HSV-1 or HSV-2?

[bunniesrus]

I am a 31 year old female and when I was 16 I had unprotected sex.  I then experienced all of the symptoms of genital herpes and went to my GYN where she cultured it and confirmed it be herpes. Being so young, I didn't know much about it and thought there was only one kind of herpes.  Since that time, to my knowledge, I have never had an outbreak.  I recently opened up to my current GYN about this and he suggested that I get re-tested.  He sent me to the lab for blood work and to my surprise the results came back that I had "cold sores" or HSV-1 but not HSV-2.  I was shocked as I have NEVER had a cold sore.  I told him about the horrible first outbreak I had when I was 16 and he said that HSV-1 can affect the genital area as well.  It just seems too wierd, I have to wonder if the lab mixed up the results with the two  types.  So my question to you is, 1)is my GYN correct that HSV-1 can appear genitally as well?  And 2) Do you think I should get re-tested just to be sure it is HSV-1 and not HSV-2?
Thank you!

[Alan Rockoff, MD]

Yes, HSV-1 can affect the genitals.  It tends not to recur as often, which fits your situation.  I think it would be a good idea to have your doctor draw type-specific herpes tests (for both type 1 and type 2.  If your type-2 test is negative, that would show that your original herpes outbreak was type 1.  I am not sure exactly how contagious that is if you have no active outbreak.  You might put that question to Dr. Handsfield at the STD forum.

Best.

Dr. Rockoff

[needitresolved]

Not the doc, but know a fair bit about this.

It sounds very much like a typical HSV-1 infection. Of people that are infected with HSV-1 genitally, 40% have NO recurrances following their initial outbreak, 50% have 1-2 over the next 1-2 years and none thereafter. Less than 10% have recurrent outbreaks.

Further HSV-1 rarely sheds asympotmatically, unlike HSV-2. If you indeed have HSV-1 genitally, it's highly unlikely that you are contagious at all now. Many (indeed most) doctors would say you have no ethical obligation to inform future partners.

So your outbreak pattern coupled with your test result seems like strong evidence that you were indeed infected with HSV-1 genitally.

But, the thing to do is make sure your blood test was the right kind. Herpeselect is the best kind if you're in the US, but make sure that it is an IgG glycoprotein based test, NOT an IgM test which are still sometimes carried out but are worthless nonetheless.  

My source for all this is Dr Hansfield, a world leading STD expert who fields questions in the STD section of this site. The percentages I referenced were from a study carried out by Dr Wald.

Anyways I suggest you do a search for HSV-1 in the medhelp search engine.

Good luck.

[bunniesrus]

Thank you for the information.  I was not aware of those statistics.  I want to find out what kind of test my lab used before going to get re-tested.  Quick question, the person I contracted this from when I was 16 did not perform oral sex on me.  Is it possible to transmit genital HSV-1 from regular sex?

[needitresolved]

Genital to genital transmission of HSV-1 is possible but rare.
Most cases are acquired orally, but I think it's definitely still worth following up, particularly in light of your test results.