HSV-1 genital herpes questions

Hi guys,

I contracted genital HSV-1 from an ex-girlfriend about 7 years ago. When I contracted it from her she was in the very initial stages of her outbreak and didn't realise she was having one. I also had a mild skin condition at the time (tinea) around my inner thighs which is probably contributed to me getting HSV-1 from her genitally. I also didn't know she had it, she hadn't disclosed.

7 years have passed, and besides my initial outbreak which lasted for several days I haven't had any noticeable outbreaks at all, except for a very mild outbreak towards the end of last year which presented as a mild itch (6 years after initial outbreak).

I am currently seeing someone and I have disclosed my status to her. It's been hard for us because there is so much conflicting information out there. We're in a distance relationship and this does weigh on us. I don't want to alarm her, but I also don't want to underplay the risks, and obviously I want to avoid passing my HSV-1 infection onto her as best I can.

I have the following questions:

1. My partner is still a virgin, but I understand that many people have HSV-1 orally and are unaware of it. I contacted Dr. Peter Leone with the list of questions I'm about to ask, and he simply said that if she has HSV-1 orally, that makes her immune from getting HSV-1 genitally from me. Is this correct?

2. If I have HSV-1 genitally, does that make me immune from getting it orally? The reverse in other words of question 1.

3. Because I have had genital HSV-1 for 7 years now, and have only had one noticeable outbreak which was very mild since at the end of last year, does that mean that the chances of me passing it onto her are very low (presuming she does not have HSV-1?). Obviously we would avoid sex when there is evidence of an outbreak, the last thing I want is to pass it on for her.

I know that you shed HSV-1 asymptomatically and there is no way of knowing when you are or aren't, but I'm presuming that the chances of spreading the HSV-1 when symptoms are not present are much lower than when they are.

I understand further that HSV-1 outbreaks in the genital area are also less common than with HSV-2.

Taking into account that I have genital HSV-1 have had only 1 visible outbreak that I know of in 7 years following my initial outbreak when I contracted it, how great are the chances of me passing HSV-1 onto her genitally, provided we make use of the precautions of using protection and abstaining if an outbreak occurs.

Does the chance decrease over time? I read somewhere that the transmission rates are highest in the first year.

4. Can I give her HSV-1 orally through oral sex from my genitals from asymptomatic shedding? Is the chance of her contrating HSV-1 orally from my genitals not higher than genital-genital transmission, seeing as HSV-1 prefers the area around the mouth?

5. Does taking acyclovir or other antivirals while being sexually active by myself reduce the risk of transmission to her. Are there side-effects if taken over a long period of time, does the virus develop resistance?

6. If she did get HSV-1 from me genitally, would her body react in a similar way to mine? Thankfully I've only had the one painful initial outbreak and one very mild one in seven years. I have read that different people react differently, but not sure if some strains of the virus are more aggressive than others.

We both really care about each other and I have been very honest with her about my HSV-1 diagnosis and the risks and implications if she gets it. As much as we want to be intimate with each other, the last thing I want to do is pass on my genital HSV-1 infection to her obviously. We are both struggling with the idea of getting it from me, and a part of me is trying to decide whether being sexually intimate is worth that risk. We're trying to work out what the risks are of her contracting it from me, providing we avoid sex if I'm having an outbreak, taking into account it's HSV-1 and not 2 and that I have only had one very minor outbreak since my initial one seven years ago.

If we do decide to be intimate with each other, I don't want her to have all these questions weighing on her or me and for us to know as best we can what the risks are.

Thanks for you time guys.

Hi there,

Wow lots of questions! Many of which I have been researching for myself after a recent diagnosis. Your comment regarding conflicting information is very true and makes navigating the dating world with this virus even more difficult but I’ll attempt to answer these questions as best I can!

1. From what I understand, this is true. If she happened to have HSV-1 orally then she wouldn’t be affected by it genitally. That being said, current methods of testing can’t actually tell you where the virus will present itself unless she is swab tested when she has an outbreak in either place and by then you’d know obviously without a test. It would still be a fantastic idea for her to be tested so that it’s out of the way and you don’t have to feel so much anxiety about this decision.

2. Yes that’s what I’ve read.

3. Generally speaking the first 6 months to a year is the most contagious the virus will ever be so 7 years on you should be considerably less infectious. This isn’t to say that the chance of transmission isn’t still there, it is. It would be a good idea to look into possibly taking anti-virals to lower you shedding rates but again just get her tested before you start asking these huge questions! If she already has it this will all be relatively unimportant.

4. Yes you can. If oral sex is a thing you’re participating in you’ll be far more likely to transmit it to her mouth than to her genitals. This is just because HSV1 thrives more in the mouth area than in the genitals. That being said, you can still transmit it to her genitals but it’s not as likely. It should be noted that HSV1 in the mouth region is far more contagious and shedding rates are far higher so consider that when making your decision and that if you don’t stay together she may have to deal with the implications of that.

5. Yes antivirals will lower the risk of transmission because they lower your shedding rates and lower the likelihood of outbreaks. Some specialists think that taking antivirals with GHSV1 won’t do much because the shedding rates are already so low but for me it wasn’t even an option because i want to make sure that i’m doing everything I can. From what I’ve read there are no side-effects for most people but if there are, there are a few different types of antivirals that you can take so there are other options if one doesn’t work for you. From what I understand they don’t lose effectiveness either.

6. There is no way to tell how her body would react. Literally absolutely no way to tell. Hypothetically, her immune system could be weaker and it could react badly and not be able to fight the virus and end up with frequent outbreaks. That’s just one scenario but anything could happen. Some of the people on this forum have far worse horror stories so take your pick really. I think generally, GHSV1 is recorded to have fewer outbreaks than GHSV2 and often far less severe. But as I said, you won’t know until it happens how a persons body will respond. It's a big gamble.

Some links you might like to take a look at:

https://herpeslife.com/genital-hsv-1-herpes-and-oral-sex/

https://herpeslife.com/hsv-1-hsv-2-types-of-herpes/

This is a really hard decision but you’re both doing the right thing in finding out the facts before you make any choices. I really can’t recommend enough that she be tested because that will make this whole decision making process a whole lot easier.

Hope this helps! Best of luck.

Hi,

Thanks very much for your reply. The information is very helpful and I appreciate the time you took to help answer my questions and it was very helpful. I especially appreciate your answer to question 4, I think that's something worth keeping in mind. Interesting point about the antivirals and GHSV-1 too.

I've also done a bit of extra reading since initially posting this which confirms everything you've said. Especially from this forum: https://www.westoverheights.com/herpes-forum/page/1

I've also read that you shed asymptomatically about 50% of the time compared to symptomatic shedding, I know that's just an average, but that would imply that in 7 years I've only shed four times (twice asymptotically and twice symptomatically). Not sure if that statistic is at all correct, or how much it varies.

All the best and good on you too for being proactive and finding out everything you should know. I feel better having some clearer idea of how things stand. Thanks again for all your help.

Hi, since kca already did a good job with the answers, I thought I'd add the reason why what he/she said is true on each.

1. You are all but immune from infection in a different location after a few months of having the virus because you have built enough antibodies for the virus. Outside of weakened immune systems, a second infection basically never happens.

You should have her get an igg test to determine if she already has hsv1.

2. As stated, it's almost impossible for you to get HSV1 orally.

3. There's a lot to break down here that works in your favor.

a) Yes, shedding decreases over time. It will probably increase very late in life as your immune system weakens. This is probably why shingles mainly happens to the elderly.

b) Yes, hsv1 genitally sheds less frequently than hsv2, perhaps as much as 6x less, if there were a direct proportion between outbreak frequency and asymptomatic shedding frequency.

c) The fact you've had so few outbreaks means that you probably have a better immune system than the average person who has symptomatic genital herpes, and the numbers you see online are taken from the whole symptomatic population, with very little asymptomatic people included. Having fewer outbreaks is correlated with less frequent asymptomatic shedding.

4. Yes, and it is higher. It's up to the two of you whether oral sex should be on the table. There probably isn't enough documentation of this transmission route to establish just how likely it is.

5. Yes, it reduces transmission risks, because it inhibits viral replication.

6. As kca says, who knows. Everyone's different. A lot depends on her personal immune system.

As for the 'strains', this is a theory. It could be right, it could be wrong. If it is right, then yes she'd probably have mild symptoms.

Hi JeffH,

Thanks a lot for the extra information. Everything is much clearer now than things were before. Everything I've read subsequently confirms what you've said.

One other question or concern my partner had was if having sex (especially if you've been celibate for a long time), can act as a trigger for an outbreak?

I'd assume that outbreaks are random and more affected by the immune system possibly being low, or being sick at the time, and not affected by having sexual contact, but perhaps there is some kind of correlation?

Thanks again for all the help Jeff and kca24.

No worries at all! Happy to help out as best I can.

In reply to your most recent question, I can only answer from personal experience that yes, sex is a trigger. I've only had one initial outbreak but have had a number of instances where I've experienced prodomes (tingling mainly) after sex. Fortunately, I up my dosage of antivirals and they have always stopped the symptoms from developing into an outbreak.

If you have a look through some other discussion posts on this site, many of them discuss this issue in length and it would seem that it is a problem for quite a lot of people. Especially in the first 6-12 months after the first outbreak. I imagine if you hadn't had sex in a while/hadn't had sex ever, it would likely be an issue for her/you. Again I have to say that it's impossible to know until it happens. I think it's often noted that any stress or friction that can cause microtears to the genital area are often the cause of outbreaks after sex. This is often because the HSV lays dormant waiting for a weakness to present itself in that area so that it can flare up again. Simple terms sorry haha I didn't know the best way to explain that.

That being said, my first outbreak occurred when I was physically the healthiest/fittest I've ever been. I like to think there's a connection between general health and outbreaks but that certainly hasn't been my experience yet.

Lubrication/adequate foreplay should hopefully keep this issue at bay. Just take things slow would be my recommendation.

Let us know what you decide and how everything goes (:

https://www.amazon.com/gp/product/B005LQ6USY/ref=oh_aui_d_detailpage_o01_?ie=UTF8&psc=1

Terri Warren is more knowable than most doctors on this subject.

Thanks Dave,

Have read through her forums extensively already and she has a free handbook too with all the essential info.

https://www.westoverheights.com/herpes/the-updated-herpes-handbook/

Thanks for the additional comments tca254!

All the best to you guys.