I have genital HSV-1. Do I have to take the same precautions as HSV-2?

Q: I just found out that I have genital HSV-1.  I’m confused about a lot of things. I’ve read a lot about how HSV-1 can be passed from oral to genital contact, but not a lot about how likely it is to be passed genital to genital. Now that I have HSV-1 genital herpes, do I have to take the same precautions as someone with HSV-2? If someone already has HSV-1 in their mouth, could sex with me cause them to have a genital outbreak? Although I’ve never had a cold sore, could I pass the HSV-1 to someone by kissing them? By giving them oral sex? If they give me oral sex, will they get oral HSV-1? Since my first outbreak (which was very severe) I have never had another one. Also I am female. Do these things make it less likely that I will pass on the virus? My first outbreak was a terrible experience, and I do not want to cause anyone else to go through that, but I’m also not sure if I’m being overly cautious.

HSV-1 Girl

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A:  That’s a lot of questions!  Here’s our best attempt to help you out.

– Genital HSV-1 is extremely common! In fact, HSV-1 is now the leading cause of new genital herpes infections. HSV-1 can be passed to another via genital, anal or oral sex, just like HSV-2.

– Yes, you will have to take the same precautions against spreading HSV-1 just as you would with HSV-2. (See How to Reduce Your Risk).

– 60-80% of the general population already have HSV-1 orally.  Most people don’t realize that cold sores are the same thing as herpes (HSV-1).  Most people don’t realize that it’s possible to spread HSV-1 to another person via oral sex, even when they don’t have a visible cold sore.  A lot of people think oral sex is safe, and don’t use any sort of protection.  But anytime you are swapping body fluids, there is a risk of spreading something.

– Sorry you had a terrible first herpes outbreak.  Herpes affects each person differently based on a number of variables such as your own immune system, etc.   Most people with herpes don’t even know it because their symptoms are not noticeable, or are very mild and infrequent, and are mistaken for something else.  Other people get outbreaks all the time.  Some people have 1 outbreak and then never again.  Some people only have symptoms a few times a  year.

— Even when someone is not having any symptoms, it is still possible for them to spread herpes to their partner because the virus can be shedding from the surface of the skin without causing any sores or symptoms.

– The only way to know for sure how often a person is shedding the virus without symptoms is to take part in a herpes research study where your skin is swabbed on a daily basis and then tested for evidence of the virus.  In one study, the subjects tested positive for the virus on up to 10% of days, even when they had no symptoms.  But even in that study, each person was different.  Some people shed more often, and some people shed less often.   So each person is different.

– The good news is that by using suppressive therapy – such as taking daily Acyclovir or Valacyclovir – which can dramatically reduce the number of days of asymptomatic shedding. (See Herpes Treatments).  In one research study, patients who took suppressive therapy shed the herpes virus only a fraction of a percent of the time.  So combining suppressive therapy with proper and regular use of condoms is a very effective way to reduce your risk of spreading the virus to someone else genitally.  If you use dental dams, then oral sex is safer too.

– Bottom line – HSV-1 and HSV-2 cause pretty much the same symptoms and one is not better or worse type of herpes than the other.  Both types of herpes can cause outbreaks either orally or in the genital region, or even on the buttocks, back or thighs. The treatment options are the same. The methods of reducing your risk of spreading it are the same.  However, everyone is different and may experience (or not experience) symptoms differently.  Most people with HSV-1 and/or HSV-2 got it from someone who wasn’t experiencing symptoms at the time, didn’t know they could spread it, and may not have even known that they had any form of herpes.

Now that you know that you have herpes, you can take precautions to reduce your risk of spreading it and by doing that, you’re a safer sex partner than most other people out there who have herpes and don’t know it and who are not taking suppressive therapy or using any protection.  Good luck!

DWH