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STDs (Expert Forum)
New genital HSV-1 questions
Answered by
University of Washington
Seattle - WA
This forum does not cover AIDS/HIV issues. This forum is for questions and support regarding STD issues such as: Chlamydia, Crabs (pubic lice scabies), Gonorrhea, Hepatitis (viral), Herpes, HPV, Molluscum Contagiosum, PID, Rectal Infections, Syphilis, Trichomonas, Warts, Yeast Infection.
IMPORTANT
This forum is limited to questions about STDs other than HIV/AIDS. For questions about HIV prevention, or if you have general questions about safe sex (e.g., condoms, how to protect yourself from HIV and STDs), please visit the HIV Prevention and Safe Sex Forum
Some of the most common types of questions concern the risk of HIV or STD after a particular sexual exposure, and about symptoms that might or might not be due to HIV. If your question is along these lines, please visit the HIV Prevention and Safe Sex Forum.
This forum is limited to questions about STDs other than HIV/AIDS. For questions about HIV prevention, or if you have general questions about safe sex (e.g., condoms, how to protect yourself from HIV and STDs), please visit the HIV Prevention and Safe Sex Forum
Some of the most common types of questions concern the risk of HIV or STD after a particular sexual exposure, and about symptoms that might or might not be due to HIV. If your question is along these lines, please visit the HIV Prevention and Safe Sex Forum.
New genital HSV-1 questions
by cboarder, May 30, 2006 12:00AM
Dr. H,
Thank you for your wonderful feedback and website. It truely is a great service for all who utilize it.
I was recently diagnosed with genital hsv-1 and had my first noticeable outbreak 6 weeks ago. I am healthy, heterosexual male and the outbreak was very mild. There was only one very small sore the size of a pencil tip, which was cultured for HSV-1 and negative for HSV-2. I have done a ton of reading on your site and understand that my reoccurences should be few and far between. I currently am in a relationship and we have refrained from sexual contact for the past 3 months so she could be tested as well. She has had a herpes select test done and was negative for both HSV1 and HSV2. I want to be as safe as possible not to infect her. Please bear with me on my laundry list of questions because I want to be as safe and smart as possible since it's just not my self that this affects. Thanks.
1. If I am on suppresive therapy and avoid having sex when there is an outbreak, are condoms still necessary since our relationship is going to be long term? Does Valtrex do a good job of suppressiing HSV-1 shedding? Does any type of chemical such as spermicide help kill the hsv-1 virus during intercourse?
2. If she has HPV, can HSV-1 increase her chances of cervical cancer? I have seen different opinions of HSV-2 and this topic, but not HSV-1.
3. Is herpes encephalitis only caused by HSV-1 in the facial nerves (since I have genital hsv-1, any need to be concerned since my infection is not of the sacral region)? Is herpes encephalitis only seen in immuno-compromised patients such as HIV and cancer?
4. Can HSV-1 cause any type of Neuralgia, or other CNS problems? Or, is just shingles that cause post-herpetic neuralgia?
5. As long as I am not touching any open sores, is there any chance of spreading it to my face or anywhere on her after the first year, while I develop antibodies (i.e. occular herpes).
6. Currently, there are trial sites across the US for a herpes vaccine. Is it worth us looking into her becoming part of vaccine trial to lessen her chances of becoming infected?
Doctor, thanks for your help because my biggest concern is for her, not myself. Your feedback is greatly appreciated because I want to handle the next steps in our relationship appropriately and safely. Take care and best of luck!
Thank you for your wonderful feedback and website. It truely is a great service for all who utilize it.
I was recently diagnosed with genital hsv-1 and had my first noticeable outbreak 6 weeks ago. I am healthy, heterosexual male and the outbreak was very mild. There was only one very small sore the size of a pencil tip, which was cultured for HSV-1 and negative for HSV-2. I have done a ton of reading on your site and understand that my reoccurences should be few and far between. I currently am in a relationship and we have refrained from sexual contact for the past 3 months so she could be tested as well. She has had a herpes select test done and was negative for both HSV1 and HSV2. I want to be as safe as possible not to infect her. Please bear with me on my laundry list of questions because I want to be as safe and smart as possible since it's just not my self that this affects. Thanks.
1. If I am on suppresive therapy and avoid having sex when there is an outbreak, are condoms still necessary since our relationship is going to be long term? Does Valtrex do a good job of suppressiing HSV-1 shedding? Does any type of chemical such as spermicide help kill the hsv-1 virus during intercourse?
2. If she has HPV, can HSV-1 increase her chances of cervical cancer? I have seen different opinions of HSV-2 and this topic, but not HSV-1.
3. Is herpes encephalitis only caused by HSV-1 in the facial nerves (since I have genital hsv-1, any need to be concerned since my infection is not of the sacral region)? Is herpes encephalitis only seen in immuno-compromised patients such as HIV and cancer?
4. Can HSV-1 cause any type of Neuralgia, or other CNS problems? Or, is just shingles that cause post-herpetic neuralgia?
5. As long as I am not touching any open sores, is there any chance of spreading it to my face or anywhere on her after the first year, while I develop antibodies (i.e. occular herpes).
6. Currently, there are trial sites across the US for a herpes vaccine. Is it worth us looking into her becoming part of vaccine trial to lessen her chances of becoming infected?
Doctor, thanks for your help because my biggest concern is for her, not myself. Your feedback is greatly appreciated because I want to handle the next steps in our relationship appropriately and safely. Take care and best of luck!
Doctor's Answer
by H. Hunter Handsfield, M.D., May 30, 2006 12:00AM
, May 30, 2006 12:00AM
Thanks for the thanks about the forum. I'll try to help.
1) Data on sexual transmission of herpes are available only for genital HSV-2 infection, not HSV-1. All anti-herpetic therapies are somewhat less active against HSV-1 than HSV-2 and in preventing asymptomatic shedding or transmissionn of genital HSV-1 has not been studied and should not be assumed. On the other hand, asymptomatic shedding, as well as clinical outbreaks, probably are less common than for genital HSV-2. All in all, if you avoid sex during outbreaks and are taking Valtrex, my guess is the transmission risk to your partner is very low, even without condoms. Spermicides have not proved very effective in STD prevention; to my knowledge, no useful data are available for herpes in particular.
2) HSV probably plays any important role in cancer risk in HPV infected persons. If there is any increased risk, it is too small and too uncertain to be a concern.
3) I Herpetic encephalitis is very rare. It is logical to assume it is more common as a result of oral HSV-1 than genital, but I am unaware of data on this.
4) Some people believe that some cases of HSV-1 and/or HSV-2 can cause syndromes similar to post-herpetic neuralgia seen after herpes zoster, but it is controversial. If it occurs at all, it is rare.
5) Self infection to a new part of the body (autoinoculation) is very rare for established, recurrent herpes of either type. Almost all cases occur during the initial infection.
6) The vaccine in clinical trial is designed to prevent HSV-2, not HSV-1. It's not relevant to your situation.
Good luck-- HHH, MD
1) Data on sexual transmission of herpes are available only for genital HSV-2 infection, not HSV-1. All anti-herpetic therapies are somewhat less active against HSV-1 than HSV-2 and in preventing asymptomatic shedding or transmissionn of genital HSV-1 has not been studied and should not be assumed. On the other hand, asymptomatic shedding, as well as clinical outbreaks, probably are less common than for genital HSV-2. All in all, if you avoid sex during outbreaks and are taking Valtrex, my guess is the transmission risk to your partner is very low, even without condoms. Spermicides have not proved very effective in STD prevention; to my knowledge, no useful data are available for herpes in particular.
2) HSV probably plays any important role in cancer risk in HPV infected persons. If there is any increased risk, it is too small and too uncertain to be a concern.
3) I Herpetic encephalitis is very rare. It is logical to assume it is more common as a result of oral HSV-1 than genital, but I am unaware of data on this.
4) Some people believe that some cases of HSV-1 and/or HSV-2 can cause syndromes similar to post-herpetic neuralgia seen after herpes zoster, but it is controversial. If it occurs at all, it is rare.
5) Self infection to a new part of the body (autoinoculation) is very rare for established, recurrent herpes of either type. Almost all cases occur during the initial infection.
6) The vaccine in clinical trial is designed to prevent HSV-2, not HSV-1. It's not relevant to your situation.
Good luck-- HHH, MD
My specific case is unlikely but true: my partner contracted genital HSV-1 by culture by an unfortunate oral-genital exposure to a mouth sore I had. I also tested positive for IgG to HSV-1 at the same time. We were careful for at least two months and used condoms and non-oxynol-9 spermicide (which has herpicidal activity in vitro) anyway. I still had no genital symptoms and we decided to forgo the condoms and spermicide. I developed genital HSV-1 subsequently, despite the fact that I already had antibodies. It never hurts to be more careful because once herpes infects it stays for a lifetime.
My story is just an example and a warning that you should be very careful especially very early in the disease. I would say the first 6 months at least. Why not take all the precautions for a little while: condoms, spermicide and valtrex daily (maybe even 1gm at bedtime instead of 500 mg)? If you do this for 6 more months you can then be more at peace with the low risk to her. You will also not have to worry much about breakouts for yourself. It will let the relationship develop more normally without the extra psychological stress of herpes. After some months have passed you will be in a much better spot to make a decision about what to do next. This is just my advice from a retrospective personal view and as a doctor. Good luck!
1. Have you had many outbreaks genitally because you acquired HSV-1? Are you taking suppressive therapy?
2. Has this situation put much stress on your relationship? I know I've had a very hard time accepting the fact that I have a disease with such a negative stigma attached to it. Any advice for moving on and letting go of what I have.
3. In regards to my fiance, has your partner (female?) had many outbreaks? I only ask because it sounds like females have it worse in terms of outbreaks when it comes to herpes than males do.
4. Do they make condoms with non-oxynol-9 spermicide, or do you have to buy it special in a different package?
I appreciate any additional insight you can provide to help myself and my fiance deal with this situation. It really has changed a lot of things in my life.
Take Care!
-GG
Women and men have equally frequent recurrences of genital herpes due to HSV-2 (and perhaps HSV-1, but data are unclear). In fact, men report slightly more recurrences than women--but part of that probably is because it's easier to recognize subtle lesions on the penis than on the vulva; true recurrence rates probably are the same, on average. But outbreaks do tend to be more painful in women (and in uncircumcised men), because lesions ulcerate sooner in mucous membranes and moist areas than on dry skin