How can I keep my boyfriend while lowering my risk of getting his HSV-1? (Herpes Simplex 1)

September 30, 2011 8:18 AM

My serious boyfriend has just tested positive for HSV-1, while I have tested negative. We are both panicking, and need good, detailed statistics and math on the risks, reductions, and transmission rates in order to figure out what to do. Please help!

Additional factors:

Emotional: The relationship, although only a few months old, is very intense. We are very much in love and have talked about building a future together, something that has been rare for me in the past. It is a long-distance relationship, where he is planning to move to be with me. I don't want to leave him, but I also don't want to contract HSV-1 for a few reasons: firstly, I saw some research on the internet that suggests it is strongly linked to Alzheimers, which my family has some history of. Secondly, if something happens-we break up for whatever reason, or there's a car crash- I know that having an incurable, highly communicable STD will make it harder to date. Thirdly, we both want to have children, and I am very concerned about the possibility of transmitting it to our children.

The Physical: To his knowledge, he has never had an outbreak, so we don't know if he has it orally or genitally. He does not think that he has ever had a cold sore, though did say that about a year ago he had some "jock itch", which disappeared after treatment.

What I already know:
I know that the virus is most contagious during outbreaks, but there's still a risk from viral shedding in between them. I know some antivirals exist that can be used for HSV-1 and may reduce the viral shedding. I know that condoms partially protect, but not totally. I know that a high percentage of the American public is believed to already have HSV-1. I know that the risk of neonatal transmission is low if you already have the virus, but high if you acquire it while pregnant (though I'm fuzzy on the details).

What I would like to know:
What is the base male to female transmission rate for asymptomatic HSV-1? (For oral to oral, oral to genital, genital to oral, and genital to genital, if anyone has it) How much is this reduced, male to female, by using a condom, for oral and penetrative sex? (I'd like to know if one is riskier than the other) How much is this reduced by antivirals? (Ideally, in percentages by year for base transmission rates, then percentage of reduction for mitigators) Are there any other methods of prevention I don't know about? Can HSV-1 be transmitted orally to other locations of broken skin on the body, or do manifestations other places on the body take place from already having the virus? (I.e, do I have to be worried about bites, etc) I see also that some vaccines have existed at points-are any still available anywhere? (Even if they only add an additional 20 or 30 percent protection, it would help)

Please also let me know where you are finding any information, if you can-my boyfriend and I would both feel much more comfortable with solid data other than the clinic's "no no, everything will be fine."

posted by anonymous to science & nature (42 answers total)

He should get rechecked. I don't think herpes tests are nearly as accurate as, say, HIV tests, and can return false positives due to the difficulty of interpreting the results.
posted by The Lamplighter at 8:31 AM on September 30, 2011 [1 favorite]

Before freaking out too much. I would get retested a couple of times. There is a very high chance that you already have what is known as "subclinical herpes," meaning that you are asymptomatic. False negative rates for subclinical herpes are high. The estimated prevalence of HSV-1 is around 60% is the U.S. and over 75% worldwide.

Honestly, you might find coming to terms with having HSV-1 easier than worrying about not contracting it.

I'm actually curious as to why you had these tests. I was under the impression that they didn't bother doing HSV tests in absence of an outbreak, partially due to the high false-negative rate and party due to the endemic nature of the disease. I, for example, have never been tested for HSV-1, but have always assumed I had it.

To partially answer your other questions, in a quick search I was only able to turn up transfer rates male-to-female for unprotected sex in a monogamous relationship (30%). Presumably, any measures you take would bring it down from there, though your base rate might be higher if you are getting it on more often than average.
posted by 256 at 8:36 AM on September 30, 2011

I should clarify that only the blood tests are often inaccurate. I assume that's what he got, since he's doesn't currently have a sore and doesn't recall ever having one.

Do research on the specific type of test and the issues with with it before you totally lose it.
posted by The Lamplighter at 8:36 AM on September 30, 2011

Uh, statistically the blood tests are pretty accurate, actually.
posted by schroedinger at 8:40 AM on September 30, 2011 [3 favorites]

I have the feeling that in the midst of all your research (which I totally understand you'd do, because you're probably both a little freaked out), you may have garbled some of the info.

To wit:

I know that a high percentage of the American public is believed to already have HSV-1.

Are you sure it's HSV, or HPv in this instance? I might indeed be wrong, but it was H_p_v that I heard this statistic about (HPV is the human papilloma virus, which is indeed really common). I could indeed be misinformed about the HSV statistic, though, and it could be true of both.

I know that condoms partially protect, but not totally.

This is something else I've heard about HPV rather than HSV.

I saw some research on the internet that suggests it is strongly linked to Alzheimers, which my family has some history of.

WHERE did you see this? This is the very first I've heard of this, and I'm a little dubious, especially since a lot of "research on the internet" can be wack-a-doo, and also as Alzheimer's research is still kind of in its infancy right now.

What I have a hunch you're doing -- and again, I totally understand why you're doing it, so don't feel bad -- is that you're googling kind of obsessively and finding info that may not have been 100% vetted for accuracy. To follow up with everyone here, I'd see about getting him re-tested again, just in case; then if he tests positive again, then I'd look up a herpes support group and talk to THEM about all of your concerns. They are much more likely to give you accurate info -- both about how he can cope with it if he has it, and how YOU can protect yourself -- and how to emotionally handle the diagnosis.

Good luck.
posted by EmpressCallipygos at 8:40 AM on September 30, 2011 [1 favorite]

EmpressCallipygos, "Up to 8 out of 10 American adults have oral herpes." - Planned Parenthood
posted by roger ackroyd at 8:43 AM on September 30, 2011 [2 favorites]

I stand corrected, roger. Thanks.
posted by EmpressCallipygos at 8:47 AM on September 30, 2011

Uh, statistically the blood tests are pretty accurate, actually.

The more you know. FWIW, I was getting my information on this from here, but that seems to be for the scraping test.
posted by 256 at 8:49 AM on September 30, 2011

Just for the record, we're generally talking about a cold sore here. I know it can spread to other areas in sexually-related ways, but it doesn't carry the same sort of stigma as an STD. I find it hard to imagine that someone would have difficulty dating because they occasionally got a cold sore.
posted by bizzyb at 8:49 AM on September 30, 2011 [2 favorites]

Oral herpes is usually contracted in childhood. It isn't really all that avoidable. I don't believe condoms do much good, unless they are full body condoms. I want to tell you to relax, but that would be unfair because I know this is upsetting you.

Oral herpes = cold sores. Is this guy worth a couple of cold sores? I bet he is.
posted by dchrssyr at 8:50 AM on September 30, 2011 [4 favorites]

One CAN manifest HSV 1 ("oral" herpes) in the genital region, that is true. I, too, am curious about this as he's never had an outbreak in either area - how and why did he get tested?

Regardless - about 20% of American adults have it, so it's rather hard to avoid in general. Lots of folks got it from their parents through kissing as children. It's really, really, not a huge lifechanger for most people at all.

Please see www.ashastd.org for good, factual info on herpes, transmission, prevention and management.

Try to stop freaking out. Cold sores or blisters are not the end of the world.
posted by tristeza at 8:56 AM on September 30, 2011 [2 favorites]

HSV-1 is cold sores. HSV-2 is genital herpes. According to Wikipedia, over 57% of Americans have HSV-1. And that increases with age; by the time someone reaches the age of 50, there's an 80-90% chance that they've got it. So, think about that for a minute. That means that even if you broke up with your boyfriend, chances are your next boyfriend would probably have it. And he probably got it as a child when a relative kissed him on the cheek or something.

HSV-1 is pretty damn hard to avoid. In fact, when I went to my doctor a few months ago and asked him specifically to test me for herpes, he said that they only test people for HSV-2 because HSV-1 is so common.

So yeah, I would say don't worry about it. And apparently (according to one of my friends who's gotten cold sores since he was a child), the Valtrex-type drugs work really well. So if your boyfriend does get an outbreak, have him take Valtrex and don't kiss him for a few days. Apparently it clears up really quickly.

There's also the option where he could take a Valtrex-type drug regularly to prevent an outbreak, but really, I think that's overkill. They're only cold sores.
posted by Afroblanco at 8:58 AM on September 30, 2011 [3 favorites]

HSV-1 is not an STD. You are overreacting. Go to Planned Parenthood and talk to a doctor there about your questions re: pregnancy.

Are you going to kiss through a dental dam forever?

Herpes or either variety can show up in either the mouth or genital region, but simplex 1 has a "preference" for the mouth area and outbreaks are more severe in the mouth area while simplex 2 has a "preference" for the genital area and outbreaks of that are more severe in the genitals. If you get simplex 1 on your mouth (like through kissing your boyfriend) you could get a sore on your gentails even if his mouth or genitals do not come in contact with your genitals (basically, once you've got it, it's in your body and will show up at it's location of choice).

I agree with 256 that coming to terms with having it would be a better approach than trying to avoid it. REally the only way to completely avoid it would be to never touch your boyfriend.
posted by WeekendJen at 8:58 AM on September 30, 2011

Wait - I need to correct what I wrote above. HSV 2 ("genital") is found in 20% of American adults, while HSV 1 ("oral") herpes is in up to 80%. Sorry.
posted by tristeza at 8:59 AM on September 30, 2011

EmpressCallipygos, Herpes and Alzheimer's. On Wikipedia, anyway, with links to the scientific research.

Also, about 60% of the population has HSV-1, I think 10% with HSV-2.

The issue with someone having cold sores is that cold sores can be transmitted to the genitals, whether you have HSV-1 or HSV-2. There is no "oral herpes" and "genital herpes", there is herpes, and you can get it on your genitals, on your mouth, and it can be passed back and forth.

Condoms offer some protection, but because it is a disease of the skin condoms protect you only from those areas that they cover--which is not the entire genital and infected area.

OP, herpes is subject to a lot of misinformation on the internet, including AskMefi, there is a mix of people who overdo their worry (if you touch him you'll get it!) and people who are far too blasé (everybody has it, it's TOTALLY no big deal). I think you'll have better luck trying to contact medical professionals who specialize in STD education, or investigating sexual health websites like Scarleteen or Go Ask Alice.
posted by schroedinger at 8:59 AM on September 30, 2011 [4 favorites]

Oh, also if your boyfriend feels like he's geting a cold sore he should try taking the horse-pill sized Lysciene vitamins. They tend to either stop it from coming or quicken the healing period and they are cheaper than Valtrex or topical agents like Abreva.
posted by WeekendJen at 9:00 AM on September 30, 2011 [1 favorite]

I get cold sores and I do not consider them to be an STD in my case since I got them eons before ever having sex (damn you parents!). They can be transmitted through sex, but also can be transmitted other ways. I guess they are not exclusively an STD.
posted by WeekendJen at 9:05 AM on September 30, 2011 [1 favorite]

If you get simplex 1 on your mouth (like through kissing your boyfriend) you could get a sore on your gentails even if his mouth or genitals do not come in contact with your genitals (basically, once you've got it, it's in your body and will show up at it's location of choice).

I'm pretty sure that this is completely wrong.
posted by thisjax at 9:05 AM on September 30, 2011 [1 favorite]

I saw some research on the internet that suggests it is strongly linked to Alzheimers.

As you see above, the estimated prevalence of HSV1 is around 50%. As for Alzheimer's:

An estimated 5.4 million Americans of all ages have Alzheimer’s disease in 2011. This figure includes 5.2 million people aged 65 and older and 200,000 individuals under age 65 who have younger-onset Alzheimer’s.
(42)
• One in eight people aged 65 and older (13 percent) has Alzheimer’s disease.A 2
• Nearly half of people aged 85 and older (43 percent) have Alzheimer’s disease.

They are working on correlation between the two, but, you know... these are real big numbers. If 50% of people have HSV1, and 50% of people over 85 have Alzheimer's... I mean basically you can decide to worry about this or not worry about it? Ask your medical professional.
posted by RJ Reynolds at 9:11 AM on September 30, 2011

Yeah, I guess this is a tough thing to get good advice about. There is plenty of information available, and you've got some here but the bigger question, the question people are trying to answer, and the question you didn't really ask is: How should you feel about this.

My viewpoint is that it's an incurable endemic disease which in the majority of cases is completely asymptomatic and in the vast majority of symptomatic cases restricts itself to minor transient cosmetic blemishes. You have better things to worry about.

On the other hand, OMG it's an incurable disease that can have serious complications.

In the end you're going to have to decide for yourself how much you want to stress yourself out about it.
posted by 256 at 9:13 AM on September 30, 2011

Really, really, call your local Planned Parenthood and talk to them. Or read something reputable like the Herpes Handbook . I know my initial reaction to your post is not that helpful, but here it is: stop. freaking. out. Thinking of HSV-I as a highly communicable sexually transmitted disease that will torpedo your future dating is blowing things out of proportion and you're stressing yourself out. HSV-I tends to be a highly communicable virus that people get extremely commonly, often as children. Try to align your thoughts to think of it more like chicken pox and less like syphilis, because that's more reflective of its reality in most people's lives (e.g. most people have had it, it can predispose you to uncomfortable things, but it's really not a stigmatizing life-ruiner).

Also, it can take up to three months to have HSV show up on a blood test if you're asymptomatic, so you might already have contracted it and it just hasn't shown up on your test yet.
posted by verbyournouns at 9:14 AM on September 30, 2011 [1 favorite]

Sorry, my link didn't work. Herpes Handbook.
posted by verbyournouns at 9:15 AM on September 30, 2011

Herpes is just a virus. Love is much, much more special.
posted by yarly at 9:19 AM on September 30, 2011

"Oral" and "genital" herpes can both manifest in either region; the supposed distinction is entirely false. I have a relative with supposed "oral" herpes and has only ever gotten genital outbreaks, and she gets really irked when even doctors repeat this misinformation and have tried to tell her she only gets cold sores. She tests negative for "genital" herpes and positive for "oral" herpes. Please don't spread the misinformation that you can't get one or the other in certain areas. You absolutely can, and people do.
posted by Nattie at 9:32 AM on September 30, 2011 [3 favorites]

Calling HSV-1 "an incurable, highly communicable STD", while technically true on some level, is fairly crazy when talking about an incredibly ubiquitous virus that the majority of people contract non-sexually in childhood.

how is something that infects your genitals not an STD?

WHen it doesn't infect your genitals and it wasn't spread sexually - as is the case in the vast majority of HSV-1 infections?

There is a lot of dubious information around about HSV-1 an HSV-2. As far as prevalence I think the NHANES studies are the best. I think this presentation probably gives as much of a general ballpark as has any use in the discussion - as I read it, the general prevalence of HSV-1 in the 14-49 age set is roughly 60%, and among those with HSV-1 but not HSV-2 less than 2% are diagnosed with genital herpes.

The HSV-1/Alzheimer's connection is a real scientific thing, but as far as I know it has been seriously explored by only one scientific team, and what it means is up in the air. I actually think it is a generally positive thing because it points to expanded treatment options.

Please be very circumspect about HSV-1 information that is not primary scientific research. Sites like herpes.com are businesses designed to make profits selling products and ads. This doesn't mean the information they contain is all bad but you have no idea how well it has been vetted or by whom. If there isn't a reference you can verify you don't have any idea how reliable the information is.

You are not going to find reliable information on "the base male to female transmission rate for asymptomatic HSV-1" because it doesn't exist. Try to think about how you would scientifically determine the transmission rate for specific sex acts for a highly prevalent disease that the majority of all people contract, in many cases non-sexually, and are not aware of. This is basically true of all the statistical information you are looking for. It is the kind of thing practically speaking does not exist.

But accept that the most likely mode of transmission for HSV-1 is kissing.

I also do not believe that good data exists on how well antivirals prevent transmission. If you read the fine print on antiviral medication advertising they are very careful about what they will actually say with respect to whether it will really prevent spreading infections.

Relegating your boyfriend to a lifelong regimen of expensive antivirals because he has the cold sore virus like more than half the adult population of the U.S. is an extremely dubious course of action.

No vaccine has been developed with proven effectiveness and there are no vaccines commercially available.

Every time you kiss another person it is more likely than not you are contacting an HSV-1 positive individual in the manner that is most likely to spread HSV-1. You are going to have to think very hard about how much you want to let this statistical reality affect how you live your life.
posted by nanojath at 9:37 AM on September 30, 2011 [11 favorites]

Nattie: The distinction is between HSV-1 and HSV-2 which is a very real distinction between two different viruses.

HSV-1 infections are predominantly in the mouth area. Thus it is often, unscientifically referred to as "oral herpes." ~60% of Americans are infected.

HSV-2 infections are predominantly in the genital area. Thus it is often, unscientifically referred to as "genital herpes." ~25% of Americans are infected.

Both viruses can infect both oral and genital sites (among other rarer and more serious sites).

Your relative has a relatively uncommon genital infection of HSV-1. The "herpes is herpes is herpes" talk is unhelpful.
posted by 256 at 9:39 AM on September 30, 2011 [2 favorites]

Which, on that note, given the prevalence of people that carry either form of the herpes virus, and how many people get cold sores, you would have to never have even oral sex with most people to be sure you wouldn't contract herpes on your genitals. There's a point where you can't do much else except be abstinant, and it sounds like you're taking all the care you can otherwise. Don't have sex during an outbreak and come to terms with the fact you may contract it anyway, unless you want to cover the outside of your vagina with saran wrap to cover what the condom doesn't. (Not a serious suggestion, btw.)
posted by Nattie at 9:41 AM on September 30, 2011 [1 favorite]

Wait, cold sores are correlated with Alzheimer's???
posted by KokuRyu at 9:44 AM on September 30, 2011

As a (hopefully useful) anecdote: I have HSV-1. I get them all over my face, I've never had one present genitally. I get them in clusters at least a few times per year. To avoid transmitting it to either my husband or myself genitally, I abstain from giving or receiving oral sex until I have cleared the sore.

I am not concerned about giving them to him orally, he's definitely been exposed to the virus already, like most other sexually active adults, so he's not particularly concerned either. I undoubtedly got herpes from one of my many family members who also have herpes on the face.

I understand that you're concerned about transmission, but chances are, unless no one else you're close with has ever had cold sores (which I find incredibly hard to believe) you've already been exposed and are asymptomatic or are resistant.
posted by crankylex at 9:44 AM on September 30, 2011

I have not been able to find a lot of solid scientific research about HSV-1, and I've been looking because, as someone who has had active outbreaks (facially only) since childhood, I treat this as something I need to manage with my partners, since it is transmissible through sexual activity and there is a non-zero chance of transmission in the absence of an outbreak. Some of my partners have been fine with this, knowing that they have been exposed themselves or reasoning that an awful lot of people are carriers of the virus, some of them have not been okay with it at all. It's not up to me to judge other people's assessment of their personal risk, but I do try to share as much factual information as I have with them.

So here's what I do feel fairly confident saying I know about HSV-1 through personal research and experience, though I am not a medical professional of any sort:

• A lot (numbers vary, but I don't recall having seen a lower estimate than 60% of US adults) of people have HSV-1, very often acquired in childhood. Many people stop having outbreaks as they get older and may not even realize they have HSV-1. It can go dormant for decades, but it is not curable.
• Taking Valtrex (valacyclovir) as a preventative measure (rather than a treatment of an outbreak) reduces both viral shedding and the incidence of outbreaks.
• Taking acyclovir as a preventative reduces the incidence of outbreaks.
• Taking l-lysine and trying to minimize consumption of l-arginine may be helpful in preventing outbreaks.
• There is a chance that HSV-1 outbreaks will manifest genitally, though the medical consensus so far appears to be that the virus generally will prefer to reside in nerves in the face/neck and manifest sores in the mouth/nose area. The information I have seen about genital HSV-1 outbreaks attributes it to site-to-site contact transmission (oral sex), rather than the "spread through kissing, shows up on genitals" scenario proposed above (but neither have I seen that scenario conclusively disproven, which I suspect is due to it being perceived as either extremely low risk or incredibly difficult to test for).

I would not say that having active outbreaks and therefore treating it as something that needs to be addressed upfront with my partners has made it harder to date. On balance, more people have been okay with it than not. I share with my partners what I do to manage the risk of transmission (medication; attention to outbreak triggers and outbreak symptoms; no oral contact of any kind, including sharing drinks or food, if I have even a suspicion of an outbreak) based on the most reliable information I've found. To the best of my knowledge, I have not transmitted the virus to another adult.

My personal assessment of your risk of contracting HSV-1 from your boyfriend is that it's low, if he's never experienced an outbreak as an adult. I would be surprised if jock itch could be mistaken for an outbreak of herpes sores, especially if he saw a doctor about it or it responded appropriately to OTC treatment, as a viral infection should not respond to a treatment designed for a fungal infection. But if you are not comfortable with any risk of contracting HSV-1 that is entirely legitimate. I would just suggest that you keep in mind that in dating other people, your chances of encountering HSV-1 remain pretty high and if you're freaked out enough about that possibility to consider breaking up with someone you care about so much over what appears to be asymptomatic HSV-1, you're going to need a pretty rigorous screening process for future partners.
posted by EvaDestruction at 9:55 AM on September 30, 2011 [3 favorites]

256: I think you're misinterpreting my reason for pointing this out. It's exactly the opposite reason than encouraging the OP to freak out. I'm not saying her bf has genital herpes at all, but I do think it's a big mistake for people to get the idea from the thread that you cannot contract genital herpes from oral herpes and vice versa (which isn't what you're saying; we're in agreement) because that's not true and it can and does lead people to get genital herpes if they're too cavalier about having, say, oral sex before an oral outbreak has fully healed or is just coming on.

I don't think it would do the OP any good to freak out about cold sores outside of an outbreak, just because it's too common a virus to guard against perfectly. I do get cold sores so I know how pointless that would be. But it would also be wrong to say she couldn't get genital herpes from it. I've been with my husband 10 years and he's never had a genital herpes outbreak, but if we thought he literally couldn't contract it from my cold sore virus we may not be as cautious. If I feel even the slightest itching on my lip, or the inside of my mouth is broken out or even burned from food that's too hot, I don't perform oral sex because all those things often turn into cold sores for me. I also take special precautions when I feel the bonecrushing fatigue come on. So my reason for pointing it out is you won't take those precautions if you think you're immune, not to encourage the OP to panic.
posted by Nattie at 9:55 AM on September 30, 2011

Check my link, KokuRyu - it's definitely interesting but I think still very preliminary. It sure seems like a reasonable (UNPROVEN! UNPROVEN!) hypothesis of those results that the action of HSV-1 in immunologically compromised elders is a common if not prevalent cause of Alzheimer's! This could be a very good thing - antivirals could seriously combat the development of Alzheimer's. But that all remains to be seen. All they've found clinically as far as I can see is a lot of HSV-1 DNA in amyloid plaques. Super suggestive, but who knows where the research will go. Worth keeping an eye on if you're interested in both or either diseases.
posted by nanojath at 9:58 AM on September 30, 2011

HSV-1 is such a common thing, and there's a not insignificant chance that you're going to end up with it even if you break up with this guy. It's a minor nuisance, not a major life changing catastrophe. It's not even really an STD. My ex-GF caught it in HS and she was a virgin. I lived with her for 2 years and I've never had a cold sore, even years later. I don't actually know if I have it or not, I've never bothered getting tested, and I haven't ever had symptoms.

Look around you on any bus. More than half the people there have it. Half the people you work with every day have it. Half your family members probably have it. It's not worth even contemplating ending your relationship over.
posted by empath at 10:25 AM on September 30, 2011 [1 favorite]

I'm pretty sure I caught HSV-1 as a child, probably from a kiss or snuggle, or maybe even just sharing a cup. The impact on my life is almost exactly zero -- once a year or so I might get a small cold sore a the corner of my lip, which goes away on its own after a couple of days. Every woman I've ever dated had it, too. I've known people who got scabies and bedbugs from sleeping with people (well, the bedbugs I guess they got from the other person's bedding, but the idea is the same) -- the only way to be 100% free of anything would be to never have the kinds of normal, comfortable intimacy with lovers and friends that makes being human pleasant.

There are good over the counter and prescription treatments for oral herpes if he gets the kinds of awful outbreaks that some people do; otherwise I'd worry about this about as much as if someone got a case of athlete's foot once in a while.
posted by Forktine at 10:44 AM on September 30, 2011 [2 favorites]

Couple other things - if you want to investigate more his history on this, you also might want your BF to ask his parents if he ever had cold sores when he was a little kid - it's pretty common for people to contract this as children or infants, be symptomatic for years, and then have the symptoms disappear with adolescence. If they weren't on the severe side it's possible he was never even aware of them. Also, the jock itch thing is almost certainly a red herring. It's a fungal skin infection in the same family as athlete's foot and ringworm, it's very common, not really likely to be mistaken with herpes, and if the treatment he was given for it worked then it was most likely just what it looked like.
posted by nanojath at 10:53 AM on September 30, 2011 [1 favorite]

I have had occasional cold sores since I was a child. I have a standing prescription for Valtrex with my doctor. When one starts to arrive (usually stress related after travel for me), the Valtrex kills it in a day or so. My wife and I try to avoid kissing during that day. Other than that, it doesn't effect our lives at all.
posted by jeffamaphone at 11:12 AM on September 30, 2011

Not touching the alzheimers thing with a ten foot pole...but while hsv1 can present on genitals it dous not like to be there and will likely quickly go away. Hsv2 is similar in that it can present orally. There is some crazy worrying going on here that is not in proportion to reality.
posted by boobjob at 11:23 AM on September 30, 2011

To respond to your request for data, according to some recent internet research I've done:

The prevalence of HSV-1 among the US population is about 60%, meaning, to my mind, that it's not worth doing much to avoid getting it beyond avoiding contact when there's open sores.

The national prevalence of HSV-2 is much less - about 16%. But this varies by gender, age and location. About 20% of women between 15-49 have HSV-2, compared with about 11% of men in the same cohort, according to the CDC. According to 2004 data, 26% of New Yorkers over age 20 had HSV-2 - 36% of women and 19% of men. Only 19% are aware that they're infected. The WHO estimates that only between 13-37% of HSV-2 cases are symptomatic. The wikipedia "epidemiology" section goes into more detail, including international prevalence.

Wikipedia also has a whole section about transmission rates, under the "Prevention" section. Transmission rates also vary by gender. Transmission rates from M-F are approximately 8-10%, while F-M transmission is lower, approximately 4-5%. I don't know if this is broken down in the cited studies by oral sex, PIV sex, etc. This is, I think, iif you abstain during an active outbreak. Apparently anti-virals and condoms each reduce your risk by a further 50%, though you'd have to read the studies carefully to be sure.
posted by foodmapper at 1:55 PM on September 30, 2011

Wow, this is the first time that I've been made to feel like I have an STD. I've gotten cold sores since I was a tween, so do most people in my family. Yes, I have HSV-1, and no, I have never disclosed that to a partner specifically because, really, it's never occurred to me that I should. I get cold sores once in a while, I hate them with the passion of a thousand burning suns (mostly because I got teased mercilessly in school for them), but they're not... that bad.

I have a prescription for Acyclovir which I take when I feel one coming on. It minimizes the size and inflammation and makes them go away in four days rather than a little more than a week. I've had cold sores around my ex boyfriend, who never developed one, and I've had plenty of cold sores around my fiance, who also has never developed one. If they have HSV-1, they're asymptomatic. My mom probably gave me HSV-1 by being my mom, in that she was around me all the time. Or maybe my dad gave me HSV-1 by being my dad, or my aunts by being my aunts. Some of us show symptoms, some of us never do, even if we've all been exposed to the same virus.

I take care not to kiss anyone, use the same utensils or glasses, or touch my face when I have an outbreak, or feel one coming on. That's the extent of any prevention I feel obligated to undertake. As far as I know, I've never given anyone a cold sore who'd never previously had a cold sore (ie, there'd be a slightly higher chance I'd develop one if, say, my dad had one right then and vice versa. But that risk was dwarfed by the correlation to PMS, for example, or, in some people, chocolate. Or sunshine. Everyone has their own triggers). I hate to tell you that you're overreacting, but it's really hard not to feel that that is the case. Your boyfriend's doctor will likely give him all the information he needs on minimizing his risk of exposing others to the virus, but really, it's pretty damn endemic.

What I really mean to say by all this is that HSV-1? Not that bad. I'd be much happier if it didn't exist, obviously, but, I'll take it. Also, anecdotally, all people I know who have symptomatic HSV-1 have had symptomatic HSV-1 since they were children. Also, also? Had my fiance freaked out the first time I got a cold sore (two weeks into dating him) I would have been pretty damn traumatized by his reaction.
posted by lydhre at 2:09 PM on September 30, 2011 [1 favorite]

From the OP:

I appreciate so many responses to this. Some clarification: I am not considering breaking up with my partner over this, I just want to know numbers and prevention tactics to try to make both of us more comfortable. I just wanted to forestall people who might advise me to break up, as some of my RL friends did. For those asking why he/we got tested, we both got a full and complete battery because we were considering moving to physically unprotected sex.

I understand that many people have cold sores and want to reassure me that it is no problem: I do have a lot of friends who feel similarly and respect that as a valid perspective, but for me, I would rather not have this at all. I also understand that some people do not feel the need to tell potential partners that they have the virus, but personally, I think that would prevent people from being capable of giving me informed consent, which is something I require for any sexual activity.

Also, this is not something that I'm the only one freaking out about: this is something that really concerns my boyfriend too. He is wonderful and amazing, and right now thinks that there's no way he can keep from transmitting this to me if we stay together. Since he's very into math and science, if I can show him actual statistics and studies that show it is not guaranteed and there's a healthy chance I may not get it with prevention, this will help him too.

EvaDestruction: thank you, that is very helpful. Also nanojath, for giving reasons why it might be hard to find data.

posted by jessamyn at 7:17 PM on September 30, 2011

It's generally only infectious when you have an outbreak. I have avoided giving coldsores to all of my partners, including a partner of 4 years, and I had multiple outbreaks with him, and he was tested for it.
Tingle/cold sore? No kiss.

I have a friend who has been married for 20 years, and similarly has never given HSV-1 to her husband.

Odds are, that he has oral HSV-1, and has never had an outbreak. This is very, very common.
I think it's unlikely he'd get jock itch mixed up with a cold sore.

Frankly, I was a little petrified about adding to the conversation given how much misinformation has already been given (putting to top of list of things Mefi does not do well :( ), BUT -

Herpes viruses generally like to settle in one of two places, mouth or genitals (aside from medical weird freak-out places, like brain or eyes). Once you have it in one place, you cannot get it in the other. Ie if you have HSV-1 on your mouth, you cannot get it on your genitals.
Either of HSV-1 or HSV-2 can infect either location, but are more commonly associated with HSV-1 -> oral, HSV-2 -> genital.

Therefore the thing I'd want to worry about most of all, is being currently uninfected, and being infected with HSV-1 on your genitals. Because most of the population has HSV-1, so you have a much higher chance of being exposed to it, than HSV-2.

(Frankly, I'm happier already being infected with HSV-1, knowing I CAN'T get it on my genitals).

But, I'm not meaning to worry you - as above, it is very very easy to NOT give it to your partner. And, if he hasn't had an outbreak, you're not likely to get it - ie it's almost more likely you'd randomly get it somewhere else.

Also, if either of you get an outbreak, it's not the end of the world. During an outbreak, you can actually hit it with some pretty strong anti-virals, that make it less likely you'll break out again.
posted by Elysum at 9:26 PM on September 30, 2011

Your boyfriend did not test positive for HSV 1, he tested positive for the antibody for HSV1. The presence of the antibody is not very predictive of future outbreaks or transmissibility. I usually discourage people from getting antibody tests for HSV because the most likely result of a positive test is exactly what has happened here -- lots of anxiety and little actionable information. In this case, you've moved from a situation of ignorance -- infection with a chronic possibly annoying but non-fatal infection is either impossible or possible but the overall transmission of a symptomatic infection is low -- to a situation of slightly more information -- infection with a chronic possibly annoying but non-fatal infection is not impossible but the risk of overall transmission of a symptomatic infection is low. Add to this the fact that seroprevalence is so high in the general population, that there's a 90% chance your boyfriend's exposure site was oral (when he was a child), the fact that he's never had an outbreak, that condoms and dental dams don't really prevent infection, and that you two are in love, my opinion is that this is a meaningless test. Try to avoid sex over or kiss any ulcerated mucus membrane or skin, which is always good advice, test or no test..

My wife (the infectious disease doctor) gets cold sores and takes acyclovir periodically for this. I have never had cold sores. In reality our antibody status is probably identical to you and your boyfriend's, yet it has never occurred to us to go get tested *because it doesn't matter in my life one iota*. I am still going to kiss her all over her body and have crazy unprotected monkey sex because I love her. It's the point at which I notice weird sores that will drive me to seek medical care, most likely to get a viral culture of the lesion and a prescription for acyclovir.

My advice is to celebrate your negative HIV test and just go crazy with each other.

And for all the other kids out there, think about this and run through the different possible scenarios before you go in to your doctor and request testing for "every" STD. I spend way more time counseling asymptomatic HSV antibody discordant couples than I do actually treating herpes. Do you really want this test? It's not even standard of care to test pregnant women in our clinic anymore, something we did for years.
posted by Slarty Bartfast at 2:28 AM on October 1, 2011 [4 favorites]