Can I get Herpes Simplex Virus type 1 in the genital region if I already have cold sores?

Question:
Hi,

I just met a person who I really like.

He also just told me he has Herpes Simplex type 1, but in the genital area.

I have had cold sores all my life with sporadic outbreaks and thus I suspect that I have Herpes Simplex type 1, in the oral area. Usually, the outbreaks occur when I don’t sleep or when I get allergies. I will go and test myself soon to confirm or check this. Where do I do this?

My first main question is the following. What is the risk of him infecting me with the genital form if we were to have unprotected sex? After reading lots on the web it seems that you are at a lower risk of getting one type of Herpes Simplex if you already have the other since it normally keeps to the area where you get outbreaks. Is this true for my situation? What about the reverse (me infecting him with the oral one)?

The second question is what is the risk of him infecting me if we use protection? I have read about the asymptomatic spread, viral shedding. Can Herpes Simplex type 1 spread from areas where it is not usually broken out? In effect: can it go from him in the area not covered by the condom if he usually has outbreaks in a part that covers the area infected (although of course not during outbreak).

Thank you so much for helping me.

Answer:
To answer your first question, there are many different ways to go about testing. Many places offer laboratory based testing, which is the highest quality testing available. Usually, there is no long wait, as there would be in a clinic, to get tested, as well as to receive your results. On top of this, they don’t send you to a clinic. Rather, they would send you to a private, and thus discreet, patient service center. Check out the links in the sidebar (right side) if this is what you are looking for.

The general principle about herpes is that there are two types, HSV1 and HSV2. HSV1 usually appears orally, while HSV2 usually appears genitally, but in about 30% of cases, HSV1 appears genitally and HSV2 appears orally.

The first thing that you should do would be to get tested. It would be in your best interest for you and you partner to be tested for both HSV1 and HSV2. I am not sure how your partner determined that he has HSV1 genitally, but the most accurate way would be to run a culture test on a swab of the blister or outbreak. In the absence of outbreaks, you could get tested for both HSV1 and HSV2, using a separate IgG test for both, at least three months after possible exposure. If only HSV1 shows up positive and the only outbreaks that have been observed are in the genital region, then it can be safely assumed that the genital outbreaks are caused by HSV1. This aside, you should make sure that what you have been observing orally, is actually herpes, or specifically HSV1. Many people have canker sores, and they think that this is herpes. It is actually an aphthous ulcer, is not contagious, and is similar to herpes in terms of symptoms.

Now, let’s move on to your second and third questions.

If you and your partner have HSV1, then you can’t get it from him, and he can’t get it from you, because both of you already have standing antibodies towards HSV1. In your specific scenario, you should be protected from getting HSV1 in the genital region, if you already have it orally. Once you know you have HSV1, then you really not subject to getting it again, no matter the location. On the other hand, if you don’t have HSV1, and what you have been noticing is not actually herpes, then you could get it from your partner. You could get it genitally, from sexual intercourse; you could get it orally, from performing oral sex on him. In reality, if you don’t have HSV1, you could receive it orally and genitally, if you are infected at the same time. For example, if you perform oral sex on him and then have intercourse with him, you would likely receive the virus in both areas, because you haven’t built up that immune response to protect you from getting re-infected.

If you have HSV2, then you aren’t necessarily immune to receiving HSV1, but this would provide some resistance against infection. How much resistance? That isn’t exactly established, but we do know that having one type of herpes (thus having those antibodies) lends some resistance against the other type of herpes.