Already get cold sores on my lips can I contract genital herpes through oral sex

Ok here is my question.  I occassionally get cold sores or fever blisters as they are called on my lips.  I have since I was a teen and I am 27 now.  Last night someone I have been seeing performed oral sex on me.  After I noticed a scab/bump above their lip.  I could not say for sure it was a cold sore but it resembled one.  I have heard that if you already get cold sores on your lips then you can not contract genital herpes from someone performing oral sex on you who has it on their lips.  Because you already have the herpes virus in your system.  Is this true?  If not what are the chances that I have contracted gential (genital) herpes.  Thank you for your help.

[H. Hunter Handsfield, M.D.]

People who already are infected with HSV-1 or HSV-2 in general are immune from catching it again, anywhere on the body.  The immunity probably isn't absolute, and there may be exceptions.  You would be wise to not permit people with overt (i.e., visible) oral herpes lesions or other sores around the mouth perform oral sex on you.  But even if you slip up on this, as you might have done, you are very unlikely to get a new genital HSV-1 infection.

Good luck--  HHH, MD

[gracefromHHP]

If this was hsv1 orally then you have significant protection against acquiring it genitally.  There is more active virus present in an active cold sore though so it's always best to avoid performing oral sex on someone with an active cold sore present.  Should you develop any genital symptoms within the next 3 weeks then see your doctor within 24-48 hours for a lesion culture and typing.  You can also ask the person who you were with if they know they get cold sores or if they've ever been tested for herpes.

grace

[passedHSV1]

I have noticed a distinct change in the advice you are giving people inquiring if they can contract HSV-1 genitally after having it orally. You have also corrected the FAQ section of this webiste to reflect this change in attitude. I am wondering what prompted this change in advice?

Before you were advising everyone who asked the question of this posting, that one is "immune" and can't catch HSV-1 in a new location on the body (unless it was through the original 1st exposure) "even if they tried". Have you had a sudden "change of heart" or have you consulted with the other experts in your field like Dr. Anna Wald or Grace from ? (and I mean this as a stinging remark since I asked you specifically and in no unclear terms to define the level of immunity and you mislead me)

I applaud your new, more cautious advice, even if it comes too late for some people like me.Maybe all the others who think the $10 advice on this section from an "expert" is a bargain should reconsider how they spend their money. First rule as a doctor, DR. HHH, is "do no harm".... remember?

I think you should fully explain yourself  and why you didn't change your cavalier advice until another MD challenged your facts....Sorry if it sounds rough, but it is the truth and you are very lucky not to face a serious lawsuit. Make a note of this in your conscience as you give thousands of opinions to desperate people seeking your advice.

And yes, I should have known better. No answer from you required DR. H.H.H!!!

[t1234]

Those are strong comments--How do you know you passed or
acsquired HSV1 genitally when you or they were already
infected?

Many people interpret Cold Sores, cuts, fusions, etc on the mouth as HSV1 when it may not be.

So unless you or they had a "swab" tested and typed you
can not be sure.  An anti-body test can't tell you for
certain where the infection is and they are prone to
false positives.

Im not saying it didn't happen--nothing in biology is
certain to an absolute degree--but it's more probable
than your underlying assumptions about the prior HSV1
infection were wrong.

[who_is_this]

Just for reference passedHSV1's first couple posts were:

http://www.medhelp.org/forums/STD/messages/1429.html
and
http://www.medhelp.org/forums/STD/messages/1434.html

[GymBoiNC]

First, when I said After I meant after we had sex.  I did not notice the person had a scab until then.  I feel better knowing that I maybe immune.  But I am also confused.  You said it is unlikely I would devlope genital herpes.  But in the FAQ you do state if you already have HSV-1 you can not contract it anywhere else on your body and you can not contract HSV-2 orally.  Now is this correct or is there a chance I can get genital herpes even though I have HSV-1 already.

[gracefromHHP]

gymboi - Reread what  Dr H wrote to you - he said "But even if you slip up on this, as you might have done, you are very unlikely to get a new genital HSV-1 infection. "


Your hsv1 oral infection provides you with significant but not 100% protection against acquiring the virus elsewhere - like your genital area.  There are a few folks who are unlucky enough to have a well established oral hsv1 infection and then contract the virus either genitally or elsewhere later on. It doesn't happen very often thankfully but it can.  Avoiding contact with an active cold sore on your genital area is always a good idea - just to err on the side of caution.  


passedhsv1 - I am not an expert but I play one on tv ( not really but it's the best line I could come up with ).


grace

[t1234]

My understanding it may not be 100 per cent but it's probably greater than the accuacy rate of any HSV test--greater than 95 per cent.

So for all practical purposes it's zero.

Also, I don't think there's any fairly documented cases of transmission except for multiple site exposures during the initial infection or shortly thereafter before the body
has a chance to build up the antibodies.

Of course, if you other problems with your immune system,
because of another desease, all bets are off, but you'd
be pretty sick.

[H. Hunter Handsfield, M.D.]

Good grief.  You're interpreting my comments and advice to individual questioners too rigidly.  Generalizations always have there exceptions.  In fact, here is another generalization, which probably has its exceptions--but still serves the purpose:  there are no absolutes in biology or medicine.  But in general, the "even if they tried" comment still is valid (as a generalization).

Anna Wald and I are close friends and in personal contact at least once a week.  But we have had no discussions or communications about the level of immunity to new infection with the same HSV type.  Gracefromhpp is a herpes-knowlegeable health professional but we have not met; I know her only from this forum.

Your comment is on the edge of appropriateness and you are very close to being excluded from further participation here.  Not because I take your criticism personally, but because no ad hominem attacks are permitted on this forum.  Mellow out, my friend.

HHH, MD

[gracefromHHP]

"Also, I don't think there's any fairly documented cases of transmission except for multiple site exposures during the initial infection or shortly thereafter before the body
has a chance to build up the antibodies."


documented in the journals - no there isn't that I'm aware of. I've been on herpes boards for over 5 years now and indeed there have been several people on them who had well established oral hsv1 infections who years later on contracted hsv1 genitally - as confirmed by lesion culture and typing.  So yes it can happen - it just isn't likely to happen - hence why I worded my reply the way I did.  Some folks are just unlucky.

grace

[passedHSV1]

I still never got a straight answer from you, Dr. HHH. I am an MD as well and I originally contacted you via this site right after my girlfriend tested culture positive for HSV-1 genitally as a result of oral-genital transmission from me. I had IgG 's to HSV-1 of 5.0 level drawn at the same time she tested positive.

My problem with your advice is that I asked you specifically knowing the facts above: "hey...what are the chances that I can contract genital HSV-1 from her now if I have unprotected sex...is the protection solid enough for me to go ahead and return to normal sex without condoms?" Your advice was that I could not catch it and that I was worried too much and "splitting hairs" and anyone worrying as much as I did should seek psychological help (pretty condescending I thought).  Well, I did catch HSV-1 genitally and I am quite upset about your advice, yes.

What I think you should have said is..."look, she has a brand new genital HSV-1 infection and she will probably be shedding virus heavily for a while so you might as well be careful for a while, wear condoms and/or have her stay on valtrex for 6 months or so just to be sure because exceptions do happen even if the protection is pretty strong given your oral HSV-1 infection and presence of IgG antibody".

That is all you had to say to make sure you gave the right advice. Why paint the protection as absolute when you could have played it safe? What was the harm in that...giving an advice similar to what "GracefromHHP" above says?  Dr. Wald had a very simple and direct advice when I asked the same question "we don't think the protection is 100% but we seldom see this type of transmission" (unfortunately I had just developed symptoms when I received her advice). Why is it that you can't admit that you were over-generalizing when you were saying "you can't catch it even if you tried"? (Now of course, you give advice with the proper qualifications).  I find it all the more irritating that you knew you were communicating with another MD and that you could get pretty technical in you medical explanations and statistics....Your attitude instead was more in the vein of "oh well, so you might catch genital Herpes...so what...you worry too much about it"

Lastly, I am not concerned with you taking me off this webiste for challenging the advice you have given. It would fit very well with your overall ability to accept criticism...even your response to my last remark "just mellow out!" you say (instead of adressing the issue) . Hard to do now Dr. HHH...very hard to do when your whole life has changed because you have a Herpes infection and it could have been so easily averted.

[monkeyflower]

There's a considerable difference between helpful, constructive criticism and an attack. These are attacks. I understand that you're angry, but I think your anger is misplaced. It's natural to want to blame someone for our misfortunes, but the truth is most of the time there really isn't anyone to blame. Things happen. That's life. I hope you are continuing in therapy.

I have herpes too, and it's certainly not worth all this anger and angst; at worst, it's inconvenent at times. Truthfully, having herpes is only as bad as you think it is. Any changes in your life are just a result of your thoughts and feelings about having herpes, not from having herpes itself. You're exactly the same person you were before you were diagnosed.

[t1234]

I agree with Monkeyflower.

But let me get this straight.

You gave HSV1 genitally to your girlfriend (apparently
she was HSV1 negative and you were HSV1 positive) and
now you are upset she gave it back to you genitally.

That makes a statement!!!!!!

You may be an MD, but how do you know you contacted HSV1 in
this way? Did you have it swabbed and typed. Did you
confirm the result with a backup test. Did you have oral
breakouts.  Were they swabbed and typed in the past before
you met your girlfriend.

Assuming your description is true, the more likely explanation
is that you had HSV1 genitally in the first place (not orally --
or you have have been simultanesouly infected by a previous partner before your body had time to build up the antibodies)
and had just never had noticeably breakouts.  And your girlfriend got it via genital to genital contact.

You probably just noticed symptoms now because you're looking
for them as a result of your girlfriend or anxiety, etc caused
them to appear.

Sorry, I'm with Dr. Hansen.

[t1234]

I understand how one could draw that conclusion from
the boards.

But the key word is on the boards.  Although I'm sure
the people posting they believe its true, but there's no way of
verifying this.

You don't know for sure that they orginally had an HSV1 infection or what the condition of their immune system
was.

Herpes is just one of a family of virus's.  It these virus
are transmitable after the body has extablished antibodies,
why develop vaccines. Under that senereo they'd never work
and we know vaccines do work.

Of course if you find any medical studies or clincal trials regarding this issue, please post a cite. I would love to see them.

[monkeyflower]

I totally agree. I think if isn't documented in the medical/scientific literature, and herpes experts only *think* it could happen, obviously it's not common - and maybe it's questionable whether it happens at all.

[passedHSV1]

I am angry at the bad advice given and here is why.

I read IN DETAIL, the research paper on HSV-1 published in the April, 2003 issue of "Sexually Transmitted Diseases" journal  by Dr. Anna Wald, which Dr. HHH quotes heavily when giving advice about genital HSV-1 (including the facts in the FAQ).

Here's where he is wrong:

1. The study had 77 people who came in with the initial diagnosis BY CULTURE of genital HSV-1. They were followed on average about 700 days, but some up to 4 years.

2. Of the initial 77 people in the study 4 OF THEM HAD PREVIOUS HISTORY OF ORAL HSV-1....it's right there in the table on page 2. So they contracted genital HSV-1 after having oral HSV-1.... 4 out of 77 people represents 5%...it's not a once in a million "unlucky occurence". I wish Dr. HHH would have read this before making his blanket statements that you can't catch genital HSV-1 in another location after having it orally "even if you try". BAD ADVICE! You wanted documented scientific proof not just anecdotal reports monkeyflower: Anna Wald, MD is a world renown expert in the filed and Dr. HHH admits to having learned much of his knowledge from her...it's too bad he mis-interprets her results and then passes wrong information to patients. This science does not lie.

3. Dr. HHH is also wrong in quoting the percentages of recurrence. He states in the FAQs that 40% of the study patients never had another recurrence (not true... 43% had no recurrence the first year...67% no recurrence the second year). Some of the patients recurred after taking the first year "off".

More importantly, 23 of the patients were followed into the 4th year and 11 of these (parts of the initial 77) continued to have recurrences into the 4th year. 8 of these had just one recurrences, but 3 of them had 2,3, and 4 recurrences respectively in year 4. If my math serves me correctly 11 of 77 patients represents 14% who continued to have long term recurrences. Dr. HHH still maintains that less than 10% will continue to have recurrences past 2 years. I

f you read the FAQ's  you would also think that after initial diagnosis with genital HSV-1 the course is simple: you will just have 1-2 more episodes and then it will stop. It is not so. 27% had 2-8 episodes in year one of infection and 15% had 2-5 episodes in year 2.

Again I ask the question: WHY DOWNPLAY THE TRUTH ABOUT GENITAL HSV-1? Why can't you be accurate?

All this aside, I am not blaming Dr. HHH for what happened to me. I brought this on to my partner first and then, after not wearing protection 2 months later, onto myself. Yes, I was cultured genitally and I am not just imagining the symptoms. I had lesions and they responded to Valtrex.

That being said, I have a serious problem with Dr. HHH's advice to me because I specifically asked him what the chances are of my contracting HSV-1 genitally and he made me sound like a lunatic for worrying about such an issue. It's serious disregard for another person. He either knew he was giving wrong information and he did not care or he did not know he was giving out wrong information because he did not do his research well enough. Either one is worrisome for someone who has a massive website in which he dispenses "expert" information to thousands of people who panic about herpes and listen to his advice.

[t1234]

I haven't read the study but I think you're making an assumption
That may not be true.

The statement

Of the initial 77 people in the study 4 OF THEM HAD PREVIOUS HISTORY OF ORAL HSV-1....it's right there in the table on page 2. So they contracted genital HSV-1 after having oral HSV-1....

doesn't justify the conclusion you come to.

Assuming they contacted genital HSV1 after having oral
HSV1 is not evidenced by the above statement

They probably were originally HSV1 negative and contacted
Both Genital and Oral HSV1 during the first exposure before
the antibodies had a change to develop.

I think this is consistent with Dr. Handsfield's position although I don't want to speak for him.

This should be no surprise as a person with Oral HSV1 could in
Fact transmit it genitally and orally to a HSV1 negative person
Through oral sex and kissing on the mouth.  Both these activities normally occur during a single sexual encounter.

In my opinion, you probably already had Genital and Oral HSV1
and just didn't realize you had it genitally.  Your girlfriend,
in my opinion, never transmitted it to you

As a side note, there's a danger in trying to read into these small scale studies more than is justified.  For example the
statistical failure rate of the tests may be 5 per cent.

The only way to really measure the transmission rate, if it exists, is to find a statistically significant number of couples
who are positive for oral HSV1 and measure the genital transmission rate.  How you would do this with the
current technology may be a problem. Antibody tests
cannot determine where the infection is. Cultures or swabs
are not possible if the person contacting it genitally
have no symptoms.

[passedHSV1]

I don't know why you perpetuate your theory when you have not even made the simple effort to read the actual study by Dr. Anna Wald. Do me a favor and stop siding with the theory that YOU want to believe and stick with the scientific facts. The 4 people I mentioned in that study had PREVIOUS oral HSV-1 history. It's there in black and white. I tried to reproduce the table directly from the study below for you since I don't know if you will go searching for it yourself.

TABLE 1. Demographic, Behavioral, and Clinical Characteristics of Study Participants With Genital HSV-1 Infection
                                                                         No. (%) of Participants or Other Value Variable                                      All                         Women                            Men
Patients                                     77(100)                  48 (62)                        29 (38)
Age (y) at genital HSV-1 acquisition: median (range)
                                                 23 (17

[passedHSV1]

I see the table in the previous post did not come out even with the spacing work I did. Sorry that you will not be able to deschipher it but you really need to look at the actual scientific paper before you draw any more conclusions.

I wish there was a link I could give you for the full text but I had to purchase the article directly from the puiblisher online. A correction: it is in the February 2003 issue.

You may try accessing the article at this link but I can't guarantee that it will work:

(highlight, copy, and  paste into your address bar):

http://www.stdjournal.com/pt/re/std/pdfhandler.00007435-200302000-00015.pdf;jsessionid=E8iFNdDGVFzPQmiDR782Fj3ZAsXya40p7RZsaQGFZoK6631WmxWk!-1551178825!-949856144!9001!-1

[passedHSV1]

One more note on this article:

It is a bit confusing on re-read. On the first page it mentions that all 77 patients were "without prior antibody to HSV" but in the table on page 2 there are 4 patients listed with "oral HSV-1 history". If you believe the serology, then those 4 didn't really have a history of HSV-1 ....OR.... they were in the small subset of people who develop HSV infection without ever developing antibodies.

In any case, I am not sure which is correct....it makes one wonder which part of the article reflects the true story.

t1234, I would like to make an additional comment to you: I was already HSV-1 IgG positive with only oral symptoms at the time that my partner was diagnosed with genital HSV-1. 2 months later and only after we stopped using condoms, I developed genital symptoms.

[t1234]

I just downloaded the article and read it.

It states "Only Patients with documented primary
genital HSV1 infection, defined as newly acquired HSV1
infection in persons without prior antibody to HSV, were
included..."

By my read this article supports my position.  In other words 4-5 per cent contacted both oral and genital HSV1 at the time
of the initial infection.  I never said you couldn't get
it at both sites before your antibodies had a change to
develope.

To me it's interesting at how small these numbers of multiple
site infections were.  I would expected them to be greater
as sexually incounters normally involve kissing.

This study was directed at determining the recurrances of
HSV1 outbreaks after primary infection.  It does not
attempt or nor was it designed to draw any conclusions about
immunity to subsequent HSV1 infections--at least that's
my read.

Again I think that's what happened to you.  I think you
contacted both oral and genital HSV1 from a past partner
and never noticed or had any genital outbreaks which is
not unusual.  Maybe after your partner got it you were
just more vigilant. I don't think your girlfriend had
anything to do with it.

But there's no big deal about having HSV1 either orally or genitally.  Its a non-issue and no reason to "screw up" your sex life.

[needitresolved]

What interest me is the occurrence of HSV1 genital infections. I recently had a blood test (6 months post exposure) which came back positive for HSV1, neg for HSV2.

It's hard for me to tell because my symptoms are minor but I would say I have had 2-3 outbreaks after my initial infection (which itself presented only with some pain at the tip of the penis). Because of this I have started to doubt the accuracy of the test (It was an IgG glycoprotein based test with 90-95% accuracy). i.e. wondering whether I got a false negative for HSV2

But if passedHSVs figures are correct, it's still likely that my pattern is typical (but not common) of an HSV1 pattern in the first year - correct?  

[needitresolved]

I should clarify: it's been 2-3 outbreaks following the initial infection (at the time it was diagnosed as NSU).

I've never had a lesion able to be cultured. The 2 skin breaks I think were OBs had healed over in a matter of hours. It's very fustrating because one can't help but live in hope until you have been definitely diagnosed, but at the same time its hard to move on. I've put off several possible relationships because I don't know what the situation is.  

The docs and councilor at my STD clinic have advised me not to worry about it, not to tell partners, and to just wear condoms. But that doesn't sit well at all.

[monkeyflower]

How do you know you have HSV1 genitally? What you describe doesn't sound like outbreaks at all. Besides, if your doctor and the STD counselor told you not to worry about it, then you clearly have nothing to worry about. Think about it. Certainly they wouldn't encourage you to feel comfortable not telling partners/use condoms if you actually had anything transmissible :-) You can feel free to have other partners - use condoms for your own protection.

[monkeyflower]

I forgot. Any lesion that can never be cultured and heals within hours most definitely isn't herpes.

If you still can't move on from this, I encourage you to seek counseling.

[needitresolved]

The 2 lesions healed over in a matter of hours - they were really just red areas I noticed while masturbating, even on close inspectiontion I couldn't see any broken skin) but they left scabs. One only a couple of tiny, thin lines, the other one just one small scab that lasted for two weeks.

I am getting counselling for this, after a year of unhappiness because of this, I need it.