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HSV 1 confusion / clarity?
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HSV 1 confusion / clarity?

Hi all.

Firstly really helpful forum / info site :)

I have a couple of questions if anyone can help!

Bit of background:

I returned from a holiday with my girlfriend of 4 months, and two days later noted a what looked like a shaving rash in the hairy (shaving) area at the base of my penis. At the same time I developed a mild 'flu like illness and very runny nose in addition to very swollen lymph nodes only in my groin. The rash worsened and I had a few small sores in the same area and two spots on the shaft. After 7 days I went to a GUM clinic. They said it was likely HSV or bacterial rash. In short swabs and bloods confirmed HSV 1, genitally. I had further bloods taken 10 days post 'symptoms' which showed positive antibodies for HSV 1 present.

My girlfriend was also ill on return from holiday - sore throat, raised lymph of her jaw, tiredness - different symptoms to me. She reported no new genital symptoms.

I have never had a cold sore or any kind of notable rash / spots in the genital area and therefore never been tested for HSV or antibodies.

My girlfriend and I see each other infrequently and when we do meet up have a lot of oral / vaginal sex over a short period, like a week intensively.

She told me before we had sex that she was STD free prior to her last long term relationship inc. Herpes? Not sure if she actually had antibodies tested. And has only had sexual contact with me since.

On the last two occasions we had sex she had UTI type symptoms after one/two days of sex - soreness, frequent urination, very mild bleeding.

So... my questions are:

1. Is this likely to be my initial primary outbreak - basically is this likely to be the first time I contracted HSV 1? The Doctor said this is possible or I may have autoinoculated myself? If the later is true, would my I have 'flu and raised lymph for > 2 weeks? The fact that I had had the HSV 1 antibody present after at least 10 days post 'symptoms' didn't really clear it up as I understand that you can develop antibodies after 4-5 days of initial infection.

2. If my girlfriend has asymptomatic HSV 1 orally / genitally, what are the chances of me reinfecting her or making her symptomatic? She reports never having had a cold sore / symptoms.

3. Can the HSV 1 virus only infect a a person when there are breaks in the tissue - an entry point or can it enter via normal mucus membranes. From reading a lot (now!) I understand that skin-to-skin contact / friction are risky when you have active sores or shedding but i this due to the risk of the contact areas potentially having tiny entry points rather than normal unbroken skin?

Sorry is these questions have been talked about elsewhere or are silly!

Thanks, S.
Tags: HSV, HSV-1
11 Comments Post a Comment
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Avatar_m_tn
1). This is most likely your primary outbreak, and it's the first time you've contracted HSV-1 orally or genitally. If you had a prior oral HSV-1 infection then you wouldn't have been at risk for HSV-1 genitally. Autoinoculation only occurs during the primary outbreak, and is the result of touching a sore on another part of the body and then touching another part of the body. It's as close to impossible as it gets to autoinoculate yourself after having your first outbreak orally or genitally. Since you didn't note having a cold sore present from this exposure, you didn't autoinoculate yourself. The flu symptoms and swollen lymph nodes you are having are associated with the primary outbreak, and will not be associated with further outbreaks. Some people develop detectable antibodies within a week after symptoms and many develop antibodies within 2-3 weeks.

2). If your girlfriend has HSV-1 genitally or orally then there are no precautions needed to be taken during sex. Once someone has HSV-1 in one location they are immune or at the very least extremely resistant to acquiring the same type of infection (HSV-1) in another part of the body. Also, couples don't ping pong their shared HSV-1 infections back and forth. You won't reinfect her or make her symptomatic. Most people with cold sores (HSV-1) get only a couple of them early in childhood and then don't get any in adulthood so it's obvious why she can't remember. Here are some links for you in regards to future sex with this partner from the leading STD experts:

http://www.medhelp.org/posts/STDs/Afraid-if-i-have-hsv/show/1865117

http://www.medhelp.org/posts/Herpes/Oral-Sex-exposure/show/1837909

http://www.medhelp.org/posts/STDs/Partners-have-different-HSV1-genital--oral-/show/1129351

http://www.medhelp.org/posts/Herpes/Spreading-Cold-Sores-or-HSV1/show/1822568

http://www.medhelp.org/posts/STDs/Afraid-if-i-have-hsv/show/1865117

3). Small and microscopic breaks in the skin or through mucus membranes are how herpes enters the body. The viral load is signifcantly higher when a sore is present, so even if there are no breaks in the skin, if herpes enters the mucus membrane, a person is most likely going to become infected.

Bottom line: Most adults are infected with HSV-1 (50-90% of Americans), and only 10% of people make it out of life without acquiring an HSV-1 infection. There's about a 50% chance that you wont have another outbreak, and if you do, your outbreaks will likely be 1-2 over a span of three years and then none.
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Avatar_m_tn
Just a side note: Most likely you got genital HSV-1 from oral sex since 90% of cases involving genital HSV-1 are caused by oral sex while the other 10% are caused by genital-to-genital sex.
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Avatar_m_tn
Thank you.

1) I know nothing is 100% but this is what I had expected. So basically unless I had already had HSV 1 genitally (no preious symptoms ever) it is very unlikely that I gave it to myself even if I unknowly had oral HSV 1?

One further question, I have had a really stuffy nose (one nostril) for a further week after my runny nose / 'flu symptoms - when I blow it there is always some frank blood in addition to little clots and old blood. Is this something to be concerned about? Are herpes sores INSIDE the nose common? Again I have no oral or facial symptoms? The GUM doctors seemed unconcerned saying t is just likely trauma / bacterial? I did get the nose swabbed blindly and await the results.

Thanks again.
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101028_tn?1348750963
typically the gum clinics don't offer type specific herpes igg blood testing. do you know what blood testing was hsv1+ initially when you also had your lesion culture done?  

Your gf will also need to make sure she seeks out type specific herpes igg blood testing. Typically at gum clinics this is not offered so she might have to seek out private testing and pay out of pocket at different clinic.  you two can't make educated decisions about what precautions to take until you know who has what though overall the risk that she'd contract hsv1 genitally from you is very low even if she doesn't have hsv1 herself.

not unusual to have a dry, irritated nose even when you have a lot of mucous flowing with a cold. nose bleeds in winter are fairly common from the irritation of boogers and nose blowing.  

grace
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Avatar_m_tn
Hi Grace.

Thanks for your input.

I went to a private clinic approx. 10 days post 'symptoms' to have IgG igM bloods. IgG for HSV 1 was positive for a new infection, HSV 2 negative. With positive IgM both. I had healing by this point.

I have asked for the blood taken at approx. 7 days post 'symptoms' to be tested retrospectively but not sure if this is still viable or will happen.

This may clear things up but probably not haha!

Either way I have accepted it and am not looking to attribute blame (it wouldn't matter to me which way the infection happened) however unfortunately not everyone is as well informed as the people on here and myself now (only really now I hasten to add after weeks of scouring the literature and internet!). Before I was quite oblivious to Herpes.

Grace can you recommend any tpical treatments for the healing scars - to help speed up skin healing / discolouration and appearance?

Thanks again!

S
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Avatar_m_tn
In regards to scarring, just leave it alone for now. It's probably just the skin healing and not associated with scars. Herpes rarely scars, and if it does then it's usually due to the result of trauma (picking at it) or severe OBs.

If the sores are past the scabbing stage then you can apply a mild lotion such as eucerin to the skin. I'd wait at least three months (maybe five) before you do something drastic to remove potential scars since it does take the skin a good amount of time to heal completely. If there are still scars then visit a dermatologist, urologist, or plastic surgeon and they can use laser treatment to remove the scars with ease.
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101028_tn?1348750963
igm herpes testing isn't worthwhile to have done. repeating your testing before at least 3 months post encounter isn't worthwhile either.  meanwhile is your partner getting tested?
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Avatar_m_tn
Thanks for the advice.
Very reassuring at this point.
The more I read, the less I worry.
Thanks,
S
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Avatar_m_tn
No, wasn't concerned re: IgM but wondered if the blood taken at 7 days would have shown HSV 1 IgG antibodies or not to indicate no previous contact.

I will discuss the situation next time I physically see her and then she can decide if she wants to be tested I suppose?

She didn't have an obvious outbreak except 'flu / sore throat.

Thanks for all your advice on the forum.

S
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Avatar_m_tn
Hi Grace,
you may be interested but the blood that was taken 7 days post 'symptoms' tested seronegative for HSV 1 antibodies.
The second sample of blood taken 10 days post 'symptoms' was seropositive as I had mentioned before.
So it seems this was a classical first primary HSV 1 infection.
Thought this may be helpful to other people with regards testing.
Thanks,
S
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101028_tn?1348750963
I questioned it because you said bloods and swabs confirmed hsv1+ in your first post.  just wanted to make sure I understood better what testing you had had done.  
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