Herpes schmerpes

March 8, 2008 6:57 PM

Boy meets girl. Boy falls for girl. Girl tells boy she has genital herpes (type 1). Boy says that's OK, I want to be with you. Now boy wants advice on safety.

She tells me that she has roughly 1 outbreak per year, usually fairly mild. She also tells me that she has never, to her knowledge, passed it on to a partner, and she has been in long term relationships where they were having unprotected sex.

I know that, obviously, wear condoms. I also know that condoms are not 100%. But what about other acts: digital penetration, oral sex, analingus? I've had cold sores before (last one was maybe 4 years ago, before that it had been at least 3-4 years) so I assume I have orally the same type she has genitally and that dental dams are probably unnecessary (can I be tested for oral herpes in the absence of symptoms?). I just want to make sure that it doesn't spread to any weird parts of my body or hers. Advice?

posted by anonymous to Health & Fitness (10 answers total)

There are two common strains of herpes virus, so you may or may not have her strain already. It's more likely that you actually have a different strain as the strains have a relative predilection for oral or genital infection (though there is crossover). That said, you may even already carry both strains. There are many completely asymptomatic carriers of HSV-1 and HSV-2. The only way to limit transmission is via barrier methods, and even with perfect condom use, and in the absence of a symptomatic breakout or visible lesions, herpes can still be transmitted. It can be transmitted via oral sex as well as analingus though firm statistics are hard to come by. The predilection for transmission is via mucous membranes so relatively speaking, digital penetration is much less likely to lead to transmission. If she's willing to consider suppressive therapy daily with a medication like valacyclovir (Valtrex) she would further reduce the risk of transmission even during asymptomatic periods, as well as reduce her risk of a full blown reactivation, though most folks with her degree and frequency of symptoms would generally be disinclined to be on a medication daily.

You both can get tested for the two common strains of the virus, and if you share the same strain(s) then this is a moot point but I would only pursue testing if finding out that you don't have the same strains would alter your plan of action and methods of protection.
posted by drpynchon at 7:23 PM on March 8, 2008

Correct me if I'm wrong—this is way outside my general field of knowledge—but isn't herpes testing when you aren't showing symptoms kind of a wash?

I remember it being explained to me that they can only really test for antibodies, which can only shows that you've been exposed to it, not that you currently have an infection.
posted by Weebot at 7:39 PM on March 8, 2008

In this case, testing for antibodies may be the relevant issue as it likely reflects continued immune protection from reinfection. If the antibodies are positive you haven't simply been exposed to the virus; you've contracted it (as reflected by the immune response your body has developed) -- though this won't reflect whether you are symptomatic or not.
posted by drpynchon at 7:50 PM on March 8, 2008

Basically everyone, ie even you, have herpes simplex 1. It's just a matter of whether you show symptoms or not (ie cold sores). If she has a break out, etc, it can make you become symptomatic. Herpes type 2 is the badshit, it's the ones you don't want.
posted by uncballzer at 8:28 PM on March 8, 2008

OP says that she has HSV-1, but genital. Is that possible? Wikipedia seems to suggest that it is, although normally it is oral.
posted by papakwanz at 8:36 PM on March 8, 2008

You both can get tested for the two common strains of the virus, and if you share the same strain(s) then this is a moot point but I would only pursue testing if finding out that you don't have the same strains would alter your plan of action and methods of protection.

Even if you have the same strain, you still want to be careful. Herpes doesn't spread through the body, it stays in the nerve near the point of innoculation. You could give yourself genital herpes with your own strain of lip-herpes if you wanted to.
posted by fermezporte at 8:44 PM on March 8, 2008

HSV-1 can be genital or oral. Its more commonly oral. Looking how separate HSV-1 and HSV-2 have been kept through the millenia, despite any biological reason that I know of, and how its only starting to be seen in other areas, says something about how uncommon oral sex was before recent years.

Herpes type 2 is the badshit, it's the ones you don't want.
No, its herpes on your genitals you don't want. Don't think you can't spread your cold sores through oral sex.
posted by fermezporte at 8:48 PM on March 8, 2008

The predilection for transmission is via mucous membranes so relatively speaking, digital penetration is much less likely to lead to transmission.

True, true, but don't forget herpetic whitlow!
posted by gramcracker at 9:31 PM on March 8, 2008

(can I be tested for oral herpes in the absence of symptoms?)

Yes. It's a blood test. However, it's limited in that while it will tell you if you've developed antibodies to herpes and which type(s), but if you're positive for either type, it won't tell you where. You can have "genital" herpes on your mouth, and vice-versa.
posted by Violet Hour at 10:05 PM on March 8, 2008

I'm not a doctor, and certainly no expert on genital herpes, but here's some links that might interest you, for further reading.

International Herpes Management Forum
Mayo Clinic on Cold Sores
Genital Herpes - Public Health Agency of Canada
Infected for Life: How Herpes Simplex Virus Uses MicroRNA to Hide Out in Cells
UK Genital Herpes Resource Site
NHS Health Encyclopaedia - Information on Cold Sores

Best of luck to the both of you!
posted by Effigy2000 at 1:19 AM on March 9, 2008