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Hsv-1 oral to genital transmission question
Dear Doctors,
Thank you so much for providing this service. I will try to keep my initial question (relatively!) brief and check back for any follow up questions either of you may have.
Last night, my boyfriend performed oral sex on me and this morning when we woke up we noticed what looked to be a cold sore (or zit?) on his upper lip. As something with anxiety and a history of STD scares, I have been extremely worried about this encounter. He told me that he has had cold sores in the past, or so he thinks- but that they might also just be dry patches of skin that he gets also elsewhere on his body during our dry Canadian winters :). He has not had a blood test to confirm.
I have been doing some extensive reading on this board and on ASHA, and it seems that as someone with a history of cold sores (me!) that I am immune or at least very unlikely to contract Hsv-1 genitally. I should say that I have never had a herpes blood test done (relatively uncommon to do in Canada) but had my cold sore diagnosed by a nurse visually when I was a teenager (28 years old now). Mine seem to be slightly atypical- they occur usually a couple of times a year as a small pimple or pustule in the corner of my mouth, preceded by tingling and some pain, and they react to Abreva or whatever else I am using. Is it safe to assume these are cold sores (even though I never get the welts or blisters that some of my friends do) and thus that I have some measure of resistance to a new Hsv-1 infection?
On the whole, what do you estimate my risk to be? Am I worrying for nothing or is there a genuine concern here? I read on one of your other responses that the odds of transmission even if my boyfriend did have an active lesion (meaning it was not a zit) are only around 1%- is this true?
Hoping to ratchet my anxiety down some. Many thanks for this service!
Thank you so much for providing this service. I will try to keep my initial question (relatively!) brief and check back for any follow up questions either of you may have.
Last night, my boyfriend performed oral sex on me and this morning when we woke up we noticed what looked to be a cold sore (or zit?) on his upper lip. As something with anxiety and a history of STD scares, I have been extremely worried about this encounter. He told me that he has had cold sores in the past, or so he thinks- but that they might also just be dry patches of skin that he gets also elsewhere on his body during our dry Canadian winters :). He has not had a blood test to confirm.
I have been doing some extensive reading on this board and on ASHA, and it seems that as someone with a history of cold sores (me!) that I am immune or at least very unlikely to contract Hsv-1 genitally. I should say that I have never had a herpes blood test done (relatively uncommon to do in Canada) but had my cold sore diagnosed by a nurse visually when I was a teenager (28 years old now). Mine seem to be slightly atypical- they occur usually a couple of times a year as a small pimple or pustule in the corner of my mouth, preceded by tingling and some pain, and they react to Abreva or whatever else I am using. Is it safe to assume these are cold sores (even though I never get the welts or blisters that some of my friends do) and thus that I have some measure of resistance to a new Hsv-1 infection?
On the whole, what do you estimate my risk to be? Am I worrying for nothing or is there a genuine concern here? I read on one of your other responses that the odds of transmission even if my boyfriend did have an active lesion (meaning it was not a zit) are only around 1%- is this true?
Hoping to ratchet my anxiety down some. Many thanks for this service!
MEDICAL PROFESSIONAL
Looking backwards, some people with newly diagnosed herpes, recall symptoms that bothered them earlier that may have been due to herpes and say "At the time, I thought it was just a yeast infection". But in fact, the symptoms were typical for herpes, not yeast -- it's just that the patient didn't know the difference. It's not the same thing as actually mistaking the two conditions in someone who is at risk for herpes.
However, it is stories like this that have led to advice about herpes mimicking yeast. I don't know if you have yeast or just nonspecific genital itching, or other minor sensations that you would have never worried about (or maybe not even noticed) before now. But there is nothing in them that makes me worried about herpes. If they were herpes, they would not have continued these last several days -- as you say yourself, herpes would have "progressed to some other symptoms by now".
If you find a way to have an HSV blood test and want to report the result, I'll be happy to comment one last time. But otherwise, that should wind up this thread. Good luck.
However, it is stories like this that have led to advice about herpes mimicking yeast. I don't know if you have yeast or just nonspecific genital itching, or other minor sensations that you would have never worried about (or maybe not even noticed) before now. But there is nothing in them that makes me worried about herpes. If they were herpes, they would not have continued these last several days -- as you say yourself, herpes would have "progressed to some other symptoms by now".
If you find a way to have an HSV blood test and want to report the result, I'll be happy to comment one last time. But otherwise, that should wind up this thread. Good luck.
Hello again Doctor,
I am on Day 7 or 8 post-exposure right now and are still dealing with some on and off itching symptoms. If I may describe, it is kind of a generalized itch on my vulva and anal area as well. I have not noticed any redness or raised areas, and I have been diligently looking with a hand mirror 2-3 times per day as I know I am in the period where one is most likely to develop symptoms.
I have had a little bit of what feels like muscle soreness on one side of my vulva, but that went away within a few hours.
I have had all these symptoms before, like I said, so I am not sure if it is just me being on hyper-alert or whether this is something I should go to the walk-in clinic for tomorrow. I read in passing somewhere on this board that mild cases of herpes can resemble yeast infections? Or would it have progressed to some other symptoms by now?
Thanks!
I am on Day 7 or 8 post-exposure right now and are still dealing with some on and off itching symptoms. If I may describe, it is kind of a generalized itch on my vulva and anal area as well. I have not noticed any redness or raised areas, and I have been diligently looking with a hand mirror 2-3 times per day as I know I am in the period where one is most likely to develop symptoms.
I have had a little bit of what feels like muscle soreness on one side of my vulva, but that went away within a few hours.
I have had all these symptoms before, like I said, so I am not sure if it is just me being on hyper-alert or whether this is something I should go to the walk-in clinic for tomorrow. I read in passing somewhere on this board that mild cases of herpes can resemble yeast infections? Or would it have progressed to some other symptoms by now?
Thanks!
MEDICAL PROFESSIONAL
Your symptoms don't sound like herpes, especially since they apparently are nothing new for you.
Sincere thanks! Are you able to comment on the potential symptoms I described above?
MEDICAL PROFESSIONAL
All those figures are accurate, depending on the level of certainty you seek. Probably 80% of new genital herpes infections have onset of symptoms within 5-7 days of exposure; 90% within 2 weeks; and 100% within 3 weeks. Each day that passes without typical symptoms significantly reduces the chance you were infected.
Hello again Doctor,
Thank you for your insights. Might you be able to provide me with an estimated timeline after which I can be relatively certain that I am "in the clear"? I have read 3-5 days, 10 days, and 20 days as various estimates. I am on about day 3 today.
Today I am noticing a slight discharge and generalized itching, but this is not uncommon for me after oral sex, as well as some minor aching in one of my buttocks (which, knowing me, may be psychosomatic). Do you think these are concerning symptoms?
Thanks in advance.
Thank you for your insights. Might you be able to provide me with an estimated timeline after which I can be relatively certain that I am "in the clear"? I have read 3-5 days, 10 days, and 20 days as various estimates. I am on about day 3 today.
Today I am noticing a slight discharge and generalized itching, but this is not uncommon for me after oral sex, as well as some minor aching in one of my buttocks (which, knowing me, may be psychosomatic). Do you think these are concerning symptoms?
Thanks in advance.
MEDICAL PROFESSIONAL
There are no data on the exact transmission risk in the presence of an active HSV-1 oral lesion. Dr. Hook may be correct with his 1% estimate -- but in your case, the timing was oral sex just a few hours before onset of a lesion, so I could well be higher than that.
I already confirmed the same information as in my 2005 comment; see paragraph 2 of my response above.
There have been previous discussions of Canadia's peculiar and atypical public health recommendations about the HSV blood tests; see the thread linked below. PH authorities there are currently considering modification of those recommendations; perhaps there will be a change in the next few months. But for now, I continue to believe that blood tests are exactly what you and your partner should have. Such testing is definitely legal and available in Canada -- you just have to find a doctor and/or lab willing to order the tests. Or, if you're among the 90% of Canadians that live within 100 mi. of the border, perhaps you could consider testing in the U.S.
http://www.medhelp.org/posts/STDs/herpes-paranoia/show/1612258
Assuming you won't be tested, I agree that it is most likely you have had recurrent oral herpes due to HSV-1 and are not susceptible to a new HSV-1 infection. Common sense would suggest you avoid oral sex if or whee your partner has an oral lesion that could be herpes -- but even if a mistake is made, your risk probably is very low or zero.
I already confirmed the same information as in my 2005 comment; see paragraph 2 of my response above.
There have been previous discussions of Canadia's peculiar and atypical public health recommendations about the HSV blood tests; see the thread linked below. PH authorities there are currently considering modification of those recommendations; perhaps there will be a change in the next few months. But for now, I continue to believe that blood tests are exactly what you and your partner should have. Such testing is definitely legal and available in Canada -- you just have to find a doctor and/or lab willing to order the tests. Or, if you're among the 90% of Canadians that live within 100 mi. of the border, perhaps you could consider testing in the U.S.
http://www.medhelp.org/posts/STDs/herpes-paranoia/show/1612258
Assuming you won't be tested, I agree that it is most likely you have had recurrent oral herpes due to HSV-1 and are not susceptible to a new HSV-1 infection. Common sense would suggest you avoid oral sex if or whee your partner has an oral lesion that could be herpes -- but even if a mistake is made, your risk probably is very low or zero.
You also said, in an earlier post from 2005, that "Once positive to either HSV type, most people have durable (probably lifelong) immunity to reinfection with the same type, regardless of anatomic site. There are anecdotal reports of exceptions, but they clearly are uncommon." (http://www.medhelp.org/posts/STDs/Aquiring-HSV-1-genitally-after-having-it-orally/show/246390)
Does the current research still support this?
Thanks!
Does the current research still support this?
Thanks!
Dear Sir,
Thank you very much for your quick and clear response. In terms of the 1% risk, what I was referring to was a post in which Dr. Hook stated:
"The lesion you describe does not sound like a cold sore but if we play the "what if..." game, the fact is that most exposures to lesions of infected person do not lead to infection- probably less than 1% of the time." (Here is the link: http://www.medhelp.org/posts/STDs/Oral-HSV1-to-genital-questions/show/1722187).
Perhaps the situation is not analogous.
The doctor told me today that she would not do blood typing results (and implied that it is not available in Ontario at all, which I can look into) on someone who has a history of cold sores "since it would come up positive anyway."
So, if I may extrapolate on your conclusions, is it relatively safe to assume that it is unlikely I contracted genitally it due to my recurring cold sores? I know I am fishing for reassurance but I am living in a constant state of anxiety and fear.
Thanks!
Thank you very much for your quick and clear response. In terms of the 1% risk, what I was referring to was a post in which Dr. Hook stated:
"The lesion you describe does not sound like a cold sore but if we play the "what if..." game, the fact is that most exposures to lesions of infected person do not lead to infection- probably less than 1% of the time." (Here is the link: http://www.medhelp.org/posts/STDs/Oral-HSV1-to-genital-questions/show/1722187).
Perhaps the situation is not analogous.
The doctor told me today that she would not do blood typing results (and implied that it is not available in Ontario at all, which I can look into) on someone who has a history of cold sores "since it would come up positive anyway."
So, if I may extrapolate on your conclusions, is it relatively safe to assume that it is unlikely I contracted genitally it due to my recurring cold sores? I know I am fishing for reassurance but I am living in a constant state of anxiety and fear.
Thanks!
MEDICAL PROFESSIONAL
Welcome to the forum. Thanks for your question, which is very articulate, and for doing some research on it ahead of time.
It is true that people are immune, or at least very resistant to new infections with the same HSV type they already have, anywhere on the body. So if you have recurrent oral herpes (and I think you do), it probably doesn't matter whether or not your partner has oral herpes, or whether his recent lip lesion was herpes or something else.
On the other hand, If you do not have HSV-1 and your partners lip lesion was herpes, then your risk may be a lot higher than 1-2%; people may be most infectious in the few hours immediately before a new herpes lesion begins. Based on your partners recurrent oral lesions, it's at least fairly possible she does have herpes, but I can't say more than that.
This is a situation in which the HSV blood tests may help, and I would recommend that both you and your partner be tested. The results will tell whether either or both of you is infected with HSV-1 (and HSV-2) and at risk.
But in the meantime, and no matter how the tests turn out, I would advise you not to worry too much about it. Of course nobody wants genital herpes, But if it happens, HSV-1 is "preferred" over HSV-2, because the recurrence rate usually is low and sexual transmissions to new sex partners seems to be uncommon.
I hope this has helped. Let me know if anything isn't clear, And feel free to return with a follow-up comment If you and/or your partner are tested.
Best wishes-- HHH, MD
It is true that people are immune, or at least very resistant to new infections with the same HSV type they already have, anywhere on the body. So if you have recurrent oral herpes (and I think you do), it probably doesn't matter whether or not your partner has oral herpes, or whether his recent lip lesion was herpes or something else.
On the other hand, If you do not have HSV-1 and your partners lip lesion was herpes, then your risk may be a lot higher than 1-2%; people may be most infectious in the few hours immediately before a new herpes lesion begins. Based on your partners recurrent oral lesions, it's at least fairly possible she does have herpes, but I can't say more than that.
This is a situation in which the HSV blood tests may help, and I would recommend that both you and your partner be tested. The results will tell whether either or both of you is infected with HSV-1 (and HSV-2) and at risk.
But in the meantime, and no matter how the tests turn out, I would advise you not to worry too much about it. Of course nobody wants genital herpes, But if it happens, HSV-1 is "preferred" over HSV-2, because the recurrence rate usually is low and sexual transmissions to new sex partners seems to be uncommon.
I hope this has helped. Let me know if anything isn't clear, And feel free to return with a follow-up comment If you and/or your partner are tested.
Best wishes-- HHH, MD
You are reading content posted in the STDs Forum
Herpes spreads by oral, vaginal and anal sex.
Herpes sores blister, then burst, scab and heal.
STIs are the most common cause of genital sores.
Millions of people are diagnosed with STDs in the U.S. each year.
STDs can't be transmitted by casual contact, like hugging or touching.
Syphilis is an STD that is transmitted by oral, genital and anal sex.
