I gave my partner GSHV 1. Devastated and have questions.

Hi there,

I'm a 32 year old woman who has been in my current relationship for about 2 years.

I got my first coldsore at around 25 years old and have had about 4 since - less than 1 a year. My last one was 2 years ago.

I had no idea I was able to pass on the virus when I was not showing any symptoms, especially as I haven't had a coldsore in 2 years.

I gave my boyfriend oral sex a few weeks ago and a couple of days later he had some blisters. We were both bewildered. He went to the doctor and has been diagnosed with GHSV 1. I feel absolutely terrible that I passed this to him as I had no idea it was even possible. Thankfully, he has been very understanding and the outbreak was not too major.

We are now extremely confused about our sex life and the doctor has not been very helpful. Here are my questions:

1. Do we now need to use condoms every time we have sex? My understanding is that because I have HSV 1 orally, I can't get it genitally - but I've heard of cases in which it happens. What's the general consensus?

2. Do we need to be using condoms every time I give him oral sex?

3. If I were to perform oral sex on him with no protection and one of us was shedding (symptom free), would this cause the other to have an outbreak? For example if he was shedding, would it trigger a coldsore in me? And vice versa, if I was shedding, would I trigger a GHSV 1 outbreak in him?

4. What's the argument against him taking Valtrex daily as a preventive? The doctor told us this wasn't necessary - what are everyone else's thoughts?

Thank you so much for your time. Any help would be fantastic x

@daisychainlady My understanding as a non-medical person is that an existing established infection will largely protect you from contracting the virus in a new location. By established I mean that you've had the virus long enough to build sufficient antibodies which typically takes a few months. So you are largely protected from acquiring the virus in a second location but your bf may want to be a bit cautious for the first few months so he does not infect himself in a second location. I believe that's also uncommon, but not rare.

It is also my understanding that most people who acquire GHSV1 genitally only have that first outbreak, if they have one at all. Some have recurrences but usually infrequently. I don't recall the average for people with GHSV1 recurrences. I think it's something like once per year or once every two years. A small minority of people have more frequent recurrences and those are the people who typically opt to take antivirals, though it really is a personal choice, regardless of outbreaks.

From what I can tell, most people with herpes of either type in either location do not take antivirals. In fact, most people with herpes are unaware they have it at all. Those who do take antivirals take them for a variety of reasons. Some take them daily to suppress outbreaks because they get frequent symptoms. I believe this is more common among people with genital HSV2 but certainly not limited to them. Some people take antivirals episodically (for a few or several days) when they get outbreaks to speed healing, or they take them for a few days when they expect a triggering event (such as someone with cold sores who is going on a tropical vacation and is triggered by excessive sunlight). Some people take a smaller dose daily to reduce transmission risk to a HSV- partner. Again, this is more common among people with HSV2 which, on average, asymptomatically sheds about twice as often as oral HSV1 and three times as often as genital HSV1. In general, doctors do not seem to recommend antivirals for people without bothersome outbreaks, regardless of HSV type, but some people choose to take antivirals to minimize transmission risk as much as possible, for their own peace of mind and/or because it is important to their partner.

As for whether sex will trigger outbreaks, impossible to say. For some people, friction is a trigger, whether it's masturbation, sex, certain exercises, shaving. Only time will tell. Also, people who have recurrences generally have more of them during the first year, so if this does happen with him, it may be a temporary situation.

Oh, you had one more question about triggering outbreaks. I have never seen anything to suggest asymptomatic shedding in one infected partner triggers outbreaks in another infected partner. I would not worry about that. I would just refrain from contact during outbreaks as you have already been doing.

I'm sorry you guys are going through this. Many people don't know herpes can be transmitted in this way. Even if they did, life would be pretty boring if we always prioritized safety over pleasure. It sounds like you took the reasonable precaution of refraining from contact when risk was high and rolled the dice when risk was very low. That is what most people do in life and for good reason. Hang in there. (((HUGS)))

@optimist Thank you so much for your response. I think, based on what you said, we will use protection for the first 6 months for all forms of sex, and then hopefully after that we will be ok to carry on as usual.

Relieved to know that one of us shedding wont cause an outbreak in the other. I assumed that shedding would be an OB trigger - but if that were the cause, I suppose a couple who both had oral HSV 1 would constantly have coldsores due to either person shedding, and that doesn't seem to be the case?

There's so much information to take in.

I feel like there's a huge gap in education around herpes - I for one had absolutely NO idea that I could pass anything on if I didn't have a cold sore present (and hadn't had one in 2 years). The select friends I spoke to (while waiting for my partners test results) all have oral HSV1 and assured me it's impossible to pass when you have no symptoms - like me, they are completely unaware.

@daisychainlady My own doctors are poorly informed about how herpes presents and is transmitted. The nurse practitioner who provided my positive test results told me I had only been "exposed" and did not "have it" because I did not have symptoms. The doctor I followed up with said I could only ever transmit it if I had an active ulcer. Meanwhile, the CDC says "Most individuals infected with HSV are asymptomatic or have very mild symptoms that go unnoticed or are mistaken for another skin condition" and "Transmission commonly occurs from contact with an infected partner who does not have visible lesions and who may not know that he or she is infected." (Source: https://www.cdc.gov/std/herpes/stdfact-herpes-detailed.htm)

Something like 80% of adults have either HSV1, HSV2 or both. More than 80% of those HSV+ people don't know they're infected, yet they are capable on transmitting herpes to a partner who is not yet infected with the same type. (An exception to this is that having an established HSV2 infection largely protects someone from acquiring HSV1. The reverse is not true.) And as you pointed out, even those who are infected may not be aware of how transmission works, either due to poor sex education, media misrepresentation, or poor information from doctors. Doctors seems to be most focused on treating symptoms in the minority of people who develop symptoms. IMO, that approach is understandable, given how pervasive HSV is and how it most often goes unnoticed or has very mild symptoms. But it would be great if they also educated patients who are not presenting with symptoms to help people make more informed personal choices about testing and safe sex, and also to help reduce the stigma associated with such a common virus.