Oral HSV-1 to genital?

[juicebox8787]

Long story short I have had ohsv1 for probably 15 years about 8 years ago I got a surpise cold sore and accidentally spread it to my partner gentially through oral sex. They had the initial OB which was confirmed hsv1 and then didn't have one again until last year, so 2 OBs in 8ish years. Well we had sex and the next morning they woke up with an OB. About a month after that when we were traveling I developed what I thought was the worst yeast infection of my life, my whole undercarriage was uncomfortable and there was typical yeast infection symptoms but burning and itching like crazy but no sores that I could really see and wasn't in a spot that I could really look but I made my parter look and they didn't see anything either. Fast forward a week or so to us getting home I went a saw a doc not my regular and explained and asked for a swab she said she saw irritation but nothing that looked like outright sores she swabbed anyway and it was negative for hsv. Now almost 6 months later I am still struggling with this itchy uncomfortable sensation. I've been to my OB probably 10 times and had another swab done on what looked like a tiny painful scratch that also came out negative. She said it probably would bc there wasn't any fluid to swab. I went ahead and went on daily antivirals and I still have the same issues just not as intense as the first time. I've had bv and yeast infections off and on during this time and been treated for them. We are monogamous and been together for 10 years and tested for everything under the sun. What are the odds it's gential hsv1? Even though I have a well established infection orally can I still get it gentially? I have had doctors say hell yes you can just bc you have the same strain orally doesn't mean shit you can still spread it on yourself and get it from your partner. But most of what I read says that autoinoculation and reinfection with the same strain somewhere else on your body is also highly unlikely. What is real? 

[mr_hopp]

Hey there @juicebox8787!

Your situation sounds really challenging, navigating the complexities of HSV1, especially with such a long history both orally and possibly genitally. It’s quite the journey you’ve been on with your partner, and I can imagine the frustration and confusion you're feeling.

First off, it’s true that having an established oral HSV1 infection typically provides some immunity against getting the same virus genitally due to the body's production of antibodies. However, there are exceptions, and it seems like your situation might be one of them, especially considering your partner's history and your symptoms. Autoinoculation (spreading the virus from one part of your body to another) is less common but not impossible, particularly if your immune system is compromised in some way. More than half of all new genital herpes cases are via oral sex when the partner with a history of cold sores goes down on their partner and passes it that way. 

Negative swab tests, especially when not done during an active outbreak or on a lesion with fluid, can sometimes not capture the virus, leading to false negatives. It’s a tricky virus to pin down without the classic symptoms or during asymptomatic shedding periods. The tricky thing is if you're not having a "swabbable" active outbreak, there's not going to be a way to truly nail down what it is since a blood test will only tell you what you already know: You have (and have had for many years) antibodies to HSV-1. So yeah, you're in the midst of an annoying gray area, lacking the necessary data to have a definitive answer.

Your proactive approach with antivirals is a good step, and it sounds like they’re helping somewhat, which could indicate a viral component to your symptoms. The odds and realities can vary so much from person to person. While reinfection in a different location is unlikely, it’s not out of the realm of possibility, especially in nuanced and individualized situations like yours.

Hang in there, and it sounds like you’re navigating this with as much care and attention (and patience!) as you possibly can. It’s okay to seek second opinions or additional tests if you’re not feeling right. Keep us in the loop about further developments, I know it's a tough and frustrating place to be.