of most new HSV infections start within 4-5 days, even though it occasionally takes up to 3 weeks.  Each day that goes by without more significant symptoms reduces the chance you caught it.  Hang in there.

Thanks for the thanks about the forum.

[canIgethsv]

The bump disappeared after a day. I also saw my primary physician who refused to prescribe me anything for it as she wanted to wait and see if it was a full blown lesion.

Now I am confused as to if it was due to my exposure or not. Hopefully I will get the testing done (I have to get it done in a std clinic as my primary physician wants to wait before getting the test done)

Thanks for your replies as it has been very helpful.

[canIgethsv]

Thank you very much for your comments. It is very helpful. I will try and get tested for HSV soon. I just have one followup question.
As part of symptoms you had mentioned sore throat, is it possible for oral herpes to be under the tongue ? The reason I am asking is because I noticed a bump under the tongue (where the teeth meets the floor of the mouth) and it is mildly painful if I touch it with my tongue.

Thanks!