How Contagious is Oral Herpes?

I have oral herpes. I've been very careful for over 20 years and to my knowledge have never infected anyone, nor transferred it elsewhere (such as my hands). Am I likely to transmit it when I'm asymptomatic by sharing a piece of food, which I haven't had a bite from, off my plate? My employer is convinced that I carelessly endangered the health of a coworker in exactly this fashion. I was sent to an infectious disease doctor who hasn't done much to allay their fears. I've been asked to have a blood test (results pending) and I am prohibited from using other people's phones or sharing utensils. The blood test included a hepatitis screen because I had that 30 years ago and they want to be sure I'm not infectious.

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Your story is an outrage. It shows complete ignorance of herpes infections. Herpes simplex viruses (HSV) 1 and 2 cause oral and genital herpes. Most cases of oral herpes are caused by HSV-1. Although the primary (initial) infection with the virus usually causes no symptoms, some people with a relatively severe infection may develop blisters on the lips and in the mouth, fever and -- in rare cases -- severe neurologic and other complications. HSV never is totally eradicated from the body, and it can reactivate many times later in life. Typically, reactivations are mild in nature and result in blisters around the mouth known as cold sores and fever blisters. Severe reactivations are rare.

Some infected people never have any symptoms and infection is detected only by a blood test that identifies antibodies (disease-fighting proteins) the body makes to fight the virus. A positive antibody test does not indicate how frequently (if ever) a person has had fever blisters or other symptoms. It only indicates that the person was, and thus still is, infected. More than 90 percent of all adults older than 40 are positive for HSV-1! That means that you could not infect most of your colleagues because they are already infected. Why were you singled out? It just does not make sense.

Furthermore, HSV-1 does not survive long at all outside the human body. The virus is generally transmitted through direct contact with saliva, not through contact with inanimate objects touched by an infected person. I have never heard of transmission of HSV-1 through an untouched piece of food. Telephones and utensils also would pose minimal risk. Although it is true that one can spread the infection even if there are no oral herpes symptoms, the risk is much lower when there are no actual blisters -- and in any case, transmission usually involves DIRECT contact.

As far as hepatitis is concerned, again, the risk you pose to any other employee is negligible. Even if you have active hepatitis B or C, the transmission of these viruses requires exposure to blood or sexual contact.

I think that your work situation is grossly unfair to you. As I said above, most of your colleagues would also test positive for HSV-1 antibodies. Anyone who tests positive would have the same (very small) risk of passing the virus on to anyone else who happened to be negative. I believe that any prejudice against you for having herpes infection is wrong, and it may be illegal. If the infectious diseases physician does not support you in this instance, then I would find another infectious diseases doctor.

by Harold Oster
 

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