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Confusing test results and HSV1 Genital Herpes
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Confusing test results and HSV1 Genital Herpes

I met this great young woman several months ago who told me early on she had been recently diagnosed with genital herpes and that her prior boyfriend had then also tested positive. We have never had sex.. She says she has never had another genital sore and recently had a very expensive STD blood test that is supposed to be super accurate and she says it came back negative for HSV 2 but positive for HSV 1.  She said that first test several months ago was a swab test of a small but visible genital sore done by a highly professional Dr. . That Dr. still says there is no doubt that the swab test came back positve for HSV from that genital sore. That Dr. is now saying the recent blood test coupled with the earlier swab test means she definitely has gential (genital) herpes but it happens to be HSV 1 herpes  instead of HSV 2. The woman received oral sex from her prior boyfriend, but she is thinking now maybe that Dr. is wrong and the first test, i.e. the swab test, was just wrong, and that she doesn't have genital herpes, that the earlier sore must have been something else.  
Questions  --
1) Is there any test (no matter how expensive) that could be done now (including perhaps repeating the swab test several times or a better swab test?) that will tell whether a person has HSV 1 in the genital area? What if there are no visible sores in the genital area at the time of her re-test?
2) In my own blood tests I have tested positive for HSV 1 since I was a kid  but negative for HSV 2 via blood tests including recently and have never had any sores, etc in my genital area. I'm pretty confident I have the traditional oral HSV 1.  Does having oral HSV 1 prevent me from getting HSV 1 in the genital area if we have sex and she does have HSV 1 genitally? Or can I still catch it there as well? I have read conflicting info on this.  ARE YOU POSITIVE OF THE ANSWER TO THIS? WHERE CAN I READ THE DATA?
                 THANK YOU!
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55646_tn?1263664409
I believe that her doctor is correct. 40% of new genital herpes in the US is HSV 1, not HSV 2, so that makes sense.  If a swab test is positive (but untyped) and the antibody test is positive only for HSV 1, then she only has HSV 1 and the genital lesion must have been HSV 1.  

No one has a study showing that if you have HSV 1 in one location that you can't get it in a new one, but I think all experts would agree that it is extremely unlikely.  If that was likely to happen, then small children you have cold sores would often get genital infection as well as they touch their mouths and genitals all the time.  It is certainly possible to get HSV 1 orally and genitally at the same time, that is, you might kiss someone and receive oral sex from them at the same encounter.  But once an immune response is mounted to that type, it is very unlikely you would get it in a new place later.  

No one can offer you a guarantee about this. You are going to have to make your decision on the preponderance of professional opinion on this topic.  In thirty years of practice, specializing in herpes, I have never seen a patient who has a history of cold sores get new genital HSV 1 infection.  

Terri

8 Comments
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Avatar_m_tn
Thank you, but are there any tests that she can take now to re-test if the HSV 1 is in the genital area?  I'm guessing that no blood test can distinguish between HSV 1 in the genital area versus HSV 1 in the oral area.    How many different "brands" of swab tests are there and are some more accurate than others?  And will a genital swab test tell anything significant if there is no genital sore present?
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55646_tn?1263664409
There is no need to re-take a swab test from the genital area.  And yes, she needs a lesion present to swab.  If the swab test initially was positive, then she has genital HSV 1, period.  There are different kinds of swab tests, but their accuracy isn't like the blood tests.  If the swab test is positive for HSV from a lesion, then its positive.

Terri
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Avatar_m_tn
We've read that in child birth, the probability of having an outbreak of HSV 1 genital herpes is smaller than HSV 2, but that if the woman gets an HSV 1 genital outbreak during labor the risk of infection to the baby is slightly higher than with HSV 2,  My first question is IF there is an HSV 1 genital induced infection of the baby during labor are the actual problems, complications, and treatments to the baby the same as with an HSV 2 infection during labor?

Second, I have read conflicting opinions by "experts" on whether if you have HSV 1 orally you can later contract HSV 1 genitally.  Many people in forums say you can't, but I've heard experienced doctors say its possible, has been documented, but rare.  Are you aware of any scientific studies that prove this one way or the other?
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55646_tn?1263664409
Yes, interventions for babies with HSV 1 are the same as for HSV 2.  
No, I am not aware of any studies addressing the specific of the issue of getting the same type infection in a new location.

Terri
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Avatar_m_tn
Thank you for your advice.  If you are not aware of any scientific studies on this, what do you personally advise people --  that they can still get HSV 1 gentially even though they have had it orally, or that they can't?
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55646_tn?1263664409
Nope, I don't say that.  I tell people that if they have herpes in one location, they are highly unlikely to contract it in a new place.

This will be the last response on this thread.

Terri
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Avatar_m_tn
Sorry, I just re-read your first answer, and I guess its that you have never seen a case of it in 30 years.  But how would one know most of the time?  If someone comes in, gets a genital swab and its HSV 1, and there has never been a prior HSV test, there is no way of knowing. Think of the statistical implications of several studies that say that HSV 1 genital herpes is skyrocketing -- for example this article -- http://journals.lww.com/stdjournal/pages/default.aspx -- says 78% of new genital herpes cases at the colleges tested in 2001 were HSV 1 (up from just 31%   9 years earlier), yet numerous studies say at least 50% of the population tests positive for oral HSV 1 by the age or 20 and has for decades.  Studies from the UK and Isreal show even greater increases in HSV 1 genital herpes.  Either you can catch HSV 1 genitally despite having it orally, or else all the increase in HSV 1 genital cases is coming only from the half of the population that doesn't test positive for oral.  The odds of that are miniscule.
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Westover Heights Clinic
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